Kaiser to pay $3.75M to resolve false claim allegations

Four Kaiser Permanente health care entities in California have agreed to pay the government about $3.75 million to resolve allegations of false Medicare and Medicaid payment claims, the U.S. Justice Department announced this week.

U.S. Attorney Joseph Russoniello of San Francisco said the government alleged that from 1996 to 2002, the Kaiser entities reported that certain services were provided by teaching physicians when in fact the services were provided by medical residents without the supervision of teaching doctors.

Russoniello said teaching physicians must be present during key portions of services provided by residents to ensure the quality of patient care and the senior doctors' presence must be reflected in patient records for purposes of Medicare and Medicaid billing.

The four entities, all part of or affiliated with Oakland-based Kaiser Permanente, are Kaiser Foundations Hospitals Inc., Kaiser Foundation Health Plan Inc., and the Permanente Medical Group Inc., all of Oakland; and Southern California Permanente Medical Group, based in Pasadena.

Russoniello said Kaiser voluntarily disclosed the misconduct to the U.S. Department of Health and Human Services under a voluntary self-disclosure program created by the department's inspector general's
office.

Kaiser Permanente spokesman John Nelson said, “We are pleased to have reached this settlement, and will continue to work on behalf of our members to maintain the integrity and billing processes.”

Nelsons said Kaiser Permanente discovered insufficient payment documentation for residents' work during an internal review and disclosed the problem to the federal and state governments in 2005.

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