
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
Blake Lively's sexual harassment claims against Justin Baldoni dismissed. Where the case stands now. - 2
Web designers for Independent ventures - 3
Fundamental Home Items Each Animal person Needs - 4
15 Outrageous Cosplay Outfits That Will Blow You Away - 5
Israeli forces kill one person in series of attacks on southern Lebanon
Red Crescent: More than 100,000 civilian structures damaged in Iran
A Gustav Klimt painting is now the most expensive piece of modern art sold at auction. The fascinating history behind the $236 million 'Portrait of Elisabeth Lederer.'
An Extended time of Careful Nurturing: Individual Bits of knowledge on Bringing up Kids
A definitive Manual for 2024's Most In vogue Wedding Dresses
Germany sees third consecutive diesel price record after rule change
6 Methods for further developing Rest Quality
Washington state experiences historic flooding as Skagit River hits record high level. See flooding maps, highway closures and forecasts.
Truly amazing Palaces: Which Is Your Number one?
Lego's $650 Pokémon set is already sold out as demand, preorders surge












