Kaiser Permanente Affiliates Pay $556M to Settle False Claims Act Allegations

"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."

"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 affiliates agreed to pay $556 million to resolve allegations of violating the federal False Claims Act by submitting invalid diagnosis codes for Medicare Advantage enrollees to obtain higher government payments. The civil settlement resolves claims brought under the FCA whistleblower provisions by former employees Ronda Osinek and Dr. James M. Taylor, who will receive $95 million. The government alleged that Kaiser knew fraudulent Medicare Advantage practices were widespread and ignored red flags and internal warnings, including physician concerns and compliance-office audits. Kaiser Permanente is a nonprofit integrated care system with over 9,470 staffed beds and facilities in multiple states. The settlement covers several Kaiser Foundation and Permanente medical group affiliates.

Read at San Jose Inside