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U.S. Justice Department joins lawsuits alleging Kaiser Medicare fraud

The U.S. Justice Department has joined a series of whistleblower lawsuits alleging that Kaiser Permanente engaged in a years-long scheme to defraud the federal government out of Medicare payments.

The six complaints allege that since 2009 the company systematically pressured doctors to amend medical records by adding “diagnoses that patients did not actually have” in order to receive higher Medicare reimbursements, according to federal prosecutors.

The original suit, filed under the False Claims Act in 2013 by a Kaiser data specialist in San Rafael, claims the company also used data mining to “retroactively change patient medical records.”

Deputy Assistant Attorney General Sarah Harrington said:

“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.” 

The suits seek an unspecified amount of money in damages plus attorney fees and court costs. Kaiser has denied all allegations of wrongdoing.

According to a statement posted on the company’s website Thursday:

“We are confident that Kaiser Permanente is compliant with Medicare Advantage program requirements and we intend to strongly defend against the lawsuits alleging otherwise.”

The statement continues:

“Our policies and practices represent well-reasoned and good-faith interpretations of sometimes vague and incomplete guidance from (Centers for Medicare & Medicaid Services).” 

A case management conference is scheduled for Oct. 22 via Zoom.

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