Kaiser Permanente Agrees to Pay $556 Million to Settle Medicare Overbilling Claims
The New York Times • • business
Key Points:
- Kaiser Permanente agreed to pay $556 million to settle federal lawsuits alleging fraudulent overbilling in its Medicare Advantage plans, marking the largest settlement in a Medicare Advantage case to date.
- The lawsuits, filed over a decade ago, accused Kaiser of overstating patient illness severity to receive higher government payments.
- The Justice Department revealed that Kaiser executives pressured doctors to add numerous diagnoses after patient treatments, inflating payments through bonus funds tied to sicker patient profiles.
- Kaiser did not admit wrongdoing as part of the settlement, while government officials emphasized the need to protect Medicare Advantage from fraud and ensure it serves patients rather than corporate profits.
- Medicare Advantage plans, which cover over half of eligible government health coverage recipients, have faced ongoing scrutiny and multiple
