Kaiser Foundation Health Plan allegedly knowingly submitted diagnoses that were not supported by the beneficiaries’ medical records to increase the monthly payments it is receiving from Medicare.
A whistleblower filed a lawsuit against K
aiser Foundation Health Plan
The settlement resolves allegations in a lawsuit filed by a whistleblower, Teresa Ross against Kaiser Foundation Health Plan. She filed the case under the qui tam, provisions of the False Claims Act, which allows private parties to sue on behalf of the government over fraudulent claims for government funds such as Medicare. The law also permits a whistleblower to receive a share of any recovery of funds from the defendant. Ross will receive approximately $1,500,000 from the settlement.
In a statement, DOJ Civil Division Assistant Attorney General Jeffrey Bossert Clark said, “The United States relies on Medicare Advantage Organizations to submit accurate diagnosis data to Medicare to ensure that the compensation they receive is appropriate. We will continue to pursue those who undermine the integrity of the Medicare program and the data it relies upon.”
The settlement resolves allegations in a lawsuit filed by a whistleblower, Teresa Ross against Kaiser Foundation Health Plan. She filed the case under the qui tam, provisions of the False Claims Act, which allows private parties to sue on behalf of the government over fraudulent claims for government funds such as Medicare. The law also permits a whistleblower to receive a share of any recovery of funds from the defendant. Ross will receive approximately $1,500,000 from the settlement.
In a statement, DOJ Civil Division Assistant Attorney General Jeffrey Bossert Clark said, “The United States relies on Medicare Advantage Organizations to submit accurate diagnosis data to Medicare to ensure that the compensation they receive is appropriate. We will continue to pursue those who undermine the integrity of the Medicare program and the data it relies upon.”
