
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
Pick Your Favored method of transportation - 2
The Way to Monetary Health: Individual budget Change - 3
What's the new 'Knives Out' mystery about? Everything to know about 'Wake Up Dead Man,' including who's in the cast and what the reviews say. - 4
Figure out how to Consolidate a Brain science Certificate with Social Work - 5
Novartis eyes more bolt-on acquisitions, CEO says
Top 20 Wellbeing and Wellness Applications for a Sound Way of life
Catch the moon dancing with bright star Regulus tonight
Yoshi mania, Happy Meals and not-so-great reviews: A small talk guide to 'The Super Mario Galaxy Movie'
1st results from Blue Ghost lunar lander reveal how much we still don't know about the moon
David Duchovny's new thriller has him stripping down at 65. But its chilling premise hits close to home.
6 Popular Men's Aromas On the planet
Figure out How to Analyze Medical attendant Compensation Patterns Across Different Specializations
Figurine of a woman and a goose offers peek at prehistoric beliefs
Kiefer Sutherland arrested after allegedly assaulting a ride-share driver in L.A.












