Overview
- The Justice Department said five Kaiser affiliates in California and Colorado will pay $556 million to settle allegations tied to Medicare Advantage risk-adjustment submissions.
- Prosecutors allege Kaiser pressed clinicians to add diagnoses after visits using addenda and internal queries to raise risk scores and government payments.
- The alleged conduct spanned 2009 to 2018 and included mining patients’ medical histories and linking bonuses to meeting diagnosis targets.
- The settlement resolves qui tam suits brought by former employees Ronda Osinek and Dr. James M. Taylor, who will receive about $95 million.
- The government emphasized that the claims are allegations with no determination of liability, and Reuters reported Kaiser had not immediately commented.