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The US Government joined six whistleblower cases against Kaiser.
Kaiser is charged with systematically defrauding Medicare for over 10 years, exposing Kaiser to $3 billion in damages and penalties.
Kaiser lied about nearly 50,000 nonexistent diagnoses to submit $1 billion in fraudulent claims. The Department of Justice announced they would seek treble damages (up to three times in damages).
Allegations show that Kaiser up-coded the severity of their patients' medial conditions. Kaiser claims that, “our policies and practices represent well-reasoned and good faith interpretations of sometimes vague and incomplete guidance from CMS.”
In one case a doctor allegedly diagnosed a patient with high blood pressure only to be told by a Kaiser employee six months later to add diagnoses of aortic atherosclerosis emphysema and prostate cancer [United States v. Kaiser, No. CR11-0107 (N.D. Iowa Aug. 30, 2013)].
The government charged that, “wrongful acts that defraud the program cannot continue and will be pursued.”
Commentary:
This is a breakthrough monster Medicare fraud case. In the past the government targeted small practitioners. This case will make history.
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