
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
Sea Ice Hits New Low in Hottest Year on Record for the Arctic - 2
Iran war triggering Easter staycation boom - 3
Excelling at Discussion: Genuine Examples of overcoming adversity - 4
From Lounge chair to Money: Online Positions That Will Change Your Profession - 5
RFK Jr. says fewer flu shots for kids may be 'better.' What experts say.
Striking American and European television Projects: A Survey
Novo Nordisk cuts Wegovy price in South Africa for a second time
Latvia seeks emergency UN meeting over Russian missile attack on Lviv
Taylor Swift changes 2 song lyrics on 'Reputation' on the night of her Eras tour documentary premiere
Vacation destinations in America
25 Years Ago, Audi's Rosemeyer Concept Was A Steampunk Supercar With A Massive Engine
Aspirin can prevent a serious pregnancy complication — but too few women get it, new report suggests
Find Exemplary Scents: An Extensive Aide
Remains of banker missing since 1999 found on California beach by family looking for seashells












