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U.S. Justice Department joins lawsuits alleging Medicare fraud by Kaiser Permanente

Hospital system denies allegations of wrongdoing

The U.S. Justice Department has joined a series of whistleblower lawsuits alleging that Kaiser Permanente engaged in a years-long scheme to defraud the federal government out of Medicare payments.

The suits allege that since 2009 the company systematically pressured doctors to amend medical records by adding "diagnoses that patients did not actually have" in order to receive higher Medicare reimbursements, according to federal prosecutors.

The original suit, filed under the False Claims Act in 2013 by a Kaiser data specialist in San Rafael, claims the company also used data mining to "retroactively change patient medical records."

"Today's action sends a clear message that we will hold health care providers and plans accountable if they seek to game the system by submitting false information," said Deputy Assistant Attorney General Sarah Harrington.

The suits seek an unspecified amount of money in damages plus attorney fees and court costs.

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Kaiser has denied all allegations of wrongdoing.

"We are confident that Kaiser Permanente is compliant with Medicare Advantage program requirements and we intend to strongly defend against the lawsuits alleging otherwise," according to a statement posted on the company's website Thursday.

"Our policies and practices represent well-reasoned and good-faith interpretations of sometimes vague and incomplete guidance from (Centers for Medicare & Medicaid Services)," the statement reads.

A case management conference is scheduled for Oct. 22 via Zoom.

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U.S. Justice Department joins lawsuits alleging Medicare fraud by Kaiser Permanente

Hospital system denies allegations of wrongdoing

by /

Uploaded: Thu, Aug 5, 2021, 4:58 pm

The U.S. Justice Department has joined a series of whistleblower lawsuits alleging that Kaiser Permanente engaged in a years-long scheme to defraud the federal government out of Medicare payments.

The suits allege that since 2009 the company systematically pressured doctors to amend medical records by adding "diagnoses that patients did not actually have" in order to receive higher Medicare reimbursements, according to federal prosecutors.

The original suit, filed under the False Claims Act in 2013 by a Kaiser data specialist in San Rafael, claims the company also used data mining to "retroactively change patient medical records."

"Today's action sends a clear message that we will hold health care providers and plans accountable if they seek to game the system by submitting false information," said Deputy Assistant Attorney General Sarah Harrington.

The suits seek an unspecified amount of money in damages plus attorney fees and court costs.

Kaiser has denied all allegations of wrongdoing.

"We are confident that Kaiser Permanente is compliant with Medicare Advantage program requirements and we intend to strongly defend against the lawsuits alleging otherwise," according to a statement posted on the company's website Thursday.

"Our policies and practices represent well-reasoned and good-faith interpretations of sometimes vague and incomplete guidance from (Centers for Medicare & Medicaid Services)," the statement reads.

A case management conference is scheduled for Oct. 22 via Zoom.

Comments

Nebuchadnezzar
Registered user
San Ramon
on Aug 8, 2021 at 2:46 pm
Nebuchadnezzar, San Ramon
Registered user
on Aug 8, 2021 at 2:46 pm

Kaiser is known for cutting corners when it comes to patient care. I am not surprised. In fact I got my Covid-19 shot from the FEDs in the bay area, even before Kaiser offered me the shot. Disgraceful. I point the finger at the previous CEO who died and the current one. The senior management team needs to be fired.


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