
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
Americans generally like wolves − except when we’re reminded of our politics - 2
IAF intercepts over 90% of drones launched by Iran, Hezbollah during Operation Roaring Lion - 3
As cases of a rare, deadly infection rise, doctors worry fewer teens will get vaccinated - 4
What is ‘Auld Lang Syne’? Why we sing this song at midnight on New Year’s Eve. - 5
Releasing Learning Experiences: A Survey of the \Learning Made Fun\ Instructive Application
Yemen's Houthis ready to join Iran war if needed, raising new shipping risk
25 of the world’s best sandwiches
8 Fundamental Stages: Novice's Manual for Secure Your Android with a VPN
Why is everyone talking about Paul Dano? George Clooney becomes the actor's latest defender in this 'time of cruelty.'
A volcanic eruption may have catalyzed the plague's arrival in Europe, study suggests
The Rhythms of the Street: Shipping's Tune in the Economy's Symphony
Brazil's ex-president Bolsonaro operated on for hernia
Charlotte faith leaders hold interfaith forum on Black and Palestinian solidarity
Germany raises prospect of military forces to secure Ukraine peace











