
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
NASA says Maven spacecraft that was orbiting Mars has gone silent - 2
Remarkable Spots for Hot Air Swelling All over The Planet - 3
NASA Perseverance rover sees megaripples on Mars | Space photo of the day for Jan. 7, 2026. - 4
FDA approves Wegovy pill for weight loss - 5
‘RuPaul's Drag Race’ Season 18: How to watch without cable, premiere time, cast list and more
Upgrading the Healthy benefit of Your Local Vegetables
Island Travel Guide: Must-Visit Objections for 2024
The Secret Destinations Amex Says Will Be More Popular Than Bali by 2026
Warning for snow and ice extended
Kids get diseases like lupus, too. As researchers hunt better treatments, this camp brings joy
The Best Design Bloggers for Style Motivation
The Job of a Land Legal counselor in Property Exchanges
A definitive Burger Confrontation: Which One Rules?
Christmas 2025 skywatching guide: What you can see in the night sky on Dec. 25













