
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
Pick Your Top Method for starting the Morning - 2
Watch live as near-Earth asteroid Eros buzzes the Andromeda Galaxy on Nov. 30 (video) - 3
A Manual for Pick Dependable Vehicle Rental Administrations For 2024 - 4
Savvy Tips for Seniors Hyundai IONIQ EV - 5
Artemis moon mission breaks record for distance from Earth
Islamic State group militants claim capture and execution of a Nigerian brigadier general
Earth’s magnetic field protects life on Earth from radiation, but it can move, and the magnetic poles can even flip
The Specialty of Compromise: Examples from Reality
Iranian missile hit on Ne'ot Hovav factory leads to fear of chemical leakage
Remain Fit: Powerful Wellness and Work-out Schedules for a Better You
The Job of a Land Legal counselor in Property Exchanges
I’m a doctor. Here are 10 science-backed tips to help you get healthier.
7 Popular Vacation destinations In China
Authorities arrest 7 bodyguards in connection with a Mexican mayor's assassination












