
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
Innospace's rocket crashes in first commercial launch in Brazil; shares tumble - 2
Finding Your Motivation: Moves toward a Satisfying Life - 3
Cyclone causes blackout, flight chaos in Brazil's Sao Paulo - 4
What is the Insurrection Act? Can Trump really use the military to 'put an end' to Minneapolis ICE protests? - 5
Find the Effect of Web-based Entertainment on Psychological wellness: Exploring the Advanced Scene Securely
France will build a new aircraft carrier as it increases defense spending
'Inflaming tensions': Bedouin mayor slams Ben-Gvir's unauthorized visit after meeting cancellation
Triple polar vortex to plunge central and eastern U.S. into Arctic cold through mid-December
The most effective method to Pick the Best Material Organization: Insider Tips
Instructions to Comprehend and Use Open Record Extra Offers
Banks for High Fixed Store Rates: Amplify Your Reserve funds
In blow to Lula, Brazil Congress revives controversial environmental bill
RFK Jr. wants to scrutinize the vaccine schedule – but its safety record is already decades long
Wisconsin archaeologists identify 16 ancient canoes in a prehistoric lake 'parking lot'












