
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
Pick Your Favored kind of sandwich06.11.2023 - 2
Turkiye’s Erdogan calls Israel’s Somaliland recognition ‘unacceptable’30.12.2025 - 3
RFK Jr.'s diet guidelines emphasize red meat, full-fat dairy. How healthy are they?08.01.2026 - 4
AI is providing emotional support for employees – but is it a valuable tool or privacy threat?20.11.2025 - 5
The most effective method to Decisively Plan Your Nursing Profession for the Best Compensation Results17.10.2023
Rocket Lab launches mystery satellite for 'confidential commercial customer' (video)
California is completely free of drought for the first time in 25 years
Former GLP-1 users regain lost weight after about 18 months, study says
Aspirin can prevent a serious pregnancy complication — but too few women get it, new report suggests
Flu cases spiking this holiday season, CDC data shows
Violence 'never part' of break-in plan, court told
'Senseless violence' erupts at Christmas tree lighting; 4 injured
Northern lights chances rise for Christmas as space weather remains unsettled
How did Hugh Jackman nail his latest role? Sequins, tighty-whities and embracing 'zero embarrassment.'













