
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
Finding the Universe of Workmanship: Individual Encounters in Imagination - 2
Flights canceled at 40 U.S. airports: Follow live updates as FAA cuts to air traffic take effect amid government shutdown - 3
Plane Passenger Allegedly Includes ‘Bomb Threat’ in Hotspot Network Name, Forces Flight to Make Emergency Landing - 4
Doomed SpaceX Starlink satellite photographed from orbit - 5
Change Your Skincare: 10 Inventive Magnificence Gadgets
Scientists sent a menstrual cup to space. This is how it went
Winona Ryder didn't take the 'Stranger Things' plot lightly. How 'otherworldly' grief and a kidnapping in her hometown informed her character.
Robert Irwin on winning 'Dancing With the Stars' 10 years after sister Bindi: 'This was everything I dreamed it would be and so much more'
UK can legally stop shadow fleet tankers, ministers believe
Tire Brands for Senior Drivers: Guaranteeing Security and Solace
Medical team successfully delivers baby and removes massive tumor
Cyclone causes blackout, flight chaos in Brazil's Sao Paulo
Blue Origin launches New Glenn rocket on company's first NASA-scale science mission
Instructions to Warmly greet Certainty and Appeal












