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Kaiser Permanente pays $1.8 million over billing flaws

By Joe Rojas-Burke, The Oregonian

November 12, 2009, 7:45PM
Kaiser Permanente's Oregon-based unit has agreed to pay $1.8 million to settle charges of false billing brought by the federal Medicare program.

The U.S. Justice Department said Kaiser's hospice program billed for services without obtaining written certifications of terminal illness required by federal regulations.

Kaiser Permanente said it voluntarily disclosed the billing errors to the government in 2005, when the company discovered the errors during an internal review.

"When we first noticed the billing error, we reported it and moved aggressively to improve our handling of paperwork," said Kaiser Permanente compliance officer Maryann Schwab, in a written statement Thursday. She said the company has put in place new procedures and auditing measures to prevent further billing errors.

Kaiser Permanente provides health care to about 470,000 people in Oregon and Southwest Washington. The billing errors occurred between 2000 and 2004, according to the government and the health plan.

Kaiser Permanente said that the hospice care was provided appropriately to patients who were terminally ill, but that the company failed to provide the required documentation.

Medicare hospice care providers must obtain written certifications of terminal illness for each hospice patient from the medical director of the hospice and the patient's attending physician, if the beneficiary has one. Medicare requires a hospice to obtain these certifications before billing.

"By requiring that health care providers comply with Medicare's standards, we ensure that beneficiaries receive hospice care that is medically necessary and meets appropriate medical standards," said Tony West, Assistant Attorney General for the Justice Department's Civil Division, in a written statement.

The case was handled by the Justice Department's Civil Division, the Acting U.S. Attorney for the District of Oregon and the Office of Inspector General of the Department of Health and Human Services.

Joe Rojas-Burke: 503-412-7073


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