Court Rules U.S.' Medicare Advantage Suit Against Kaiser Permanente May Move Forward
Highlights
A California federal court partially dismissed the government’s claims against Kaiser Permanente, but permitted claims based on sub-regulatory disease classification guidelines to proceed.
Kaiser is alleged to have violated the False Claims Act by submitting inaccurate diagnosis codes via addenda for its Medicare Advantage Plan enrollees to receive higher reimbursements.
The court held that both the Medicare Advantage Contract and the governing regulations require compliance with the coding guidelines.
The U.S. District Court for the Northern District of California determined that the United States’ claims against Kaiser Permanente for submission of inaccurate diagnosis codes via addenda may proceed. Although the court narrowed the scope of claims in the action, it determined that both Kaiser’s Medicare Advantage contract with the Centers for Medicare & Medicaid Services (CMS) and the governing federal regulations required Kaiser’s addenda to comply with the International Classification of Diseases (ICD) coding guidelines.
Keep Up to Date in a Changing World
