
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
Israeli girl suffers cardiac arrest during sirens in Safed, hospitalized in serious condition - 2
35 million tons of food go to waste yearly in the US. Experts share tips to help stop it - 3
SpaceX launches Italian Earth-observing satellite to orbit on the 1st mission of 2026 (video) - 4
2024 Ferrari Roma With Just One Owner & 3,300 Miles For Sale At $... - 5
Volcanic eruption led to the Black Death, new research suggests
Finding the Force of Mentorship: Self-awareness Through Direction
One perk to marrying Richard Marx later in life? 'We don't have time' for stupid arguments, says Daisy Fuentes.
Carnival fever hits Lagos as locals celebrate Afro-Brazilian heritage
21 Things You Ought to Never Tell Your Childless Companion
Marvel's X-Men are joining the battle in 'Avengers: Doomsday': Watch the teaser
Delta flight bound for Atlanta makes emergency landing after engine issue
Top notch Feasting: A Manual for Worldwide Acclaimed Eateries
James Webb Space Telescope watches 'Jekyll and Hyde' galaxy shapeshift into a cosmic monster
Step by step instructions to Guarantee Your Fender bender Legal counselor has Areas of strength for a Record













