
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
'Spending more on gas than groceries:' Rising fuel prices drive more San Antonio families to the Food Bank amid Iran war - 2
Genome study reveals milestone in history of cat domestication - 3
Single women risk rape and exploitation in search for better life in Europe - 4
Astronomers detect black hole blasting winds at incredible speeds - 5
Eight wounded, cars catch fire in central Israel following strike from Iranian cluster munition
NASA’s Pandora telescope will study stars in detail to learn about the exoplanets orbiting them
Broken toilet, T-shirts on windows and collecting saliva: The weirdness of daily life aboard Orion
Vote in favor of your Favored kind of craftsmanship
China's 'Venice Of The East' Is A Historic Canal City Near Shanghai With Arched Bridges And Lantern-Lit Waterways
Quantum Computing’s Next Major Breakthroughs Could Come From Australia
Visiting This Japanese City Just Got A Little More Expensive (Here's What Travelers Should Know)
Taylor Swift's 'The End of an Era' docuseries: Everything you need to know, plus how to watch for less
Pick Your #1 Sort Of Espresso
The architect of Iran’s military survival remains defiant












