
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 Most Astonishing Arising Advancements to Watch - 2
Merz postpones Norway trip for Belgium talks on frozen Russian assets - 3
It May Take a Year to Restore Abu Dhabi Aluminum Output, EGA Says - 4
Top Breakfast Food: What's Your Morning Enjoyment? - 5
Air superiority and long-range strikes: what China's war games say about how it might assault Taiwan
Volcanic eruption led to the Black Death, new research suggests
'Stranger Things' made him a heartthrob. He left Hollywood anyway.
Family Matters: Tips and Guidance for Effective Nurturing and Everyday Life
Qatar, Ireland accuse Israel of using chemical weapons on Palestinians, demand watchdog probe use
Reporter's notebook: Inside the IDF’s ‘Hamas Village,’ and how Israel is rewriting urban warfare
How HIV/AIDS got its name − the words Americans used for the crisis were steeped in science, stigma and religious language
Expert advice for new stargazers: How to begin your amateur astronomy journey
The Best Cell phone Brands for Tech Aficionados
Investigating Inside Plan and Home Style: Change Your Residing Space












