Kaiser affiliates will pay $556M to settle a lawsuit alleging Medicare fraud

"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 whistleblower complaints."

"The lawsuit alleged that Kaiser entities gamed the Medicare Advantage Plan system, also known as the Medicare Part C program, which gives beneficiaries the option of enrolling in managed care insurance plans. Prosecutors contended that Kaiser pressured its physicians to create addenda to medical records, often months or more than a year after an initial consultation with an enrollee, because more severe diagnoses for beneficiaries generally result in larger payments to the plan."

Kaiser Permanente affiliates agreed to pay $556 million to resolve allegations of Medicare fraud and pressured physician recording practices to increase Medicare Advantage reimbursements. The consolidated legal claim originated from six whistleblower complaints filed by the U.S. Department of Justice more than four years earlier. The settlement covers several Kaiser entities, including regional foundation health plans and Permanente medical groups. Prosecutors alleged the system encouraged post‑consultation addenda to medical records, sometimes months or over a year later, to reflect more severe diagnoses that produce larger payments. Kaiser said the settlement included no admission of wrongdoing and avoided trial costs.

Read at www.mercurynews.com