The US Department of Justice said on Friday that it is intervening in six whistleblower complaints alleging that members of the Kaiser Permanente consortium violated false claims by submitting incorrect diagnostic codes to their Medicare Advantage Plan applicants for higher compensation.  The department filed its dispute in the U.S. District Court in San Francisco U.S. ex rel. Osinek v. Kaiser Permanente et al.
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 PC Kaiser is headquartered in Oakland, California.
Deputy Attorney General Sarah E. Harrington of the Department of Justice's Civil Department said in the statement: “Medicare's managed care programs depend on the accuracy of information provided by caregivers and plans to ensure patients receive the right level of care, replacement.
"Today's actions send a clear message that we will hold accountable caregivers and plans if they try to play the system by providing false information."
Whistleblower law firm Constantine Cannon LLP, based in San Francisco, said in a statement that the whistleblower in the case, Dr. James M. Taylor, had worked at Kaiser & # 39 ;s Colorado Permanente Medical Group, where he was medical director of the income cycle / claims and doctor director of coding.
The statement said that Dr. Taylor "had repeatedly suggested solutions internally " while he was a Kaiser employee "to address the issues described in his whistleblower complaint, but corrective action was either ignored by the organizations or implemented just shortly before Kaiser would return to previous behavior. "
Kaiser issued a statement in part stating:" We are convinced that Kaiser Permanente complies with the program requirements of Medicare Advantage and we intend to strongly defend you against the lawsuits claiming otherwise. "