The Department of Justice (DOJ) has intervened in multiple suits against Kaiser Permanente that allege the healthcare giant submitted inaccurate codes for its Medicare Advantage members to juice reimbursements.
According to the lawsuits, Kaiser Permanente pressured its physicians to include addenda on patient records to additional diagnoses. These updates were at times made months or more than a year later, for conditions the patient did not have or that were not considered at the time of their visit, the DOJ said.
The false claims allegations were initially filed in a series of whistleblower suits, the DOJ said.
“Medicare’s managed care program relies on the accuracy of information submitted by health care providers and plans to ensure that patients receive the appropriate level of care, and that plans receive the appropriate compensation,” said Deputy Assistant Attorney General Sarah E. Harrington of the Justice Department’s Civil Division in a statement.
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“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," Harrington said.
In a statement to Reuters, Kaiser Permanente said it is "confident" that it is in compliance with federal Medicare regulations.
"We are confident that Kaiser Permanente is compliant with Medicare Advantage program requirements and we intend to strongly defend against the lawsuits alleging otherwise," Kaiser said. "Our policies and practices represent well-reasoned and good-faith interpretations of sometimes vague and incomplete guidance from CMS."
The cases have been consolidated in California federal court.