Kaiser Foundation Health Plan Will Pay $6.3 Million to Settle Medicare Advantage Fraud Allegations, Whistleblower Will Receive $1.5 Million

Kaiser Foundation Health Plan Will Pay $6.3 Million to Settle Medicare Advantage Fraud Allegations, Whistleblower Will Receive $1.5 Million

Kaiser Foundation Health Plan’s Washington subsidiary (formerly Group Health Cooperative) has agreed to pay $6,375,000 to resolve allegations that it claimed patients were sicker than they were and billed a government health program for nonexistent conditions.

Based in Seattle, Group Health Cooperative (GHC) was founded in 1947 and has been often characterized as a respected nonprofit health insurance plan. Kaiser Permanente acquired the company in 2015.

GHC allegedly defrauded Medicare Advantage (MA) in an attempt to reverse financial losses endured between 2008 and 2010 due to “poor business decisions by company management.”...

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