
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
Hamas delegation meets Egypt’s spy chief amid mutual ceasefire violation claims - 2
Productive CRM Programming for Client Relationship The executives - 3
Fake new headlights rule steer Australian drivers astray - 4
The Main 15 Applications for Efficiency and Association - 5
Senior's Manual for Obtaining a Hyundai Ioniq EV: Tips
Changing Negative Cash Mentalities: Enabling Your Monetary Excursion
German politician urges more face-to-face interaction in digital age
Saturn's moon Titan may not have a buried ocean as long suspected, new study suggests
Court clears Beersheba assault suspect of link to Haymanut Kasau disappearance, extends detention
Your kid wants it now. What saying yes, no or not yet teaches kids about money and instant gratification.
80 km. on foot: Sharren Haskel’s three-day march in protest of haredi draft bill
Novo Nordisk cuts Wegovy price as CEO pledges to go 'all in' on weight loss pill
FDA proposes use of sunscreen ingredient popular in other countries
Cocaine, caffeine, painkillers consumed by sharks in Bahamas, study finds













