Kaiser to pay $6.4 million to settle claims of invalid Medicare Advantage diagnoses

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, Kaiser to pay $6.4 million to settle claims of invalid Medicare Advantage diagnoses

Kaiser Permanente can pay the federal authorities practically $6.four million to settle allegations that its Washington well being plan claimed its Medicare Benefit members had been sicker than they really had been to spice up funds.

The U.S. Division of Justice introduced the settlement with Kaiser Basis Well being Plan of Washington, previously often called Group Well being Cooperative, on Monday. It doesn’t decide legal responsibility.

The federal government says the settlement resolves its allegations that the well being plan knowingly submitted diagnoses for its Medicare Benefit members that weren’t supported by these sufferers’ medical information to inflate the funds it obtained. The Medicare program pays personal insurers who run Medicare Benefit plans a hard and fast, month-to-month quantity per member that’s adjusted based mostly on every member’s well being standing, with larger funds for sicker members.

The whistleblower lawsuit that prompted the federal government’s investigation was filed by Teresa Ross, a former Group Well being worker. She is going to obtain about $1.5 million for her function within the case.

The federal government depends on Medicare Benefit insurers to submit correct diagnoses to Medicare to make sure they’re paid appropriately, Assistant Lawyer Basic Jeffrey Bossert Clark with the DOJ’s Civil Division mentioned in a press release.

“We are going to proceed to pursue those that undermine the integrity of the Medicare program and the info it depends upon,” he mentioned.

Oakland, Calif.-based Kaiser didn’t instantly reply to a request for remark.


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