
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
The most effective method to Guarantee Simple Availability in Seniors' SUVs - 2
French Senate debates social media ban for under-15s - 3
Best Exciting ride: Which One Rushes You the Most? - 4
Two IDF officers, civilian face indictment in alleged Gaza aid-truck smuggling scheme - 5
Genome study reveals milestone in history of cat domestication
Must-Have Cooking Machine in Your Kitchen
25 Most Beautiful Villages in France You Can Actually Visit
Reclassifying Achievement: Individual Accounts of Seeking after Interests
Warming winters lead to more nitrate pollution in the drinking water near farms
‘I love this work, but it’s killing me’: The unique toll of being a spiritual leader today
Instructions to Pick the Right Dental Embed Trained professional: An Exhaustive Aide
Israeli girl suffers cardiac arrest during sirens in Safed, hospitalized in serious condition
Attacks on Iran's Bushehr nuclear plant and on Iraq border crossing
UN experts urge investigation into Israel’s killing of Lebanese journalists













