Feds Intervene in Medicare Advantage Lawsuits

application-black-and-white-bw-care-checking-checklist-1571505-pxhere.com (1).jpg

The United States intervened in six complaints alleging that members of the Kaiser Permanente consortium violated the False Claims Act by submitting inaccurate diagnosis codes for Medicare Advantage plan enrollees in order to receive higher reimbursements. Kaiser allegedly pressured physicians to create addenda to medical records after patient encounters, often months or over a year later, to add diagnoses that patients did not actually have and/or were not actually considered or addressed during the encounters. Read a story from The Associated Press and a Department of Justice press release. 


SMP Resource Center products often contain links to copyrighted material. The SMP Resource Center is providing these links as a convenience and for informational purposes in our efforts to report and educate on Medicare fraud; they do not constitute a guarantee, endorsement, or approval by SMP of any of the information available on the external site. SMP bears no responsibility for the accuracy, legality, or content of the external site or for that of subsequent links. If you have any questions or concerns about the links provided, please contact the SMP Center at nliebau@smpresource.org