
By Jonathan Stempel
Jan 14 (Reuters) - The U.S. Department of Justice said five Kaiser Permanente affiliates in California and Colorado agreed to pay $556 million to resolve claims they illegally pressured doctors to add codes for diagnoses they never considered to patients' medical records, in order to inflate Medicare payments from the government.
Wednesday's settlement resolves two whistleblower lawsuits accusing the affiliates of Oakland, California-based Kaiser of violating the federal False Claims Act.
Kaiser did not immediately respond to requests for comment. The affiliates included Kaiser Foundation Health Plan, Kaiser Foundation Health Plan of Colorado, Colorado Permanente Medical Group, Permanente Medical Group, and Southern California Permanente Medical Group.
Under Medicare Advantage, also known as Medicare Part C, patients who opt out of traditional Medicare may enroll in private health plans known as Medicare Advantage Organizations, or MAOs.
The Justice Department said requiring diagnosis codes helps ensure that the Centers for Medicare & Medicaid Services pays MAOs such as Kaiser's more money for sicker patients.
Kaiser's alleged improper activity included having doctors "mine" patients' medical histories for potential diagnoses to add to medical records, and linking bonuses to meeting diagnosis goals. The alleged wrongdoing occurred between 2009 and 2018.
“Fraud on Medicare costs the public billions annually, so when a health plan knowingly submits false information to obtain higher payments, everyone - from beneficiaries to taxpayers - loses," Craig Missakian, the U.S. Attorney for the Northern District of California, said in a statement.
The settlement resolves claims by former Kaiser employees Ronda Osinek, a medical coder, and James Taylor, a doctor who oversaw risk adjustment programs and coding governance.
They will receive about $95 million from the settlement, the Justice Department said.
The False Claims Act lets whistleblowers sue on behalf of the government, and share in recoveries.
(Reporting by Jonathan Stempel in New York; Editing by Matthew Lewis)
LATEST POSTS
- 1
The most effective method to Promoter for Cutthroat Medical attendant Compensations in Your Medical services Office - 2
The 1st full moon of 2026 rises tonight! Here's what to expect from January's supermoon Wolf Moon - 3
Step by step instructions to Contrast Lab Precious stones and Normal Jewels - 4
Rick Steves Doesn't Want You Overlooking This Food Spot While In France - 5
Iran war fuels fears of new inflation wave among German consumers
Journey Lines for Each Explorer: Track down Your Ideal Journey
Mount Everest Climbers 'Poisoned' by Guides Prompting Mass Helicopter Rescues in $20 Million Insurance Fraud Scheme, Police Say
UK to hold fresh pork, other affected Spanish products at border amid African swine fever outbreak
Pick Your Favored kind of salad
With Obamacare premium hikes, more people opting for no coverage or cheaper plans
Rescuers again fail to free whale stranded on Germany's Baltic coast
Why is everyone talking about Paul Dano? George Clooney becomes the actor's latest defender in this 'time of cruelty.'
At UN climate conference, some activists and scientists want more talk on reforming agriculture
6 Exercises to Anticipate in 2024












