
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
Well known SUVs With Low Energy Utilization In 2024 vote - 2
Germany's Merz under fire in Brazil for his comments on Amazon host city of COP30 - 3
Why the weirdest sea level changes on Earth are happening off the coast of Japan - 4
More than half way to the moon, the Artemis II astronauts are grappling with a toilet problem - 5
Early diagnosis leads King Charles to scale back cancer treatment in the new year
Empathy and reasoning aren’t rivals – new research shows they work together to drive people to help more
UK forecast to face weaker growth and higher inflation from Iran war
Young Muslims in Germany feel left out of Mideast debate, experts say
What's inside Mexico's Popocatépetl? Scientists obtain first 3D images of the whole volcano
74 suicide warnings and 243 mentions of hanging: What ChatGPT said to a suicidal teen
The Most Astonishing Arising Advancements to Watch
See the moon shine with Saturn in the southern sky after sunset Dec. 26
Viable Monetary Tips to Advance Your Monetary Circumstance
Air travelers face higher ticket prices as Iran war drives up oil prices













