
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
As tetanus vaccination rates decline, doctors worry about rising case numbers - 2
Discovery of ancient pleasure boat reveals Egypt's maritime history - 3
Best Augmented Simulation Ride: Which One Feels Generally Genuine? - 4
Flu cases spiking this holiday season, CDC data shows - 5
'Set up an Army Radio station at President’s Residence': Source close to Katz slams Herzog
EU Commission prepares €90bn Ukraine loan despite Hungary's veto
This Week In Space podcast: Episode 188 — A New NASA Leader Rises?
The Way to Business: Startup Illustrations Learned
Moon milestones: A rundown of Artemis 2's many spaceflight firsts
Mother and Stepson Rescued After Being Swept Over 6 Miles in Paddleboarding Mishap
Car Investigation: A Survey of \Past the Outside\ Car
Investigating Cooking and Culinary Expressions: An Excursion Through Flavors
Reviving Your Home with Nutritious Indoor Plants
Step by step instructions to Guarantee Your Fender bender Legal counselor has Areas of strength for a Record












