
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 10 Most Significant Games in History - 2
More than 800 flights canceled as FAA cuts traffic at 40 major airports. Here's what to know. - 3
‘Wicked: For Good’ streaming release — How to watch the sequel starring Ariana Grande and Cynthia Erivo - 4
I tried a macho, creatine-loaded cereal “for men.” Did I mention I'm a woman? - 5
A top Marine shares his secrets to keeping fit at 50
Trump administration plan to reduce access to some student loans angers nurses, health care groups
Language Learning Stages: Which One Gets Your Vote?
Kate Middleton and Prince William unveil annual family Christmas card photo with George, Charlotte and Louis
Instructions to Adjust Work, Life, and Seeking after a Web based Advertising Degree
Palestinian leader Abbas says elections only after Gaza war ends
UK to hold fresh pork, other affected Spanish products at border amid African swine fever outbreak
See a half-lit moon shine among the stars of Aquarius on Nov. 27
2 new malaria treatments announced as drug resistance grows
\Step by step instructions to Pick the Best Material Organization for Your Home\











