
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 Integrate Compact disc Rates into Your Retirement Arranging - 2
Tesla Germany Registrations Quadruple to 9,252 Vehicles in Best March Ever - 3
Europe’s Airlines Run Low on Fuel - 4
Interstellar comet 3I/ATLAS reveals weird wobbling jets in rare sun-facing tail - 5
One spent $20 on candy. Another paid $700 for a custom costume. Here's how Halloween costs stacked up this year.
Watch live as near-Earth asteroid Eros buzzes the Andromeda Galaxy on Nov. 30 (video)
Vote In favor of Your Favored Web-based Book Retailor
US EPA will reassess safety of herbicide paraquat, says its chief
The Tradition of Stone: A Gander at Notable Structures Through the Ages
4 buzzy new TV shows to watch — plus the return of 'The Comeback,' 'Jury Duty' and more
Former United Launch Alliance CEO Tory Bruno joins competitor Blue Origin for national security projects
Human evolution’s biggest mystery has started to unravel. How 2025 tipped the scales
Step by step instructions to Look at Compact disc Rates: A Thorough Aide
Most loved Public Dish: Which One Addresses Its Nation Best?













