In the largest Medicare Advantage fraud settlement to date, Kaiser Permanente has agreed to pay $556 million to settle Justice Department allegations that it billed the government for medical conditions patients didn’t have. (Shutterstock)
- The U.S. Labor Department reached a settlement with Kaiser Foundation Health Plan over investigations into its mental health and substance use disorder services.
- Kaiser agreed to pay at least $28 million to reimburse members for out-of-network care and a $2.8 million penalty to the federal government.
- The insurer also committed to policy reforms, including reducing appointment wait times and improving care review processes.
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Feb 10 – The U.S. Department of Labor said on Tuesday it has settled with Kaiser Foundation Health Plan to resolve multiple investigations into the company’s practices on mental health and substance use disorder services.
The agreement resolves allegations that Kaiser failed to maintain adequate provider networks for mental health and substance use disorder care, and improperly used patient responses to questionnaires to deny care, the Labor Department said in its statement.
“We have made many enhancements to our mental health care delivery system and acknowledge there is still work to be done to ensure our interventions and therapies are aligned with our members’ expectations and to ensure we achieve the best patient outcomes,” the company said in an emailed statement.
The settlement does not involve current practices or issues, the company added.
Under the settlement agreement, Kaiser will compensate at least $28 million for the costs its members incurred when seeking out-of-network mental health and substance use disorder services.
It will also pay a $2.8 million penalty to the federal government.
Kaiser has also agreed to reform company policies by reducing appointment wait times and improving care review processes to ensure members receive medically necessary care, according to the Labor Department.
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(Reporting by Sneha S K in Bengaluru; Editing by Vijay Kishore and Alan Barona)
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