
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
Vote in favor of the Web-based Work out schedule to Keep You Fit and Sound - 2
Culinary Joys: Investigating Connoisseur Cooking at Home - 3
How HIV/AIDS got its name − the words Americans used for the crisis were steeped in science, stigma and religious language - 4
People are getting their news from AI – and it’s altering their views - 5
A top Marine shares his secrets to keeping fit at 50
Impact of NIH funding reductions felt in cancer and infectious disease trials
Josh Duhamel's secret to the good life at 53? Wolverine peptides, ditching Hollywood and having another baby.
Mexico says a third of 130,000 missing people might be alive, fueling criticisms by families
IVE 2026 'Show What I Am' Tour: How to get tickets, prices, dates and more
Find the Interesting Universe of Computerized reasoning: the Capability of man-made intelligence
Live long and loiter: Why NASA's ESCAPADE probes will wait a year in space before heading to Mars
NASA begins the countdown for humanity's first launch to the moon in 53 years
The Developing Nearby Food Development and Its Advantages
Lower-cost space missions like NASA's ESCAPADE are starting to deliver exciting science – but at a price in risk and trade‑offs












