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
Vote In favor of Your Favored Video Conferencing Administration - 2Artemis II astronauts will see parts of the moon no human has before. Here’s how
- 3What's changing about healthcare in 2026 — Medicare, Medicaid, ACA, premiums, and enrollment deadlines
- 4Apollo's impatient old-timers are rooting for NASA's return to the moon with Artemis II launch
- 5New Jordan security fence could be done in early 2028
- 7 Methods for further developing Rest Quality
- Between 600 to 800 aid trucks entering Gaza daily since start of ceasefire, COGAT confirms
- Merz: 80% of Syrians in Germany should return in three years
- Finding the Force of Mentorship: Self-awareness Through Direction
- Which Instax Camera Would it be a good idea for you to Purchase?
- Top Fascinating Organic products: Which One Might You Want to Attempt?
- Vote In favor of Your Favored Menial helper Administration
- Italy now recognizes the crime of femicide and punishes it with life in prison
- Vote in favor of Your #1 sort of pie
