Affiliates of Kaiser Permanente, the healthcare consortium headquartered in Oakland, have agreed to pay $556 million to resolve allegations that they violated the federal False Claims Act by submitting invalid diagnosis codes for their Medicare Advantage Plan enrollees in order to receive higher payments from the government.
The civil settlement includes the resolution of certain claims brought in lawsuits under the whistleblower provisions of the False Claims Act by Ronda Osinek and Dr. James M. Taylor, former employees of Kaiser Permanente. Under those provisions, private parties are permitted to sue on behalf of the United States and receive a portion of any recovery. The whistleblowers’ share of the recovery will be $95 million.
Kaiser knew that fraudulent Medicare Advantage practices were widespread and unlawful, according to the government, and ignored numerous red flags and internal warnings that it was violating Medicare rules, including concerns raised by its own physicians about false claims and audits by its own compliance office.
Non-profit Kaiser Permanente, known for its integrated model of care delivery, has the most staffed beds of any healthcare system in California, with more than 9,470 beds. Kaiser Permanente also has facilities in Hawaii, Washington, Oregon, Colorado, Maryland, Virginia and Georgia and runs the largest managed care organization in the United States.
As a closed network system, Kaiser’s hospitals exclusively serve members of the Kaiser...
The Department of Justice announced a more than half-billion-dollar settlement with Kaiser Permanente over claims the health care provider submitted false diagnosis codes for Medicare Advantage Pl...