United States ex rel. Osinek v. Kaiser Permanente et al.

Docket No.
3:13-cv-03891
District Court
California Northern

Goal

  • Award damages

Issues

This case has been consolidated with five other lawsuits filed by former employees against Kaiser Permanente. The other five cases are: United States ex rel. Stein et al. v. Kaiser Foundation Health Plan, Inc. et al. (3:16-cv-05337); United States ex rel. Arefi et al. v. Kaiser Foundation Health Plan, Inc. et al. (3:16-cv-01558); United States et al. ex rel. Bicocca v. Permanente Medical Group, Inc. et al. (3:21-cv-03124); United States et al. ex rel. Bryant et al. v. Kaiser Permanente et al. (3:18-cv-01347); and United States ex rel. Taylor v. Kaiser Permanente et al. (3:21-cv-03894). The Department of Justice partially intervened in the consolidated case. Although the cases were consolidated, claims in three of the five cases were largely or entirely dismissed. All post-consolidation filings are included on this case page.

Why This Matters:

Why This Matters: 

Former employees, joined in part by the Department of Justice, filed a whistleblower lawsuit against a group of Medicare Advantage organizations, alleging that these organizations violated the False Claims Act by submitting inaccurate, incomplete, unsupported, or otherwise false diagnosis codes for Medicare Advantage enrollees. The employees and Department of Justice allege that the defendants submitted this false information – otherwise known as upcoding – to improperly obtain millions of dollars in overpayments from the Medicare program.

Potential Impact:

Potential Impact:

In 2026, the parties entered into a settlement where the Medicare Advantage organization and its subsidiaries agreed to pay more than $550 million to resolve these allegations and to implement other corrective measures. Ensuring accurate compensation for Medicare Advantage organizations prevents fraud, protects taxpayer dollars, and keeps health care costs low for patients.

159 Major Filings

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Related Litigation

Current Status

Case Dismissed

Legal Issues

False Claims Act

Topic(s)

Coding Practices

Date Filed
August 22, 2013
Case Type
Civil
Court Type
District Court
Court
California Northern
Judge
Chen, Edward M. Appointed By: Barack Obama
Plaintiff(s)
Ronda Osinek
Lead Counsel For Plaintiff(s)
Gibbs Law Group LLP
Intervenor Plaintiff(s)
United States
Defendant(s)
Kaiser Permanente; Kaiser Foundation Health Plan Inc.; The Permanente Medical Group Inc.
Lead Counsel for Defendant(s)
K. Lee Blalack II