Kaiser plans pay $556M to settle Medicare upcoding allegations
By 
Adrianne Appel2026-01-16T17:49:00
Kaiser Health affiliates have agreed to pay more than $556 million to settle allegations originally made by whistleblowers that they ignored compliance department warnings and unlawfully reworked diagnoses for Medicare patients in order to receive higher payments from the federal government.
Two former physician employees of Kaiser plans alleged in 2013 and 2014 qui tam “whistleblower” lawsuits that, since 2009, five Kaiser plans, in California and Colorado, had engaged in a widespread, intentional scheme to defraud the government by purposefully padding their bills to Medicare.
THIS IS MEMBERS-ONLY CONTENT
You are not logged in and do not have access to members-only content.
If you are already a registered user or a member, SIGN IN now.
Related articles
-
ArticleOwner of medical supply company faces 35 years for alleged false claims, kickbacks
The owner of a medical supply company allegedly billed federal health programs $30 million for items that were unnecessary and tainted by kickbacks, according to the Department of Justice (DOJ).
-
ArticleFormer CEO of online health company ordered to pay $452M for nearly $2B in fraud
The former founder and chief executive of a health internet company will spend 15 years in prison and pay $452 million after being found guilty of a sprawling scheme that sought about $1.9 billion in false payments from Medicare, according to the U.S. Department of Justice.
-
News BriefHospitals, health IT face HHS crackdown for blocking electronic records
The Department of Health and Human Services is stepping up its enforcement against hospitals and other health entities that block the sharing of electronic health records.
More from Regulatory Enforcement
-
ArticleFalse Claims Act enforcement themes for 2026
The U.S. Department of Justice touted a record $6.8 billion in False Claims Act (FCA) recoveries in fiscal year 2025, much of that total stems from prior years’ cases and does not necessarily reflect the administration’s current enforcement direction.
-
ArticleFederal jury convicts former coal executive in Egypt-linked coal FCPA case
A former vice president of an American coal company was convicted by a federal jury for his part in an international bribery and money laundering scheme. The conviction represents an anomoly in the Trump administration’s handling of Foreign Corrupt Practices Act (FCPA) cases launched under former President Joe Biden.
-
ArticleU.K. financial regulator cuts cases to focus on investigations that achieve results
The U.K. financial regulator has dropped 100 investigations without action over the past three years, but compliance should expect a refocus of resources rather than a retreat from enforcement.