
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
Ancient mass grave discovered in water cistern during Tel Azekah excavations - 2
The 1 question we have to ask ourselves about the Taylor Frankie Paul 'Bachelorette' scandal - 3
Ancient Egyptian pharaoh's boat is being reassembled in public at the Grand Egyptian Museum - 4
Find Wonderful Stream Voyage Objections On the planet - 5
Moscow: Russia well-positioned to withstand oil market shocks
The Force of Positive Reasoning: Day to day Attestations
The German series proving subtitles can be sexy — and wildly addictive
Most loved Well known Accessory Styles For 2024
10 Fundamental Tips and Deceives to Lift Your Cell phone's Exhibition
Why most Jewish Israelis back the death penalty for terrorists
Turkey’s intel chief lays out country’s vision for Middle East, world
Lecturer who called Israel a terrorist state to remain Plaid Cymru candidate
The moon up close: How the Artemis 2 astronauts are photographing their historic lunar flyby
One month of war on Iran cost Arab countries up to $194bn: UNDP













