In a move to sweep up the confetti of deceit, affiliates of Kaiser Permanente are doling out a hefty $556 million after allegations emerged that they played it fast and loose with Medicare diagnosis codes to scoop up extra dough from the government. For the uninitiated, we're talking about the big kahunas like Kaiser Foundation Health Plan Inc. and the Permanente Medical Group factions in California and Colorado bending the rules of Medicare Advantage (Medicare Part C).
Kaiser's allegedly slick operation involved after-the-fact meddling with patient records to tag on extra diagnoses that, let's just say, weren't necessarily on the table during actual doc visits, thus yanking at the purse strings of Medicare to fatten their own pockets. So goes the claim by the US in a lawsuit that found its way to the Northern District of California's federal court back in October 2021.
Assistant Attorney General Brett A. Shumate tossed down the gauntlet on healthcare providers who might fancy tinkering with truthful info for inflated Medicare payments, as per the Justice Department's statement. Echoing the tough talk, U.S. Attorney Craig H. Missakian and his counterpart, Peter McNeilly, threw their weight behind the idea that gaming the system for profit won't go unnoticed and unchecked.
Kaiser's alleged endgame was to push their physicians toward making these dubious additions, stacking the deck with aggressive diagnosis goals, and even stringing financial perks like bonuses to them. The feds claim this wasn't some rogue move by a few outliers but a whole strategic play by Kaiser, even as their own docs and audits raised red flags about shady business afoot.
