
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
Artemis II astronauts find hidden Easter eggs as they close in on the moon - 2
Merz: 80% of Syrians in Germany should return in three years - 3
Journey Lines for Each Explorer: Track down Your Ideal Journey - 4
Exploring the Difficulties of Co-Nurturing: Individual Bits of knowledge - 5
Taylor Swift just released the 'Elizabeth Taylor' music video — but she's not the star of it
Flu surges across U.S. as doctor visits reach highest level since 1997
Flat Earth, spirits and conspiracy theories – experience can shape even extraordinary beliefs
Dirty soda started as a Mormon alternative to booze. Now it's everywhere.
From School Dropout to Example of overcoming adversity: My Excursion
Golden Globes 2026 full nominations list: 'One Battle After Another' and 'The White Lotus' lead in film and television categories
PHOTO ESSAY: Summer camp for kids with autoimmune diseases
'The Boys' Season 5 premiere: How to watch for less, what to know about the final series and more
Easy to understand Tech: Cell phones for Old in 2024
Guinea-Bissau's coup called a 'sham' by West African political figures













