Members of Kaiser Permanente’s health-care consortium defrauded Medicare out of about $1 billion by altering patient medical records to add diagnoses after the fact that either didn’t exist or were unrelated to patient visits, the Department of Justice alleges, per Bloomberg reporting.
In a complaint filed Monday, the DOJ said Kaiser mined the medical files of Medicare Advantage patients for additional diagnoses and then sought to have the physician add the new diagnoses to the medical records retrospectively using an addendum, as if the new diagnoses had been addressed in some way during the patient visit when it had not.
“The driver was money: so that Kaiser could submit these improper diagnoses to CMS for payment,” attorneys with the department said in the filing. Read more.
