Kaiser Permanente Settles Medicare Fraud for $556 Million

Kaiser Permanente affiliates have agreed to pay $556 million to settle federal allegations of Medicare fraud involving inflated diagnoses in its Medicare Advantage plans, marking one of the largest such resolutions in the program's history.

The U.S. Department of Justice announced the settlement on Wednesday, resolving claims that stemmed from whistleblower complaints filed more than a decade ago and consolidated into lawsuits in San Francisco. The case targeted several Kaiser entities, including the Kaiser Foundation Health Plan, Kaiser Foundation Health Plan of Colorado, The Permanente Medical Group, Southern California Permanente Medical Group, and Colorado Permanente Medical Group. These groups form part of the Oakland, California-based nonprofit health system, which serves over 12 million members across dozens of medical centers nationwide.

Prosecutors alleged that from 2009 to 2018, Kaiser pressured physicians to add unsupported diagnoses to patient records, often months or even years after initial consultations, to boost reimbursements under Medicare Advantage, also known as Medicare Part C. This program allows beneficiaries to enroll in private managed care plans, with...