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DOJ intervening in Kaiser whistleblower litigation


The U.S. Department of Justice said Friday it is intervening in six complaints in whistleblower litigation alleging that members of the Kaiser Permanente consortium violated the False Claims Act by submitting inaccurate diagnosis codes for its Medicare Advantage Plan enrollees to receive higher reimbursements.

The department filed its litigation in U.S. District Court in San Francisco in United States Ex rel. Osinek v. Kaiser Permanente et al.

The Kaiser Permanente consortium members are Kaiser Foundation Health Plan Inc., Kaiser Foundation Health Plan of Colorado, The Permanente Medical Group Inc., Southern California Permanente Medical Group Inc. and Colorado Permanente Medical Group P.C. Kaiser is headquartered in Oakland, California. 

Deputy Assistant Attorney General Sarah E. Harrington of the Justice Department’s Civil Division, said in the statement, “Medicare’s managed care program relies on the accuracy of information submitted by health care providers and plans to ensure that patients receive the appropriate level of care, and that plans receive the appropriate compensation.

“Today’s action sends a clear message that we will hold health care providers and plans accountable if they seek to game the system by submitting false information.” 

Whistleblower plaintiff law firm Constantine Cannon LLP, based in San Francisco, said in a statement the whistleblower in the case, Dr. James M. Taylor, had worked at Kaiser’s Colorado Permanente Medical Group, where he was medical director of revenue cycle/claims and physician director of coding.

The statement said Dr. Taylor “had repeatedly proposed solutions internally while he was a Kaiser employee “to address the issues outlined in his whistleblower complaint, but corrective action was either ignored by the organizations or only briefly implemented before Kaiser would return to prior behavior.”

Kaiser issued a statement that said in part, “We are confident that Kaiser Permanente is compliant with Medicare Advantage program requirements and we intend to strongly defend against the lawsuits alleging otherwise.”





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