
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
Iran executes two men who tried storming military facility during January protest crackdown - 2
A trip to Colombia in my 20s turned into 8 years freelancing in South America. Here's what I'd do differently. - 3
Which Film Has the Incomparable Melodic Score? - 4
Fears of global aluminum shortages intensify - 5
‘Integral part of our nation’: Herzog visits Franciscan Sisters in Jerusalem ahead of Christmas
Find the Mysteries of Effective Objective Setting: Transforming Dreams into Feasible Targets
South Africa collects record $117B tax haul
Book excerpt: "Enough" by Dr. Ania Jastreboff and Oprah Winfrey
Sally Rooney books may be withdrawn from UK sale over Palestine Action ban, court told
Mexico says a third of 130,000 missing people might be alive, fueling criticisms by families
Flat Earth, spirits and conspiracy theories – experience can shape even extraordinary beliefs
Santa's sleigh or the International Space Station? How to spot a bright Christmas flyby Dec. 24 and 25
Why are malnutrition deaths soaring in America?
Newly discovered link between traumatic brain injury in children and epigenetic changes could help personalize treatment for recovering kids













