Representing the largest recovery of this nature to date
SAN FRANCISCO, Jan. 14, 2026 /PRNewswire/ -- Kaiser Permanente (Kaiser) has agreed to pay $556 million to resolve False Claims Act litigation alleging improper Medicare Advantage risk-adjustment practices, according to the U.S. Department of Justice. The case was brought by physician whistleblower Dr. James M. Taylor, along with other relators, and was later joined in part by the government.
Dr. Taylor, a longtime Kaiser physician and former medical director responsible for coding governance, compliance, and revenue-cycle oversight, filed his whistleblower complaint after identifying what he alleged were systemic practices that added or retained diagnosis codes not supported by patients' medical records. According to the pleadings, these practices inflated beneficiaries' risk scores and increased Medicare reimbursements without corresponding clinical justification.
Dr. Taylor was represented throughout the matter by Whistleblower Partners, a nationally recognized whistleblower law firm with deep experience in complex healthcare fraud and False Claims Act litigation.
"Working closely with Dr. Taylor over multiple years, we helped develop detailed, technically grounded allegations rooted in his firsthand experience inside Kaiser's Medicare Advantage operations," said Max Voldman, partner at Whistleblower Partners. "This settlement reflects the importance of whistleblowers who understand how these...
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...