
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
Beyond oil: The crucial exports blocked by Hormuz closure - 2
Carrying on with a Sans plastic Way of life: Individual Examinations in Maintainability - 3
Step by step instructions to Prepare with Senior Protection for Inward feeling of harmony. - 4
The 12 biggest space stories of 2025 — according to you - 5
Step by step instructions to Analyze Senior Insurance Contracts Really.
Sydney Sweeney is returning in 'The Housemaid's Secret': What to know about 'The Housemaid' sequel
The Way to Recuperation: Defeating Dependence
Doggie diversity in size and shape began at least 11,000 years ago
Gaza humanitarian efforts reach key milestone as UNICEF vaccinates some 13,000 children
Gov’t approves millions for border cities in North under Hezbollah fire
Why this Tennessee special election has the 'whole world' watching
Russia’s New KVS Drone May Be Designed To Restore Reach In The FPV War
How C-reactive protein outpaced ‘bad’ cholesterol as leading heart disease risk marker
Knesset sets special panel to fast-track Karhi’s communications reform












