Overview
- Kaiser Foundation Health Plan entities in California and Colorado, including three Permanente Medical Groups, reached the settlement covering conduct alleged from 2009 to 2018.
- Federal prosecutors said Kaiser urged physicians to add diagnoses to charts months after visits via addenda, used data‑mining to flag codes, and tied bonuses to diagnosis targets in violation of CMS rules.
- Kaiser said it settled to avoid prolonged litigation, denied wrongdoing, and noted the matter did not concern the quality of patient care.
- Whistleblowers Ronda Osinek and Dr. James M. Taylor, former Kaiser employees, brought the qui tam suits and will receive $95 million from the recovery.
- The agreement is described as the largest of its kind in Medicare Advantage risk‑adjustment enforcement, with the DOJ alleging the practices generated roughly $1 billion in improper payments.