
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
Israel launches new wave of attacks against Hezbollah in Beirut - 2
PHOTO ESSAY: Scientists trying to unravel one of the body's biggest mysteries - 3
Figure out How to Amplify Innovation and Infotainment Frameworks for Senior Drivers in SUVs - 4
25 of the world’s best sandwiches - 5
Fact Check: Israeli Channel 13, Al Jazeera Did NOT Confirm Hezbollah Captured All Or Part Of Kiryat Shmona
15 Outrageous Cosplay Outfits That Will Blow You Away
Vote in favor of Your #1 4\u00d74 SUVs
Nepal’s youngest premier sworn in after releasing new rap song about unity
Chinese fossils reveal a primordial burst of animal evolution
Charli xcx recorded original songs for 'Wuthering Heights' — what to know about the new album for Margot Robbie's film
Step by step instructions to Get a good deal on Your Rooftop Substitution Venture
Sea Ice Hits New Low in Hottest Year on Record for the Arctic
Solid Propensities: Little Changes for a Superior Life
7 Powerful Techniques to Boost Efficiency with Your Cell Phone: A Thorough Aide












