
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
Explainer-What will change with the US reclassification of marijuana? - 2
Step by step instructions to Get the Best Vehicle Rent Arrangement: Insider Tips and Systems - 3
Reports: Nepal's former PM arrested over deadly protest crackdown - 4
Fireball sightings are surging across the US — here's what's really going on - 5
Vote in favor of your Favored kind of footwear
New movies to watch this weekend: See 'We Bury the Dead' in theaters, rent 'Wicked: For Good,' stream 'The Unbreakable Boy' on Starz
Taste the World: Five Food sources That Have Dazzled Worldwide Palates
A hospital discharged a woman in labor. This lawmaker wants change.
The breakout star of NASA's Artemis 2 moon mission isn't an astronaut — it's the space toilet
Instructions to Improve Your Mental Exploration with Cutting edge Measurements
6 Agreeable Earphones To Wear
7 Countries Where Newcomers Feel Most Welcome, and 3 Where They Often Don’t
South Korea president says Iran war shows the need to ditch ‘extremely risky’ fossil fuels
Tributes pour in for MIT professor Nuno Loureiro amid unresolved shooting case













