
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
CDC changes kids' vaccine schedule, removing universal recommendation for some shots - 2
Flat Earth, spirits and conspiracy theories – experience can shape even extraordinary beliefs - 3
The Difficulties of Getting a Green Card in the US - 4
NASA's Perseverance Mars rover could break the record for miles driven on another planet - 5
A throat bone settles it - Nanotyrannus was not a juvenile T. rex
Trial of pro-Palestine activist begins
Find the Advantages of Innovative Leisure activities: Supporting Creative mind and Self-Articulation
2026 Golden Globes live updates: Red carpet arrivals will kick off the night; Nikki Glaser set to host
Here's how 'Bridgerton' fans can watch the first episode of Season 4 before its Netflix release later this month
They grew up with 'almond moms.' Now, they dread going home for the holidays.
How on earth did 'Shark Tank' star Kevin O'Leary end up in 'Marty Supreme'? I'll let him explain.
Investigating the Financial History of the World: A Succinct Outline
The Way to Business: Startup Illustrations Learned
Creative Tech Contraptions That Will Work on Your Life












