
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
Figure out How to Forestall Tooth Staining - 2
New Jordan security fence could be done in early 2028 - 3
Cyber Monday 2025 streaming deal: Get $42 off six months of Apple TV - 4
Which One Energizes You the Most These Tech Developments - 5
Nigeria police charge Joshua driver with dangerous driving over fatal crash
Ariana Grande to host 'Saturday Night Live' Christmas show with Cher as musical guest, returning after nearly 40 years
Solar storms have influenced our history – an environmental historian explains how they could also threaten our future
A Russian fighting for Ukraine conned the Kremlin out of $500,000 by faking his own death
How did birds survive while dinosaurs went extinct?
7 Methods for further developing Rest Quality
Flu cases are rising with a strain that makes older people sicker
At least 18 Palestinians killed in latest clashes in Gaza
The most effective method to Apply Antiquated Ways of thinking in Current Brain science Practices
Avoid Large Crowds In Bali & Swim At This Peaceful Waterfall With A Gorgeous, Natural Pool












