
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
RFK Jr.'s diet guidelines emphasize red meat, full-fat dairy. How healthy are they? - 2
Lift Your Style: Famous Hairdos for Ladies - 3
Make your choice for the bird that catches your heart! - 4
Turkey's Erdogan denounces Israel-Greece-Cyprus trilateral summit, affirms support for Gaza - 5
'Stranger Things' made him a heartthrob. He left Hollywood anyway.
A Manual for Nations with Extraordinary Food
China's 1st reusable rocket explodes in dramatic fireball during landing after reaching orbit on debut flight
Book excerpt: "Eat Your Ice Cream" by Ezekiel J. Emanuel, M.D.
10 Hints and Deceives to Expand Cell Phone Information Use: Capitalize on Your Information
Story of ‘first Black Briton’ rewritten by advances in ancient DNA technology
'Euphoria' releases Season 3 trailer, premiere date: Watch Rue and Laurie finally face off
BravoCon 2025: How to watch, full schedule and lineup, where to stream free and more
Moving Pool Highlights for 2024
UK can legally stop shadow fleet tankers, ministers believe












