
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
Doctor's orders? ‘Belly laugh at least two to five days a week' - 2
Heat Wave Fuels Massive Wildfire In Australia - 3
The most effective method to Shield Your Gold Ventures: Procedures and Precautionary measures - 4
10 Energizing Vocations in the Innovation Business - 5
My Excursion to Monetary Autonomy: Awesome ways to save cash
Common ADHD medication prescribed in childhood may protect against risk of psychosis
More than 800 flights canceled as FAA cuts traffic at 40 major airports. Here's what to know.
Renewables cover over 50% of German electricity consumption in Q1
Flu season is ramping up, and some experts are "pretty worried"
Trump said affordability is a ‘hoax’ in his Pennsylvania speech. What do the latest numbers show?
Crew-11 astronauts undock in 1st-ever medical evacuation from the International Space Station (video)
Excelling at Cash The board: A Manual for Monetary Essentials
German economic institutes cut forecast in half over Iran war
Find the Standards of Viable Nurturing: Supporting Blissful and Strong Kids












