
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
Is new Harry Styles music on the way? Fans think so, after a cryptic website and posters pop up.12.01.2026 - 2
The most effective method to Remain Ahead in the Most recent Advanced Patterns with a Web based Advertising Degree19.10.2023 - 3
Vote in favor of Your #1 Home Exercise Gear: Execution and Comfort Matter05.06.2024 - 4
The most effective method to Apply Antiquated Ways of thinking in Current Brain science Practices17.10.2023 - 5
Was it a stone tool or just a rock? An archaeologist explains how scientists can tell the difference31.12.2025
Dominating Capable Mastercard Utilization: Key Contemplations
Track down the Ideal Weight reduction Methodology for Your Way of life
Have gravitational waves provided the first hint of primordial black holes born during the Big Bang?
'Heated Rivalry's Ilya Rozanov is now a queer icon in Russia
Monetary Versatility: Get ready for Life's Unforeseen Difficulties
Catch the moon dancing with bright star Regulus tonight
The most effective method to Amplify Profits from Gold Speculation: Systems and Tips
Tributes pour in for MIT professor Nuno Loureiro amid unresolved shooting case
She was the ultimate '90s fitness influencer. Now she's delivering Uber Eats — and rebuilding her life.












