What Kaiser Permanente affiliates paid in the Medicare fraud settlement?

Kaiser Foundation Health Plan, Kaiser Foundation Health Plan of Colorado, Colorado Permanente Medical Group, Permanente Medical Group, and Southern California Permanente Medical Group paid $556 million.

Why did Kaiser Permanente pay $556 million?

Kaiser Permanente affiliates paid to resolve claims that they illegally pressured doctors to add unconsidered diagnoses to patient records, aiming to inflate Medicare payments.

Who were the whistleblowers in the Kaiser Permanente fraud case?

The whistleblowers were former Kaiser employees Ronda Osinek, a medical coder, and James Taylor, a doctor overseeing risk adjustment programs.

Home / Crime and Justice / Kaiser Permanente Fined $556M for Medicare Fraud

Kaiser Permanente Fined $556M for Medicare Fraud

15 Jan

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Summary

Kaiser Permanente affiliates paid $556 million to settle fraud claims.
Claims alleged illegal pressure on doctors to inflate patient diagnoses.
Settlement resolves whistleblower lawsuits over Medicare Advantage payments.

Kaiser Permanente Fined $556M for Medicare Fraud

Five Kaiser Permanente affiliates in California and Colorado have agreed to pay $556 million to settle claims that they illegally manipulated patient diagnoses for increased Medicare payments. The U.S. Department of Justice announced the settlement on January 14, resolving two whistleblower lawsuits that accused Kaiser of violating the federal False Claims Act.

According to the Justice Department, Kaiser Permanente affiliates pressured doctors to add diagnosis codes for conditions they had not considered, thereby inflating payments from the government. This practice allegedly occurred between 2009 and 2018, impacting Medicare Advantage payments which are higher for sicker patients.

The settlement was initiated by former Kaiser employees Ronda Osinek and James Taylor, who will receive approximately $95 million for their role as whistleblowers. The U.S. Attorney's office emphasized that such fraud costs the public billions annually, impacting beneficiaries and taxpayers alike.

Disclaimer: This story has been auto-aggregated and auto-summarised by a computer program. This story has not been edited or created by the Feedzop team.

Kaiser Permanente Fined $556M for Medicare Fraud

15 Jan

•

Summary

Kaiser Permanente affiliates paid $556 million to settle fraud claims.
Claims alleged illegal pressure on doctors to inflate patient diagnoses.
Settlement resolves whistleblower lawsuits over Medicare Advantage payments.

Disclaimer: This story has been auto-aggregated and auto-summarised by a computer program. This story has not been edited or created by the Feedzop team.