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Signaling a watershed moment in the government’s enforcement efforts against fraud on the Medicare Advantage program, the U.S. Department of Justice announced that it is joining, in part, whistleblower lawsuits brought under the False Claims Act against Kaiser Permanente and its affiliates, one of the nation’s largest managed care groups. The lawsuits in which the DOJ has intervened include six different cases brought by ten whistleblowers, including United States ex rel. Bryant v. Kaiser Permanente, et al. Goldberg Kohn principal Roger Lewis serves as counsel in this case, proudly representing two brave whistleblowers (Bryant and Hernandez) who witnessed a fraud on the Medicare Advantage program by their then-employer Kaiser. The DOJ is expected to file a complaint-in-intervention by late October.

The lawsuits allege that Kaiser Permanente and their various affiliates defrauded Medicare by submitting diagnosis codes for patients that were unsupported by the medical record, thereby falsely inflating Kaiser's risk adjustment payments from the government. 

The government's intervention in these important cases is worth watching as it signals a widespread pattern of fraud within the Medicare Advantage program, and sends a clear message that health care providers and plans will be held accountable if they seek to gain an advantage by submitting false information.

To learn more about the government’s intervention in this lawsuit, please view the related news items below: