
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
Happy with Running Shoes for 2024 - 2
Health officials report 14 Legionnaires' disease cases in Florida, gym connection suspected - 3
Bavarian leader questions Germany's Eurovision participation - 4
How Mars' ancient lakes grew shields of ice to stay warm as the Red Planet froze - 5
US FDA approves Kura-Kyowa's blood cancer therapy
The Most Important Crossroads in Olympic History
‘Aid for Ukraine’ pierogi fundraiser event
10 Hints for an Effective New employee screening
I'm an 83-year-old yoga instructor. I'm not your typical grandma — I still work to feel fulfilled and supplement my Social Security.
From record warming to rusting rivers, 2025 Arctic Report Card shows a region transforming faster than expected
Scientists have found an alarming environmental impact of vast data centers
Smoking rate among US adults drops to record low as vape use rises, CDC report finds
Craig the beer-ambassador elephant dies aged 54
Cyclone causes blackout, flight chaos in Brazil's Sao Paulo













