
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 Recuperate After a Dental Embed Strategy: A Far reaching Guide - 2
I work with companies to confront addiction in the workplace. The hidden crisis is costing corporate America millions. - 3
Physicists and philosophers have long struggled to understand the nature of time: Here's why - 4
Parents who delay baby's first vaccines also likely to skip measles shots - 5
Vote In favor of Your Favored Language Interpretation Administration
Step into Nature: A Survey of \Handling Trails with Solace\ Climbing Shoes
Traveling Alone: An Excursion of Self-Disclosure
Early diagnosis leads King Charles to scale back cancer treatment in the new year
Seven deaths possibly linked to malfunctioning glucose monitors
The most effective method to Guarantee Thorough Inclusion in Senior Protection.
Famous Places to get-away for Americans
Scientists are getting our robotic explorers ready to help send humans to Mars
The most effective method to Pick the Right Old Consideration Administration: Key Contemplations
France to build new nuclear aircraft carrier, Macron says













