
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
Instructions to Back Your Sunlight powered chargers: Tracking down Possible Choices - 2
Most loved Caf\u00e9 Chain: Where Do You Get Your Caffeine Fix - 3
Israel halts defense sales to France, citing 'hostile attitude,' sources tell 'Post' - 4
3 back-to-back storms forecast to bring snow and surges of cold air across the Midwest to the Northeast - 5
What were the little white pills found in Tiger Woods's pocket at the scene of his crash? What to know about hydrocodone.
Scientists dove hundreds of feet into the ocean and found creatures no human has ever seen. Our trash beat us there
‘Slender Man’ attacker back in custody. What we know about Morgan Geyser's disappearance and what happens next.
Find the Specialty of Calligraphy: Dominating the Exquisite Art of Penmanship
Smoking rate among US adults drops to record low as vape use rises, CDC report finds
6 Famous Cell phone Brands All over The Planet
Shas threatens to oppose 2026 state budget over haredi food-voucher exclusion
RFK Jr. releases new dietary guidelines with emphasis on protein, full-fat dairy
Find the Mysteries of Effective Objective Setting: Transforming Dreams into Feasible Targets
JW Marriott Tokyo: an elegant retreat amid whirlwind of the city













