
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
Explosions heard across Tehran after IDF announces wave of strikes on regime terror targets - 2
Artemis 2 astronaut Victor Glover delivers inspiring Easter message on the way to the moon (video) - 3
Astronomers detect rare 'free floating' exoplanet 10,000 light-years from Earth - 4
IVE 2026 'Show What I Am' Tour: How to get tickets, prices, dates and more - 5
Jennifer Lawrence and Josh Hutcherson to reprise their roles for new 'Hunger Games' movie 'Sunrise on the Reaping'
Artemis II shares new lunar images while more than halfway to the moon
King Charles shares cancer treatment update, says it's a 'personal blessing'
'The Housemaid' movie with Sydney Sweeney and Amanda Seyfried premieres this month. What the stars have said about the psychological thriller.
Moscow accuses Berlin of stifling the opposition
Israeli Chief of Staff declares new border with Gaza Strip
10 times the sky amazed us in 2025
What you need to know about flu treatments as cases spike across the US
Discovery off Israel’s coast reveals earliest known 2,600-year-old shipment of raw iron
Turning into a Sharp Financial backer: Individual budget Wins











