The U.S. Department of Justice announced July 30 that it intervened in six False Claims Act complaints alleging Kaiser Foundation Health Plan and other affiliates of Oakland, Calif.-based Kaiser Permanente submitted inaccurate diagnosis codes for its Medicare Advantage members to receive higher reimbursements.
The allegations against the Kaiser affiliates were originally brought under the qui tam, or whistleblower, provisions of the False Claims Act. The lawsuits allege Kaiser pressured physicians to create addenda to medical records after patient visits to add diagnoses that patients did not have or were not addressed during the in-person visit. The additional codes allegedly resulted in Kaiser receiving higher Medicare reimbursements, according to the Justice Department.
Kaiser disputes the allegations.
"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 system said in a July 29 statement. "Our medical record documentation and risk adjustment diagnosis data submitted to the Centers for Medicare & Medicaid Services comply with applicable laws and Medicare Advantage program requirements. Our policies and practices represent well-reasoned and good-faith interpretations of sometimes vague and incomplete guidance from CMS. For nearly a decade, Kaiser Permanente has achieved consistently strong performance on Risk Adjustment Data Validation audits conducted by CMS. With such a strong track record with CMS, we are disappointed the Department of Justice would pursue this path."
The following Kaiser affiliates are named in the lawsuits: Kaiser Foundation Health Plan, Kaiser Foundation Health Plan of Colorado, The Permanente Medical Group, Southern California Permanente Medical Group and Colorado Permanente Medical Group.