Oakland, CA based Kaiser Foundation Health Plan has agreed to pay $6.3 million to settle allegations that it submitted false Medicare Advantage patient diagnoses in order to receive inflated payments from Medicare.
Under the Medicare Advantage program, Medicare pays private insurers based on the cost of providing care for all recipients enrolled in their plans. Generally, patients with worse or more numerous diagnoses result in larger payments while healthier patients result in smaller payments.
The suit was brought by a former employee of Kaiser Health foundation. She will receive $1.5 million for her role in the settlement.
Read the full press release here: https://www.justice.gov/opa/pr/medicare-advantage-provider-pay-63-million-settle-false-claims-act-allegations