California HMO Kaiser Permanente has agreed to pay $3.75 million to resolve allegations that several of its California units submitted false bills to the federal government for treatment of Medicare and Medi-Cal patients, officials announced Thursday.
The U.S. attorney's office in San Francisco contended that from 1996 through 2002, Kaiser units in California submitted bills that falsely claimed treatment had been provided by teaching physicians. In fact, the government said, the care had been provided by unsupervised residents.
Standards require that teaching physicians be present when residents render care to maintain quality, the government said. Payment rules require providers to record the presence of teaching physicians in patients' records in order to bill for services rendered by residents.
In a statement, Kaiser described the problem as a record-keeping issue.
Kaiser said it "discovered and voluntarily disclosed that it had not maintained the specific documentation required in order to be paid by Medicare or Medi-Cal for services performed by medical residents.
"Kaiser Permanente disclosed the insufficient payment documentation to the federal and state governments in 2005, after the shortcomings were revealed through an internal review."
It is not the first time Kaiser has been sanctioned over submitting false bills to the government. In 2005, Kaiser's Hawaii units were assessed $1.9 million in fines for submitting bills to Medicare and Medicaid for dermatology treatments that the government said were provided by an employee who was not a licensed physician's assistant.
Kaiser claimed the employee failed to stay up to date with state licensing requirements.
The Kaiser units involved in the California case are Kaiser Foundation Hospitals, Kaiser Foundation Health Plan Inc., Permanente Medical Group and Southern California Permanente Medical Group.