
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
The Best Games Crossroads in History06.07.2023 - 2
Christmas 2025 skywatching guide: What you can see in the night sky on Dec. 2525.12.2025 - 3
Spanish police and soldiers track boars, reinforce farm security amid swine fever outbreak01.12.2025 - 4
NASA astronauts to return from space early due to an 'unexpected medical issue.' What happened — and when are they coming home?12.01.2026 - 5
4 Jeep Models: Dominating Execution and Flexibility for Each Experience05.06.2024
Procter & Gamble changes Crest toothpaste packaging to address Texas AG fluoride concerns
In blow to Lula, Brazil Congress revives controversial environmental bill
Fundamental Home Machines for Improved Solace in Summer
Osteoporosis, the silent disease, can shorten your life − here’s how to prevent fractures and keep bones healthy
I visited the largest collection of public telescopes in the US in Oregon's high desert, and the dark skies blew me away
NASA's SPHEREx telescope completes its 1st cosmic map of the entire sky and it's stunning!
Mother and Stepson Rescued After Being Swept Over 6 Miles in Paddleboarding Mishap
Nature: 10 High priority Setting up camp Spots In Europe
What's the Fate of 5G Innovation?












