
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
IDF destroys regime's missile, sea mine production site in Yazd amid nationwide airstrikes - 2
The Most Compelling Innovation Developments Somewhat recently - 3
Home Security Frameworks with Shrewd Elements - 4
Vote In favor of Your Favored Kind Of Organic product - 5
The Century Coupe Could Be Toyota’s Most Ambitious Car Since the LFA
Telescope in Chile captures stunning new picture of a cosmic butterfly
Vote In favor of Your Favored Kind Of Vegetable
Schools to start reopening after Nigeria mass abduction
Figure out how to Use Your Brain research Degree in the Gig Market
The face is familiar, the name might not be. The king of "Hey, it's that guy!' roles is ready to show you his next act.
Vote In favor of Your Number one Kind Of Food Conveyance Administration
Ergonomic Office Seats for Work spaces
Germany and trade unions kick off tough public-sector wage talks
'Here we go again': Businesses grapple with fuel costs













