Five Kaiser Permanente affiliates have agreed to pay $556 million to resolve allegations that they improperly boosted Medicare Advantage payments by submitting unsupported medical diagnoses, the U.S. Department of Justice said Wednesday.
The settlement resolves claims that several Kaiser health plans and regional medical groups violated the False Claims Act by submitting diagnoses that were not supported by patient records and were later used to inflate risk-adjustment payments under the Medicare Advantage program.
Federal prosecutors alleged the Kaiser entities pressured physicians to add diagnoses to patient records after visits had already concluded, even when those conditions were not evaluated, treated, or discussed during the original encounter.
In a statement announcing the resolution, Assistant Attorney General Brett A. Shumate of the DOJ’s Civil Division said the agreement reinforces the government’s expectation that healthcare providers submit accurate and truthful information to the Centers for Medicare and Medicaid Services.
“More than half of Medicare beneficiaries are enrolled in Medicare Advantage plans,” Shumate said. “The United States will hold healthcare providers accountable when they knowingly submit or cause false information to be submitted to obtain inflated payments.”
Kaiser said the settlement includes no admission of wrongdoing or liability and that it agreed to resolve the matter to avoid the...
Five Kaiser Permanente affiliates have agreed to pay $556 million to resolve allegations that they improperly boosted Medicare Advantage payments by submitting unsupported medical diagnoses, the U...