DOJ had alleged that the Kaiser affiliates violated the False Claims Act by submitting invalid diagnosis codes to get higher government payments.
Kaiser Foundation Health Plan and other Kaiser affiliates have agreed to pay $556 million to resolve allegations that they violated the False Claims Act by submitting invalid diagnosis codes for their Medicare Advantage Plan enrollees to receive higher payments from the government.
The settling Kaiser Permanente affiliates are Kaiser Foundation Health Plan, Kaiser Foundation Health Plan of Colorado, The Permanente Medical Group, Southern California Permanente Medical Group and Colorado Permanente Medical Group.
The claims resolved by the settlement with the Department of Justice are allegations only, and there has been no determination of liability, the DOJ said.
The settlement contains no admission of wrongdoing and addresses historical Medicare Advantage documentation practices, Kaiser said.
“The agreement resolves a False Claims Act lawsuit and has no admission of wrongdoing or liability,” Kaiser said. “We chose to settle to avoid the delay, uncertainty and cost of prolonged litigation.”
WHY THIS MATTERS
Kaiser said the case was about the interpretation of the Medicare risk adjustment program’s documentation requirements.
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