
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
Man Charged for Stealing ‘Incredibly Precious’ 286-Year-Old Violin, Worth More Than $200,000, from a Tavern - 2
Unwinding History's Secrets: Looking for the Response to Antiquated Human advancements - 3
Select Your Cherished Fish - 4
The Benefits of Effective money management for Your Youngsters' Future Monetary Prosperity - 5
COGAT discovers motor oil hidden inside UN's humanitarian aid to Gaza in smuggling attempt
The most effective method to Pick the Right Material Organization: Your Definitive Aide
My Pioneering Excursion: Building a Startup
'We need everyone,' wounded reservist urges Knesset panel to advance haredi draft law
Figure out How to Recognize Early Indications of Depressions
Instructions to Amplify Certifiable Experience While Chasing after an Internet Advertising Degree
Israel reports first missile fire from Yemen since start of Iran war
Banks for High Fixed Store Rates: Augment Your Investment funds
Is Trump going to war with Venezuela?
Former defense minister Gallant vacated home over security threat under Shin Bet direction












