
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
Video Conferencing Instruments for Virtual Gatherings - 2
White House responds to Sabrina Carpenter after pop star slams 'evil' ICE video using her song - 3
The 10 Most Famous Style Minutes on Honorary pathway - 4
5 Side interests That Work on Psychological wellness - 5
Dominating Monetary Administration: A Bit by bit Manual for Making an Individual Financial plan
Vote in favor of the handheld vacuum that you love for its strong attractions!
Israel reports killing another senior Iranian oil official
Do you lean your seat back on the plane? These travel pros — and real-life couple — won't do it.
Instructions to Explore the Universe of Vehicle Leases
The best movies to watch this holiday season: Stream 'A Christmas Story Christmas,' revisit 'The Night Before' and discover 'The Baltimorons'
Astronomers may have spotted the 1st known 'superkilonova' double star explosion
Claim that Israel opened 'sewage dam' into Gaza's main river undersells sanitation crisis
Toyota Reports 2.3% Sales Drop as China Weakness Deepens
Ancient mass grave discovered in water cistern during Tel Azekah excavations











