
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
Moon memorial: Artemis 2 astronauts name lunar 'bright spot' after mission commander's late wife - 2
The most effective method to Oversee Unsold SUVs in the Car Business - 3
America's Confided in Cooler in 2024 - 4
NASA releases new photos of interstellar comet 3I/ATLAS - 5
People who talk with their hands seem more clear and persuasive – new research
Regeneron's experimental therapy combo effective in untreated cancer patients
Cuba says 33 have died of mosquito-borne illnesses as epidemic rages
First SpaceX booster for upgraded Starship fails during test in Texas
From Novice to Master: Dominating a Side interest
Obamacare enrollment declines as US subsidies expire
Kids get diseases like lupus, too. As researchers hunt better treatments, this camp brings joy
5 Great and High Evaluated Scene Configuration Administrations For 2024
Figure out How to Consolidate Cutting edge innovations in Senior's SUVs
Heart disease risk greater for women with a common condition they may not be aware they have













