Column: The government lawsuit against Kaiser points to a massive fraud problem in Medicare [Los Angeles Times (CA)]
Anthem, Inc. (ANTM)
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Source: Los Angeles Times
For the better part of a decade, a time bomb has been ticking at Oakland-based Kaiser Permanente — an accumulation of allegations that the giant health plan systematically defrauded Medicare by overstating the severity of its patients’ medical conditions. On July 30, the bomb detonated. That’s when the Department of Justice joined six lawsuits filed by Kaiser employees since 2013 asserting that they witnessed the alleged fraud. The government’s action instantly brought those lawsuits, which had been filed under seal in federal court in San Francisco, into the daylight. Taken together they allege wrongdoing on a stunning scale; plaintiffs’ lawyers involved in the cases say hundreds of millions of dollars in penalties and damage claims may be at stake. Medicare Advantage organizations...have some incentive to improperly inflate their enrollees’ capitation rates, if these organizations fall prey to greed. U.S. Magistrate Laurel Beeler At this stage, none of the allegations has been prove
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