BEVERLY HILLS, CALIFORNIA, UNITED STATES, August 12, 2021 /EINPresswire.com/ — The federal government has joined in on several lawsuits accusing health care giant Kaiser Permanente of Medicaid overbilling in its Medicare Advantage managed-care plans. Medicare Advantage, also known as Medicare Part C, is a program that allows patients to enroll in privately-run managed care plans while receiving Medicaid benefits. CMS pays those privately-run managed care plans a fixed fee per patient depending on that patient’s “risk score.” A risk score is determined by several factors including a patient’s personal information and their diagnosis.
Since 2013, six whistleblower lawsuits have been filed in the Northern District of California against the health care company. The cases, which have been consolidated by the court, are United States ex rel. Osinek v. Kaiser Permanente, 3:13-cv-03891 (N.D. Cal.); United States ex rel. Taylor v. Kaiser Permanente, et al., 3:21-cv-03894 (N.D. Cal.); United States ex rel. Arefi, et al. v. Kaiser Foundation Health Plan, Inc., et al., 3:16-cv-01558 (N.D. Cal.); United States ex rel. Stein, et al. v. Kaiser Foundation Health Plan, Inc., et al., 3:16-cv-05337 (N.D. Cal.); United States ex rel. Bryant v. Kaiser Permanente, et al., 3:18-cv-01347 (N.D. Cal.); and United States ex rel. Bicocca v. Permanente Med. Group, Inc., et al., No. 3:21-cv-03124 (N.D. Cal.).
The lawsuits claim that the fraudulent upcoding has been going on since 2009. The whistleblowers argue in their complaints that Kaiser Permanente knowingly pressured some of its doctors to input diagnosis codes that increase a patient’s “risk score.” In some instances, doctors were urged to create addenda to a patient’s chart months, even up to a year, after their visit in order to boost the risk score higher. The addenda would often reflect a diagnosis or condition that the patient likely did not have.