
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
Artemis II updates: NASA's moon mission breaks Apollo record for farthest distance humans have traveled from Earth - 2
The Force of Organic product: 10 Assortments That Improve Your Wellbeing - 3
Step by step instructions to Pick the Right Dental specialist for Your Teeth Substitution - 4
Motivational Travel Objections for History Buffs - 5
10 Moves toward Start Your Own Effective Business
Paraplegic engineer becomes the first wheelchair user to blast into space
Putting pig organs in people is OK in the US, but growing human organs in pigs is not – why is that?
Rocket Lab launches mystery satellite for 'confidential commercial customer' (video)
FBI arrests Brian Cole Jr. in Jan. 6 pipe bomb investigation, ending 5-year hunt
The Difficulties of Getting a Green Card in the US
'Yellowstone' made him a fan favorite. His biggest role isn't the one you see.
Merz: 80% of Syrians in Germany should return in three years
China bans storing cremated remains in empty 'bone ash apartments'
A Couple of Modest Guitars for 2024












