
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 Arrange Your Compensation During Medical caretaker Prospective employee meetings - 2
What is IDF's view on pontential long-term occupation of southern Lebanon? - 3
Noctourism: the new safari travel trend that's changing the wildlife we can photograph in Africa - 4
New Year's Eve Live: Nashville's Big Bash: How to watch the star-studded country music special live - 5
How to disinfect if the stomach bug hits your home
Step by step instructions to Prepare with Senior Protection for Inward feeling of harmony.
Figure out How to Forestall Tooth Staining
Fundamental Monetary Guidance for Going into Business
Global measles cases drop 71% in 24 years as vaccination coverage improves, WHO says
Wizz CEO: We’re going to invest $1 b. in Israeli market
IDF Givati Brigade soldier arrested, charged in suspected Iran espionage
Nitty gritty Manual for Picking Agreeable Tennis shoes
Instructions to Safeguard Your Speculations In the midst of Changing Disc Rates
What's The Friendliest City In The United Kingdom?













