
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
Germany's Pistorius: NATO protects Europe from Iranian missiles - 2
UK clothing inflation climbs as Middle East turmoil threatens wider price rises - 3
NASA just launched Artemis 2. What happens today could make or break the moon mission - 4
Figure out How to Really focus on Your Dental Inserts for Durable Outcomes - 5
IDF strikes Hamas terror cell operating near Israeli troops in northern Gaza
'A completely new manufacturing frontier': Space Forge fires up 1st commercial semiconductor factory in space
In a scientific first, biologists recorded a wild wolf potentially using tools
Do-It-Yourself Home Style on a Careful spending plan: Imaginative Thoughts and Tasks
Instructions to Keep up with Your Traded Teeth for Life span
'Something Very Bad Is Going to Happen' is the Duffer Brothers' first project since 'Stranger Things.' It's also 'wildly insane.'
Audits of 6 European Busssiness Class Flights
Vote in favor of your Number one natural product
Remain Fit: Powerful Wellness and Work-out Schedules for a Better You
Couch Styles of 2024: What's Moving













