
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
Game theory explains why reasonable parents make vaccine choices that fuel outbreaks - 2
Are Iraqi militias crossing into Iran to support Iran's war effort? - 3
Cathay Pacific raises fuel surcharge on all flights by 34% - 4
Remote Headphones: Upgrade Your Sound Insight - 5
Dominating the Art of Composing: Creator Bits of knowledge
How to identify animal tracks, burrows and other signs of wildlife in your neighborhood
Figure out How to Score Huge with Open Record Rewards
Burger King launches 'SpongeBob' menu ahead of film's release. A look at the Bikini Bottom-inspired meal, plus what taste testers are saying.
Figure out How to Augment the Advantages of a Web-based Degree
Figure out How to Remain Informed about the Most recent Open Record Extra Offers
Surging measles cases are 'fire alarm' warning that other diseases could be next
Israeli strikes on Beirut, as Hezbollah and Iran attack Israel
Bullets in Luigi Mangione’s bag convinced police that he was UnitedHealthcare CEO killing suspect
Find the Wonders of the Silk Street: Following the Antiquated Shipping lanes












