
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)
NEUESTE BEITRÄGE
- 1
Some Americans say they'll go without health insurance as ACA rates spike09.01.2026 - 2
The next frontier in space is closer than you think – welcome to the world of very low Earth orbit satellites04.01.2026 - 3
Partake in the Outside: Senior-Accommodating Exercises for 202406.06.2024 - 4
These HGTV stars made a pledge to keep their kids off smartphones. Here's how it's going.31.12.2025 - 5
The most effective method to Recognize an Excellent Lab Precious stone17.10.2023
Ähnliche Artikel
Exclusive-Head of Pemex's production arm to step down in coming days, sources say18.12.2025
Surging measles cases are 'fire alarm' warning that other diseases could be next28.11.2025
Chicago reports first rabies-positive dog in 61 years. What we know.24.12.2025
Manual for Picking Coastline Travel06.06.2024
Iran Used $2 Billion in Crypto to Run Its Militant Proxies in 202509.01.2026
The most effective method to Use an Internet Showcasing Degree for Advanced Predominance19.10.2023
Father and son spending Christmas together after health scares24.12.2025
Moon fever hits DC as Artemis 2 rocket 'candle' lights up Washington Monument just 1 month before launch (photos)10.01.2026
How to watch the last supermoon of the year01.12.2025
Gauging the Upsides and downsides of Visas: A Complete Aide30.06.2023














