
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
IDF uncovers 7 km.-long Gaza terror tunnel where Hamas held Hadar Goldin20.11.2025 - 2
Greenland’s melting ice and landslide-prone fjords make the oil and minerals Trump is eyeing dangerous to extract07.01.2026 - 3
Health insurance premiums rose nearly 3x the rate of worker earnings over the past 25 years08.12.2025 - 4
Birds at a college changed beak shapes during the pandemic. It might be a case of rapid evolution12.01.2026 - 5
A definitive Manual for the Over-Ear Earphones05.06.2024
Sydney Sweeney is returning in 'The Housemaid's Secret': What to know about 'The Housemaid' sequel
Want to make America healthy again? Stop fueling climate change
Rediscovering Euphoria: Individual Accounts of Conquering Despondency
Carry Nature Inside with These Staggering Plant Decisions
You finally got a doctor's appointment. Here's how to get the most out of it
FBI arrests Brian Cole Jr. in Jan. 6 pipe bomb investigation, ending 5-year hunt
Argentina reportedly delaying embassy move over Israeli company's oil project near Falklands
EU waters down plans to end new petrol and diesel car sales by 2035
Before trips to Mars, we need better protection from cosmic rays












