
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
Reactions as Artemis II astronauts lift off on historic lunar mission - 2
7 Straightforward Moves toward Move Information from Your Old Cell phone to Your New One: A Thorough Aide - 3
Fossils from China show complex life evolved millions of years earlier than once thought - 4
Find the Excellence of Old style Expressive dance: Encountering the Effortlessness and Polish of Dance - 5
Israeli tourist data from 2025 misrepresented as mass exodus to Thailand
Claim that Israel opened 'sewage dam' into Gaza's main river undersells sanitation crisis
‘Ukrainian housewives’ and Skyranger delays – German defense poster child Rheinmetall is in hot water
Affordable Care Act enrollment is slightly ahead of last year, despite expiring subsidies
Wedding trip Objections in Europe
Warship sunk by British fleet, remains of sailor found after 225 years
Want to make America healthy again? Stop fueling climate change
Spain breaks jobs record with 22 million Social Security contributors
Equality requires universal draft, participation in economy and workforce, MK Liberman says
Former biotech CEO sued over COVID vaccine alleged insider trading













