
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 Advance Space in Your Pre-assembled Home for Upgraded Usefulness19.10.2023 - 2
Shredded cheese sold in dozens of states recalled due to potential for metal fragment contamination03.12.2025 - 3
Map shows more than 1,900 measles cases across U.S.05.01.2026 - 4
Manual for 6 Busssiness Class Flights05.06.2024 - 5
Remote Headphones: Improve Your Sound Insight25.09.2023
Vote In favor of Your Favored Kind Of Vegetable
10 Delectable Specialty Mixed drinks
The most effective method to Examine a Cellular breakdown in the lungs Finding with Family
Excelling at Cash The board: A Manual for Monetary Essentials
Qantas and Virgin Australia Ban Power Bank Usage on Flights Following Safety Incidents
Instructions to Boost Your True capacity with a Brain research Degree
Dave Coulier reveals he has tongue cancer, his 2nd diagnosis in a year, after beating non-Hodgkin lymphoma
Esteem Stuffed Gaming Workstations to Consider
The Rhythms of the Street: Shipping's Tune in the Economy's Symphony












