News: Government intervenes in six False Claims Act suits against Kaiser Permanente

CDI Strategies - Volume 15, Issue 31

The United States government has intervened in six whistleblower allegations that the Kaiser Permanente consortium violated the False Claims Act by allegedly submitting inaccurate diagnosis codes in order to receive higher reimbursements from the Medicare Advantage Plan.

For outpatient medical encounters, Medicare requires that Medicare Advantage Plans submit diagnoses only for conditions that required or affected patient care, treatment, or management during an in-person encounter. Kaiser, however, allegedly “pressured its physicians to create addenda to medical records after the patient encounter, often months or over a year later, to add risk-adjusting diagnoses that the patients did not actually have and/or were not actually considered or addressed during the encounter.” This was done to increase Medicare reimbursements and is in violate of Medicare requirements.

The Kaiser lawsuits were filed until the whistleblower provisions of the False Claims Act, permitting private parties to sue on behalf of the United States government for false claims. The claims in which the government has intervened are allegations only at this time.

Editor’s note: The Department of Justice press release for these lawsuits can be found here. To read about other recent whistleblower cases, click here.

Found in Categories: 
Denials & Appeals, News