Kaiser Foundation Health Plan Inc. penalized $1.9 million for improper Medicare claims

Kaiser penalized $1.9 million
Pacific Business News
April 15, 2005

The U.S. and state attorneys general have penalized Kaiser Foundation Health Plan Inc., Kaiser Foundation Hospitals and the Hawaii Permanente Medical Group $1.9 million for making improper Medicare and Medicaid claims.

Kaiser was penalized $1 million for submitting false federal Medicare claims and $900,000 for improper state Medicaid claims.

A Kaiser employee claimed that an employee in the dermatology department had treated patients without a required state license between May 1984 and December 2001, which was confirmed by the Medicaid Fraud Control Unit, state Attorney General Mark Bennett announced Thursday.

The state said the employee who provided the treatment wasn't a licensed physician's assistant although Kaiser billed the state Medicaid program for the services provided.

The state also found that Kaiser failed to properly supervise the treatments, although the investigation didn't reveal any evidence of improper care, substandard treatment or injury to Kaiser patients.

"We take regulatory compliance very seriously at Kaiser Permanente and we regret the mistake," said Jan Head, Kaiser president.

Kaiser says the inaccurate billings to Medicare and Medicaid occurred after the state created a certification requirement for physician assistants and that the dermatology assistant practiced at Kaiser prior to the change and failed to obtain a license after the requirement went into effect.

The whistle-blowing employee filed suit in federal court under the federal and state false claims act and will receive $225,000 of the $900,000 for informing the state.

The Medicaid program will receive $115,379 for claims made based on service provided by the unlicensed service provider and the Medicaid Investigations Recovery Fund will receive $559,621 that will be used to pay for future investigations.