
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
Help Your Efficiency with These Work area Updates - 2
Jasmine Crockett in, Colin Allred out: A major shakeup for Democrats in their quest to finally win a Senate seat in Texas - 3
An Extended time of Careful Nurturing: Individual Bits of knowledge on Bringing up Youngsters - 4
What is the 'Survivor 50' Challenge? Hidden immunity idols will be up for grabs in every U.S. state. - 5
ByHeart baby formula from all lots may be contaminated with botulism bacteria, tests show
How to watch 'A Charlie Brown Christmas' for less with this Apple TV Black Friday deal
Home Plan Tips for Seniors
Strengthening through Wellness: Individual Preparation Achievement
the Wild in Style: The Reduced Portage Mustang's Bold Heritage
What are parents to do as doctors clash with Trump administration over vaccines?
DEA seizes 1.7 million counterfeit fentanyl pills in Colorado storage unit
Kate Middleton and Prince William unveil annual family Christmas card photo with George, Charlotte and Louis
Drones, physics and rats: Studies show how the people of Rapa Nui made and moved the giant statues – and what caused the island’s deforestation
Sophie Kinsella, 'Confessions of a Shopaholic' author, dies at 55 after battle with cancer










