
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 2 astronauts head for the moon after make-or-break engine burn (video) - 2
Shrewd Home Gadgets to Save Energy - 3
The Main 15 Applications for Efficiency and Association - 4
Am I a Summer, or is this a scam? What I learned from color analysis. - 5
Pocket-Accommodating Jeep Wrangler Buying Guide for Seniors
Step by step instructions to Explore Assessment Ramifications of Disc Rates
Most loved Amusement Park Firecrackers Show: Which One Lights Up Your Evening?
Trump says Venezuela will start 'turning over' oil to the U.S. Is that the reason he toppled Maduro — or is it something else?
Watch SpaceX launch NASA's Pandora exoplanet-studying satellite on Jan. 11
This widow influencer is using jokes to cope after her husband's death. It's OK if people don't get it.
Why is everyone talking about Paul Dano? George Clooney becomes the actor's latest defender in this 'time of cruelty.'
Purdue Pharma's deal means money for some victims, end of Purdue company name. Here's what to know
Eurovision Song Contest changes voting rules after controversial allegations against Israel
Sound Propensities: 20 Methods for helping Your Insusceptible Framework











