Kaiser Permanente will pay $556M to settle Medicare fraud case

"According to federal prosecutors, between 2009 and 2018, Kaiser "systematically pressured its physicians to alter medical records after patient visits to add diagnoses that the physicians had not considered or addressed at those visits, in violation of CMS rules." This allegedly allowed Kaiser to receive additional risk adjustment payments through the Centers for Medicare and Medicaid Services, or CMS, the federal agency that provides health insurance to more than 160 million Americans."

""Medicare Advantage is a vital program that must serve patients' needs, not corporate profits," Missakian said in a statement. "Fraud on Medicare costs the public billions annually, so when a health plan knowingly submits false information to obtain higher payments, everyone - from beneficiaries to taxpayers - loses.""

"Kaiser Permanente has agreed to pay over half a billion dollars to settle claims that it defrauded the federal government."

Kaiser Permanente agreed to pay $556 million to resolve claims that it defrauded the federal government after two employees blew the whistle on improper practices. Federal prosecutors allege that between 2009 and 2018 Kaiser systematically pressured physicians to alter medical records after patient visits to add diagnoses that had not been considered or addressed, violating CMS rules. Those added diagnoses allegedly produced higher risk-adjustment payments from CMS. Prosecutors say Kaiser set aggressive diagnosis-adding goals, applied benchmarks across hospitals, rewarded units that met targets with bonuses, and pressured those that did not. Kaiser is headquartered in Oakland and reported over 1.2 million patients and $82 billion in 2024 tax filings.

Read at The Oaklandside