Kaiser Foundation MA Plan to Pay $6.3M to Settle False Claims Allegations.

The alleged violations occurred in 2011 and 2012, before Group Health Cooperative was acquired by Kaiser Permanente.

Oakland-based Kaiser Foundation Health Plan of Washington will pay $6.3 million to settle whistleblower allegations that the Medicare Advantage plan knowingly up-coded beneficiaries' diagnoses to get more money from Medicare, the Department of Justice said.

Assistant Attorney General Jeffrey Bossert Clark of DOJ's Civil Division said the practice of up-coding "undermines the integrity of the program."

"The United States relies on Medicare Advantage Organizations to submit accurate diagnosis data to Medicare to ensure that the compensation they receive is appropriate," he said.

The settlement resolves allegations that the MA plan, formerly known as Group Health Cooperative, brought forward in a whistleblower suit by former employee Teresa Ross, who will get $1.5 million of the recovery money.

Kaiser Responds

Kris Greco Thompson, vice president of public relations, communictions, and brand mamagement, at Kaiser Permanente, said the alleged violations occurred, in 2011 and 2012, before it acquired Group Health Cooperative. 

"Kaiser Permanente, which acquired Group Health in 2017 after this investigation was launched and conducted, has a history of commitment to compliance in this area," Greco Thompson said.

"We've fully cooperated with the Department of Justice throughout this entire process and have agreed to a settlement to resolve the outstanding civil claims, as we believe Group Health submitted its data in good faith and in reliance on recommendations by its contracted risk adjustment vendor, which purported to be an expert in this area. Under the settlement, Kaiser Foundation Health Plan of Washington has made no admission of liability and denies the allegations," she said.