
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
How to watch 'A Charlie Brown Christmas' for less with this Apple TV Black Friday deal - 2
'We need everyone,' wounded reservist urges Knesset panel to advance haredi draft law - 3
Figure out How to Modify Your Pre-assembled Home for Greatest Solace and Stylish Allure - 4
Tzrifin base exhibition reveals Hamas and Hezbollah arms, showing structure behind attacks - 5
Find the Specialty of Calligraphy: Dominating the Exquisite Art of Penmanship
Takeda's AI-crafted psoriasis pill succeeds in late-stage studies
Spanish woman, 25, dies by legal euthanasia in case that drew national spotlight
6 Arranging Administrations to Change Your Open air Space
Vote in favor of Your #1 Instructive Toy: Learning and Tomfoolery Joined
What is ‘Auld Lang Syne’? Why we sing this song at midnight on New Year’s Eve.
Instructions to Choose the Best Web based Advertising Degree Program for Your Objectives
Wolf Bites Woman in Shocking Attack at Busy Shopping Center
This Overlooked Predator Is Running Out of Time—Why Conservationists Are Racing to Save the Striped Hyena
New movies to watch this weekend: See 'Predator: Badlands' in theaters, rent 'Black Phone 2,' stream Guillermo del Toro's 'Frankenstein' on Netflix













