Government Intervenes in False Claims Act Lawsuits Against Kaiser Permanente Affiliates

From the Department of Justice, Office of Public Affairs News dated Friday, July 30, 2021

The article states allegations against Kaiser on submission of HCC diagnoses:

"Medicare requires that, for outpatient medical encounters, MA Plans submit diagnoses to CMS only for conditions that required or affected patient care, treatment or management during an in-person encounter in the service year. In order to increase its Medicare reimbursements, Kaiser allegedly pressured its physicians to create addenda to medical records after the patient encounter, often months or over a year later, to add risk-adjusting diagnoses that patients did not actually have and/or were not actually considered or addressed during the encounter, in violation of Medicare requirements.

The lawsuits were filed under the qui tam, or whistleblower, provisions of the False Claims Act"

It will be interesting to follow this story and see how it turns out.

https://www.justice.gov/opa/pr/government-intervenes-false-claims-act-lawsuits-against-kaiser-permanente-affiliates

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