The federal government intervened in six lawsuits alleging that Kaiser Permanente upcoded claims for Medicare Advantage beneficiaries, the Justice Department said Friday.
The Oakland, Calif.-based integrated health system allegedly pressured its physicians to augment medical records often months after the care was provided to boost its Medicare reimbursement. Doctors added risk-adjusting diagnoses that patients did not have or were not addressed, the lawsuits claim.
“The federal government pays hundreds of billions of dollars every year to Medicare Advantage Plans,” Matt Kirsch, acting U.S. attorney for the District of Colorado, said in prepared remarks. “The District of Colorado will vigorously pursue investigations with our partners to make sure that money supports necessary healthcare, not fraud.”
Kaiser said it is confident that the company is compliant with MA requirements and will defend itself against the lawsuits alleging otherwise, noting nearly a decade of “strong performance” on CMS’ risk adjustment audits.