
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 1 question we have to ask ourselves about the Taylor Frankie Paul 'Bachelorette' scandal - 2
The Tiny Channel Island With 65 Residents That Chefs And Foodies Go Out Of Their Way To Visit - 3
Make Your Fantasy Closet: 10 Immortal Design Fundamentals - 4
Abbott issues US device correction for some glucose monitors over faulty readings risk - 5
Trump administration plan to reduce access to some student loans angers nurses, health care groups
Flu cases are spiking earlier than usual. What you need to know.
Cocoa Prices Undercut Amid the Prospects of Abundant Supplies
Burger King launches 'SpongeBob' menu ahead of film's release. A look at the Bikini Bottom-inspired meal, plus what taste testers are saying.
The Fate of Rest: Patterns in Shrewd Beds
French and Malaysian authorities are investigating Grok for generating sexualized deepfakes
Astronomer captures 2 meteors slamming into the moon (video)
US measles cases surpass 2,000, highest in 30 years: CDC
The Solution to Flexibility: Developing Internal Fortitude Notwithstanding Misfortune
Innospace's rocket crashes in first commercial launch in Brazil; shares tumble












