
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
Brilliant and Gleaming: Excellence and Skincare Practices - 2
Best Amusement Park Bite: What Do You Very much want to Crunch On? - 3
Top Music and Dance Celebration: Which One Gets You Going? - 4
Move. Cheer. Dance. Do the wave. How to tap into the collective joy of 'we mode' - 5
The Ascent of the Kona SUV: How Hyundai's Reduced Hybrid Is Vanquishing the Streets
A mom's viral post is raising the question: Do kids need snacks? Dietitians have answers.
Intriguing Strange Cruising Objections you Should Visit
A photographer's journey to capture a blood moon rising over the South China Sea. 'It was an incredible moment'
How did this 20-light-year-wide 'Diamond Ring' form in space? Maybe a cosmic bubble burst
Pick Your Top Method for starting the Morning
The Effect of Online Organizations on Society: Beating the Difficulties
The Force of Organic product: 10 Assortments That Improve Your Wellbeing
This Asian country is the next hot travel destination, and this is one of its best hotels
Police investigate Lahav 433 officer accused of sexually harassing subordinate policewoman













