DOJ intervenes in whistleblower litigation with Kaiser – Enterprise Insurance

The U.S. Justice Department announced Friday that it is intervening in six whistleblower lawsuits alleging that members of the Kaiser Permanente consortium violated the False Claims Act by providing inaccurate diagnostic codes for its Medicare Advantage Plan- Members submitted to receive higher refunds.

The department filed its lawsuit in the US District Court in San Francisco, United States. Ex rel. Osinek v. Kaiser Permanente et al.

The members of the Kaiser Permanente Consortium 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.

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

"Today's action sends a clear message that we will hold health care providers and plans accountable if they try to trick the system by providing incorrect information."

San Francisco-based whistleblower law firm Constantine Cannon LLP said in a statement that the whistleblower in the case, Dr. James M. Taylor, worked at Kaiser & # 39; s Colorado Permanente Medical Group, where he was Medical Director of Revenue Cycle / Claims and Physician Director of Coding.

The statement said that Dr. Taylor had "repeatedly suggested solutions internally". while on staff with Kaiser, "to address the issues described in his whistleblower complaint, but corrective actions were either ignored or briefly implemented by the organizations before Kaiser reverted to his previous behavior".

Kaiser issued a statement partially stating: "We are confident that Kaiser Permanente is eligible for the Medicare Advantage program and we intend to defend ourselves vigorously against lawsuits alleging contrary."

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