Affiliates of Kaiser Permanente have agreed to pay $556 million to resolve allegations that they violated the federal False Claims Act by submitting unsupported diagnosis codes to inflate Medicare Advantage payments. The settlement involves Kaiser Foundation Health Plan Inc. and related entities in California and Colorado.
According to the U.S. Department of Justice, Kaiser improperly increased “risk adjustment” payments by pressuring physicians to add diagnoses to patient records after visits that were not addressed during those encounters. This violates the Centers for Medicare & Medicaid Services rules. The alleged conduct occurred from 2009 to 2018 and was the subject of a complaint filed in the Northern District of California in 2021.
The settlement also resolves whistleblower lawsuits brought under the False Claims Act. The relators will receive $95 million. The agreement resolves allegations only. There has been no determination of liability.