Kaiser defrauded Medicare of $1B, Justice Department alleges

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Oakland, Calif.-based Kaiser Permanente and various affiliates defrauded Medicare of about $1 billion by adding diagnoses to patients' medical records to increase reimbursement, the Justice Department alleged in a complaint filed Oct. 25. 

The Justice Department alleges that Kaiser physicians submitted inaccurate diagnosis codes for Medicare Advantage beneficiaries from 2009 through 2018, according to Law360. Kaiser allegedly pressured physicians to create addenda to medical records after patient visits to add diagnoses that patients did not have or were not addressed during the in-person visit, according to Bloomberg Law

"The driver was money: so that Kaiser could submit these improper diagnoses to CMS for payment," the Justice Department's complaint reads. 

The complaint stems from six lawsuits filed under the whistleblower provisions of the False Claims Act. 

Kaiser disputes the claims and says it will defend against the allegations. 

"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 in an Oct. 25 statement

Kaiser said its practices and policies represent "good-faith interpretations" of guidance from CMS that is incomplete and vague.

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