
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
New 'People We Meet on Vacation' trailer teases Poppy and Alex romance: Everything we know about the new Netflix movie - 2
Figure out How to Adjust Your Handshake to Various Societies - 3
Compassion and Association: Building Significant Connections - 4
Savvy Watches: Which One Is Appropriate for You? - 5
A definitive Handbook for Securities exchange Money management
Everyone knows F1 is for the girls. I wandered into the Las Vegas desert to find out why.
Flu concerns grow in US as UK sees more cases among kids
Vote In favor of Your Favored Web based Dating Application
Starship success, a private moon landing and more: The top 10 spaceflight stories of 2025
Farewell, comet 3I/ATLAS! Interstellar visitor heads for the outer solar system after its closest approach to Earth
IDF destroys Hamas shaft in northern Gaza with loaded 'ready to fire' rocket aimed at Sderot
2024's Hot Games: Must-Play Titles of the Year
Find the Interesting Universe of Computerized reasoning: the Capability of man-made intelligence
Faulty glucose monitors linked to 7 deaths and more than 700 injuries, FDA warns













