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Federal prosecutors said a Kaiser Permanente affiliate will pay $556 million to settle a lawsuit that accuses the health care giant of committing Medicare fraud and forcing doctors to list incorrect diagnoses on medical records to obtain higher reimbursements.
The deal announced Wednesday comes more than four years after the U.S. Department of Justice filed legal claims against the U.S. Department of Justice. san francisco This combines allegations made in six whistleblower complaints.
Affiliates included in the settlement include Kaiser Foundation Health Plan; Kaiser Foundation Health Plan Colorado; Permanente Medical Group; Southern california Permanente Medical Group; and Colorado Permanente Medical Group, P.C.
Caesars, headquartered in AucklandCalifornia is a consortium of entities that together make up one of the largest not-for-profit health plans in the United States, with more than 12 million members and dozens of medical centers.
The lawsuit alleges that Kaiser entities manipulated the Medicare Advantage Plan system, also known as Medicare Part C plans, which gave beneficiaries the option of enrolling in a managed health insurance plan.
Prosecutors argued that Kaiser “forced its doctors to make supplements to medical records,” often months or more than a year after initial consultations with enrollees, because a beneficiary’s more serious diagnosis often resulted in higher payments by the plan.
“More than half of our nation’s Medicare beneficiaries are enrolled in Medicare Advantage plans, and the government wants people who participate in the program to provide truthful and accurate information,” Assistant Attorney General Brett A. Shumate said in a statement Wednesday.
Caesars did not immediately respond to a message seeking comment on the settlement. When the lawsuit was announced, Caesars defended its practices and called the allegations disappointing.
