Seattle health plan, New York consultants bilked Medicare, whistleblower suit alleges

A former employee at Group Health Cooperative in Seattle is accusing the health plan of involvement in a "scheme" related to the submission of false Medicare claims, according to Kaiser Health News.

Teresa Ross — who worked at Group Health Cooperative as director of insurance and health data analysis and then as director of risk adjustment services — alleges in a federal whistleblower case that the health plan was not bringing in enough money and tried to turn things around in 2010 by providing inaccurate information about Medicare Advantage beneficiaries, the news service reported. The inaccuracies included exaggerating the sickness of some patients and led to Medicare retroactively paying the insurer about $8 million for 2010 services, KHN reported.

Two medical coding consultants, DxID of East Rochester, N.Y., and Independent Health Association, an affiliated health plan in Buffalo, N.Y., are also listed as defendants in the case.

All defendants have denied wrongdoing and are trying to get the case dismissed, KHN reported.

Group Health Cooperative was founded in 1947 and was acquired by Oakland, Calif.-based Kaiser Permanente in 2017.

A Kaiser Permanente spokesperson told KHN: "We believe that Group Health complied with the law by submitting its data in good faith, relying on the recommendations of the vendor as well as communications with the federal government."

Read the full KHN report here.


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