
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
Defeating An inability to embrace success in Scholarly world: Individual Victories - 2
Shelby County deputies charged with assault, placed on leave - 3
Step by step instructions to Get the Best Vehicle Rent Arrangement: Insider Tips and Systems - 4
6 Solid Vehicle Fix Administrations to Keep Your Vehicle in Prime Condition - 5
Picking the Right Pot for Your Plants: An Aide for Plant Devotees
Recalled Super Greens diet supplement powder sickens 45 with salmonella
Trump announces 'Patriot Games' with 2 competitors from every state and territory: What we know
Which Carrier Do You Suggest? Vote
Council removes proposal to rename park named after former president of Israel
Minnesota jury says Johnson & Johnson owes $65.5 million to woman with cancer who used talcum powder
What we know about the 'Stranger Things' spinoff — plus the one cast member who guessed it correctly
The Way to Recuperation: Defeating Dependence
Reveal Less popular Authentic Realities You Didn't Learn in School
Intriguing Strange Cruising Objections you Should Visit











