
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
Instructions to Comprehend and Use Open Record Extra Offers - 2
25 Years Ago, Audi's Rosemeyer Concept Was A Steampunk Supercar With A Massive Engine - 3
Nordic people know how to beat the winter blues. Here's how to find light in the darkest months - 4
Giude to Best Web based Learning Stage - 5
Dad issues urgent plea to find stem cell donor for his son
Which Film Has the Incomparable Melodic Score?
Excursion to Different Universes: the Top Sci-fi Motion pictures Ever
15 Preposterous Cosplay Ensembles That Will Blow You Away
Some are walking out. Some are shouting. Some are oblivious. How kids are reacting to THAT 'Wicked: For Good' scene
Met Gala 2026 will celebrate fashion as an 'embodied art form': A guide to the theme, dress code, cochairs and hosting committee of the starry event
Pick Your Number one Sort Of Music
The Main 15 Applications for Efficiency and Association
FDA updates risk classification for voluntary shredded cheese recall
New law puts familiar drinks, creams and gummies in legal limbo













