
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
Beyond oil: The crucial exports blocked by Hormuz closure - 2
How to get tickets to Jay-Z’s sold out Yankee Stadium shows - 3
New electric car registrations rise sharply in Germany in March - 4
‘Integral part of our nation’: Herzog visits Franciscan Sisters in Jerusalem ahead of Christmas - 5
Ageless Tastefulness: An Outline of Valuable Gemstones and Adornments
Canada's Friendly Sunshine Coast City Is An Outdoor Playground Perfect For Hiking And Paddling
Washington resident contracts bird flu, first human case in U.S. since February
German foreign minister backs abandoning EU's unanimity principle
A 'Stranger Things' documentary covering the final season is on its way: Watch the trailer
4 astronauts depart ISS, leaving behind just 3 crewmates to staff the orbiting lab
Exploring the Difficulties of Co-Nurturing: Individual Bits of knowledge
Study reveals links between global food systems, obesity, and climate change
Instructions to Figure out the Various Phases of Cellular breakdown in the lungs
'Every day I planned an escape': Ariel Cunio shares details of Hamas captivity













