Kaiser Permanente accused of Medicare reimbursement scam
The scheme allegedly cost the federal government billions of dollars in Medicare reimbursement payments.
(Photo: The Kaiser Permanente office in Vacaville is pictured in a panorama captured by a Google Street View vehicle in 2019. Photo courtesy Google, Graphic by Solano NewsNet)
Federal prosecutors on Friday announced they were joining a series of whistleblower lawsuits filed against the Kaiser Permanente consortium, alleging the health care provider engaged in a scam to bilk the government out of billions of dollars through phony Medicare reimbursement charges.
The lawsuits, filed under the federal False Claims Act, claim Kaiser Permanente retroactively changed patient records in order to submit claims for medical care that was never provided to patients or for diagnosis that were worse than what were originally reflected in those records.
Kaiser Permanente provides coverage to some members under a government program called Medicare Advantage (which is also known as Medicare Part C). Through that program, hospitals provide medical care to members enrolled in Medicare Advantage plans, then submit medical codes to the government related to the type of care that was provided.
Kaiser Permanente is accused of altering those codes in order to receive higher payments. At least six whistleblower lawsuits have been filed against the company under the False Claims Act since 2013, according to information reviewed by Solano NewsNet.
The federal government is now joining those six lawsuits, which were filed in federal court in San Francisco. Kaiser Permanente operates two hospitals in Solano County.
“The integrity of government health care programs must be protected,” Stephanie Hinds, the Acting U.S. Attorney for the Northern District of California, said in a statement on Friday. “The Medicare Advantage Program maintains the health of millions, and wrongful acts that defraud the program cannot continue and will be pursued.”
Prosecutors say the claims are merely allegations at this point, and Kaiser Permanente has not been found liable for actual fraud. No criminal charges have been filed against the company in connection with the alleged scheme.
On Thursday, a spokesperson for the hospital group said the consortium was “confident that Kaiser Permanente is compliant with Medicare Advantage program requirements.”
“We intend to strongly defend against the lawsuits alleging otherwise,” the spokesperson said.
Connect with Solano NewsNet on Twitter and Facebook for breaking news updates.
We’re proud to produce independent news for Solano County. This newsletter is an all-volunteer effort. If you would like to show your appreciation, consider making a donation in any amount or signing up for a paid subscription.