US EditionKaiser Affiliates Will Pay $556M to Settle a Lawsuit Alleging Medicare Fraud
Five Kaiser Permanente affiliates settled for $556 million over allegations of upcoding Medicare Advantage claims from 2009 to 2018, with whistleblowers receiving $95 million.
- On Wednesday, five Kaiser Permanente affiliates agreed to pay $556 million to resolve DOJ allegations of improper Medicare Advantage billing, including Kaiser Foundation Health Plan and others.
- Risk-Adjusted payments from Medicare Advantage rely on diagnostic codes, and last year the government was expected to pay 20% more for enrollees, a $84 billion difference, according to CMS.
- The Department of Justice alleges Kaiser pressured physicians in California and Colorado to add post-visit addenda with unrelated codes and tied financial bonuses to diagnostic coding despite internal warnings.
- The settlement stemmed from a False Claims Act suit filed by Ronda Osinek, former data quality trainer, and Dr. James Taylor, former medical director, who will receive $95 million.
- CMS expanded audits last year to crack down on overpayments despite court setbacks, while CMS Administrator Dr. Mehmet Oz pledged scrutiny and a Senate report accused UnitedHealth of `gaming` MA risk adjustment.
56 Articles
56 Articles
Kaiser affiliates will pay $556 million to settle a lawsuit alleging Medicare fraud
Kaiser Permanente affiliates will pay $556 million to settle a lawsuit that alleged the healthcare giant committed Medicare fraud and pressured doctors to list incorrect diagnoses on medical records to receive higher reimbursements, federal prosecutors said. The deal announced Wednesday came more than four years after the U.S. Department of Justice filed the legal claim in San Francisco that consolidated allegations made in six whistleblower com…
Kaiser settles $550M fraud suit
SAN FRANCISCO — Kaiser Permanente affiliates will pay $556 million to settle a lawsuit that alleged the health care giant committed Medicare fraud and pressured doctors to list incorrect diagnoses on medical records to receive higher reimbursements, federal prosecutors said. The deal announced Wednesday came more than four years after the U.S. Department of Justice filed the legal claim in San Francisco that consolidated allegations made in six …
kffhealthnews.org
Times of San DiegoKaiser Permanente To Pay $556 Million in Record Medicare Advantage Fraud Settlement
In the largest Medicare Advantage fraud settlement to date, Kaiser Permanente has agreed to pay $556 million to settle Justice Department allegations that it billed the government for medical conditions patients didn’t have. The settlement, announced Jan. 14, resolves whistleblower lawsuits that accused the giant health insurer of mounting a years-long scheme in which it overstated how sick patients were to illegally boost revenues. “Medicare Ad…
Associated Press News
Kaiser affiliates will pay $556M to settle a lawsuit alleging Medicare fraud
Kaiser Permanente affiliates will pay $556 million to settle a lawsuit that alleged the health care giant committed Medicare fraud and pressured doctors to list incorrect diagnoses on medical records to receive higher reimbursements.
Kaiser Permanente settles Medicare fraud claims for $556M | Honolulu Star-Advertiser
Kaiser Permanente, the California-based health system, agreed to pay $556 million to the federal government and two whistleblowers to settle lawsuits accusing it of fraudulent overbilling by its Medicare Advantage plans.
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