{"id":240854,"date":"2026-01-16T07:08:07","date_gmt":"2026-01-16T07:08:07","guid":{"rendered":"https:\/\/www.newsbeep.com\/il\/240854\/"},"modified":"2026-01-16T07:08:07","modified_gmt":"2026-01-16T07:08:07","slug":"kaiser-to-pay-556m-over-allegations-of-false-claims","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/il\/240854\/","title":{"rendered":"Kaiser to pay $556M over\u00a0allegations\u00a0of false claims\u00a0"},"content":{"rendered":"<p>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 Plan customers in order to receive a higher payout from the government.\u00a0<\/p>\n<p>In\u00a0<a href=\"https:\/\/www.justice.gov\/opa\/media\/1423431\/dl\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">a 2022 complaint<\/a>, the Department of Justice claimed\u00a0Kaiser violated the False Claims Act from 2009 to 2018\u00a0in order to\u00a0\u201cunlawfully obtain payments,\u201d from the Medicare Part C program.\u00a0\u00a0<\/p>\n<p>Prosecutors alleged that Kaiser made \u201cefforts to increase its Medicare revenue by systematically pressuring its physicians to add diagnoses that did not appear in the original visit note.\u201d\u00a0<\/p>\n<p>Kaiser responded Thursday with a statement\u00a0<a href=\"https:\/\/www.justice.gov\/opa\/media\/1423426\/dl\" target=\"_blank\" rel=\"noreferrer noopener nofollow\">that confirmed the settlement<\/a>, denied any liability and\u00a0wrongdoing\u00a0and said the allegations never interfered with patient care. The settling affiliates for the national consortium based in Oakland included Southern California Permanente Medical Group,\u00a0the Kaiser Foundation Health Plan Inc. and The Permanente Medical Group.\u00a0<\/p>\n<p>The federal claims indicate that doctors were pressured to add diagnostic codes and the government was the primary victim, for \u201cadditional Medicare payments in the range of $1 billion from these diagnoses.\u201d\u00a0\u00a0\u00a0<\/p>\n<p>In some cases, according to the federal complaint, \u201cKaiser mined Medicare Advantage patient medical files for potential additional diagnoses \u2026 pressed its physicians to add the diagnoses to medical records retrospectively using an addendum to make it appear as if the conditions had been addressed in some way during the patient visit when in fact they had not \u2026 In many cases, patients were not even told that they supposedly had the diagnoses that Kaiser had added to their medical records,\u201d according to a \u201cpreliminary statement.\u201d\u00a0<\/p>\n<p>A statement Thursday from Kaiser sent via email stated the organization chose to settle for the sake of expediency, and a prevalence of similar cases point to \u201cindustrywide challenges in applying these requirements,\u201d referring to what it called the government\u2019s \u201cscrutiny over Medicare Advantage risk adjustment standards and practices.\u201d\u00a0<\/p>\n<p>Kaiser officials said there was no admission of wrongdoing or liability.\u00a0\u00a0<\/p>\n<p>\u201cThe Kaiser Permanente case was not about the quality of care our members received. It involved a dispute about how to interpret the Medicare risk adjustment program\u2019s documentation requirements,\u201d according to a statement shared Thursday by\u00a0Carol Soudah through Kaiser\u2019s Office of Public Affairs. \u201cWe remain unwavering in our mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve.\u201d\u00a0<\/p>\n","protected":false},"excerpt":{"rendered":"The Department of Justice announced a more than half-billion-dollar settlement with Kaiser Permanente over claims the health care&hellip;\n","protected":false},"author":2,"featured_media":240855,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[34],"tags":[163,521,85,46],"class_list":{"0":"post-240854","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-healthcare","8":"tag-health","9":"tag-healthcare","10":"tag-il","11":"tag-israel"},"_links":{"self":[{"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/posts\/240854","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/comments?post=240854"}],"version-history":[{"count":0,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/posts\/240854\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/media\/240855"}],"wp:attachment":[{"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/media?parent=240854"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/categories?post=240854"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newsbeep.com\/il\/wp-json\/wp\/v2\/tags?post=240854"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}