Kaiser Whistleblower Qui Tam Lawsuit
Gibbs Law Group was the first to file a whistleblower qui tam suit with particular allegations against Kaiser Permanente for defrauding Medicare and pocketing more taxpayer money than it was fairly entitled to. After an investigation into claims made by our whistleblower client and others, we are pleased to announce that both the Attorney General’s office and the Department of Justice have elected to intervene in this litigation, bringing it from under seal into the public record.
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Kaiser Qui Tam Lawsuit: What is Qui Tam?
If a person has knowledge of fraud against the federal government, they can become whistleblowers and file a qui tam lawsuit for the government’s losses under the False Claims Act. These whistleblowers are known as “relators,” and they may receive a portion of the amount ultimately recovered as a reward for bringing the claim. The False Claims Act requires a relator to file their lawsuit under seal, giving the government an opportunity to investigate the allegations and decide whether to intervene.
Gibbs Law Group files qui tam suit alleging Kaiser fraudulently inflated Medicare claims
Filed August 22, 2013, our relator’s complaint alleged that Kaiser Permanente engaged in a sophisticated scheme to bill Medicare for fraudulent claims. The relator, a certified medical coder who trained Kaiser physicians on coding guidelines, outlined Kaiser’s process of pressuring physicians to retroactively amend patient medical records to add in or change diagnoses to higher value conditions that weren’t actually made or considered at the time of treatment. This practice allowed Kaiser to improperly inflate their claims submitted to Medicare, resulting in increased revenue. For example, Kaiser prompted physicians to addend their notes months after a patient visit to change their diagnosis from “diabetes without complications” to an unsubstantiated “diabetes with mixed hyperlipidemia,” allowing Kaiser to receive greater compensation. Submission of claims based on unsubstantiated addenda is a clear violation of Medicare rules.
The United States is to file its consolidated complaint by October 25, 2021.
As private Medicare Advantage plans expand, government finds billions in improper payments
According to news reports by Axios, the US government estimates billions of dollars of taxpayer money are being stolen by private insurers from Medicare and the problem is expected to grow over time. In 2017 alone, the Centers for Medicare & Medicaid Services estimated there were $14.4 billion in improper payments from the federal government.
Even when the government announces its intent to merely audit Medicare claims for impropriety, public comment letters show insurance lobbyists have objected vigorously. (According to Axios, insurance companies list audits of their Medicare claims by the federal government as a top “risk factor” to their profits when reporting to their investors.)
In addition to Kaiser, Axios reports the US government has also probed or filed lawsuits against other large insurance companies like Anthem, Humana, UnitedHealth, and Sutter Health for improper coding in Medicare claims.
If you have knowledge of Medicare fraud, you can help end theft of taxpayer money by coming forward. Our whistleblower attorneys can help evaluate your claims and enforce your right to protection from retaliation.
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