Diagnoses for Dollars: Kaiser Pays Up
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By
January 15, 2026
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5 min
Kaiser Permanente has agreed to a historic $556 million settlement over allegations of fraudulent Medicare Advantage billing practices. The Justice Department's investigation revealed that the company overstated patient illnesses to increase payments, resulting in about $1 billion in improper claims from 2009 to 2018. U.S. Attorney Craig Missakian emphasized the need to protect Medicare from fraud. The civil suits, initiated by multiple whistleblowers, highlight ongoing issues within Medicare Advantage plans regarding patient diagnosis inflation.
1. Kaiser Permanente agreed to a $556M settlement for Medicare fraud. 2. Allegations included upcoding practices from 2009-2018. 3. Six whistleblowers were involved in the case. 4. The settlement does not admit wrongdoing by KP. 5. Medicare Advantage has grown to 34M enrollees. 6. U.S. Attorney stresses the impact of fraud on taxpayers. 7. Reports of similar practices by other insurers are emerging.
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