
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
Rachael Ray is navigating grief this holiday season. She doesn't have time for 'negative energy' on the internet. - 2
From record warming to rusting rivers, 2025 Arctic Report Card shows a region transforming faster than expected - 3
Amazon sued over 'punitive' handling of employee absences - 4
Ocean side Objections: Staggering Waterfront Breaks - 5
Takeda's AI-crafted psoriasis pill succeeds in late-stage studies
From Iran to Israel: An Iranian volunteer’s unlikely stand in wartime
Louisiana seeks California doctor’s extradition, testing the limits of shield laws
Vote In favor of Your Favored Kind Of Tea
At 72, Kathie Lee Gifford says aging isn’t what she expected. 'The golden years? It’s a lie.’
Weather forecast, Turkana style: A goat's intestines tell it all
More than 3 million eye drops have been recalled from CVS, Walgreens and other national retailers. How to check if yours are safe
Volkswagen Just Revealed a Massive Range-Extended SUV for China, and America Isn’t Getting It
Russian strikes on Ukraine kill 5 people and wound 30 more
Untamed life Safe-havens All over the Planet Offering Remarkable Creature Experiences













