
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
Investigate These Retreats Well known With Seniors - 2
Cruising Solo All over the Planet: An Excursion of Self-Disclosure - 3
Astrophotographer captures rare footage of the Hubble Telescope crossing the sun (video) - 4
6 Vehicle Rental Administrations: Pick Your Ideal Ride - 5
Instructions to Investigate Different Open Record Extra Offers Actually
10 Work Valuable chances to Assist with supporting Your Advanced degree
Hamas delegation meets Egypt’s spy chief amid mutual ceasefire violation claims
The most effective method to Examine a Cellular breakdown in the lungs Finding with Family
NASA's Voyager 1 set to achieve historic distance from Earth
Palestinian infant freezes to death in Gaza as Israel keeps blocking aid
A definitive Bike Standoff: Decision in favor of Your Number one Ride
Figure out How to Augment Eco-friendliness in Your Volvo XC40
Defense Minister Katz moves to extend IDF service to 36 months
Satellite space quiz: What's orbiting Earth?













