
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
Portable Installment Answers for Independent ventures - 2
Some Americans say they'll go without health insurance as ACA rates spike - 3
Claim that Israel opened 'sewage dam' into Gaza's main river undersells sanitation crisis - 4
Instructions to Utilize the Towing Highlights of the Slam 1500 Productively. - 5
The Best Traditional Music Arrangers in History
The most effective method to Recognize an Excellent Lab Precious stone
Rescuers again fail to free whale stranded on Germany's Baltic coast
The most effective method to Go with Informed Choices on Vehicle Leases
Ethiopian earthquakes and volcanic eruptions: earth scientist explains the link
Step by step instructions to Deal with Your Time While Chasing after an Internet based Degree
Investigating the Financial History of the World: A Succinct Outline
How Mars' ancient lakes grew shields of ice to stay warm as the Red Planet froze
4 Jeep Models: Dominating Execution and Flexibility for Each Experience
NASA's Perseverance Mars rover could break the record for miles driven on another planet













