Allegations related to Medicare risk adjustment resolved

Kaiser Permanente has reached a settlement agreement with the U.S. Department of Justice to resolve a dispute regarding certain documentation practices impacting some Medicare Advantage risk adjustment submissions between 2009 and 2018. The agreement resolves a False Claims Act lawsuit and has no admission of wrongdoing or liability. We chose to settle to avoid the delay, uncertainty, and cost of prolonged litigation.

Multiple major health plans have faced similar government scrutiny over Medicare Advantage risk adjustment standards and practices, reflecting industrywide challenges in applying these requirements. The Kaiser Permanente case was not about the quality of care our members received. It involved a dispute about how to interpret the Medicare risk adjustment program’s documentation requirements.

We remain unwavering in our mission to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve.