Kaiser MA plan agrees to pay $6M to DOJ to settle false claims allegations


Kaiser Basis Well being Plan of Washington agreed to pay the federal authorities $6.three million to settle allegations it submitted invalid Medicare and Medicare Benefit diagnoses and acquired increased funds.

The settlement introduced Tuesday closed a whistleblower lawsuit regarding the Washington-based Medicare Benefit plan previously often called Group Well being Cooperative.

“America depends on Medicare Benefit Organizations to submit correct analysis information to Medicare to make sure that the compensation they obtain is acceptable,” stated Assistant Legal professional Common Jeffrey Bossert Clark in a press release. “We are going to proceed to pursue those that undermine the integrity of the Medicare program and the information it depends upon.”


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The lawsuit’s allegations date again to 2010.

RELATED: Kaiser takes prime spot in MA satisfaction rankings

A former billing supervisor Teresa Ross alleged that the well being plan upcoded threat adjustment claims submitted to Medicare by claiming {that a} affected person was handled for a analysis they didn’t have or a analysis that was extra extreme than the one that they had, in accordance with a authorized submitting.

The plan additionally didn’t appropriate the chance adjustment claims although executives knew the claims have been false, the lawsuit stated.

The lawsuit argued the strikes have been made to recoup monetary losses for the plan.

Kaiser acquired Group Well being Cooperative, which has greater than 651,000 members, in 2017.



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