Kaiser's Cruel Calculation: A Decade of Denial

Kaiser Permanente was accused of systematically altering patient medical records to inflate risk-adjustment payments from Medicare Advantage, allegedly obtaining around $1 billion in improper payments.

The U.S. Department of Justice (DOJ) intervened in the False Claims Act lawsuit in 2021, alleging that Kaiser retrospectively added diagnoses unrelated to patient visits. Physicians reported being pressured to add false diagnoses to patient records to boost payments. CMS stated it would not have made these payments had it known the diagnoses were unrelated to actual care provided.

Kaiser's fraudulent billing practices defraud both the state and vulnerable Medicare beneficiaries.

Kaiser Permanente agreed to a $200 million settlement after failing to provide timely mental health care, violating California's mental health parity laws.

The California Department of Managed Health Care (DMHC) found that Kaiser canceled over 111,000 behavioral health appointments during a worker strike in 2022, affecting nearly 64,000 patients. Complaints about delayed access to mental health care rose by 20% between 2020 and 2021. The settlement included a $50 million fine and a $150 million investment in mental health services.

Kaiser's failure to provide timely mental health care put thousands of patients at risk.

A nurse won a $41 million verdict after claiming she was fired for raising concerns about understaffing and patient safety at a Kaiser hospital in Woodland Hills, California.

The jury awarded $11.5 million in compensatory damages and $30 million in punitive damages for wrongful termination and retaliation. Testimony revealed systemic understaffing and failures to address patient safety issues raised by the nurse. Kaiser sought mediation post-verdict but faced significant negative publicity.

Kaiser's hostile environment for whistleblowers allowed fraudulent and unsafe practices to continue unchecked.

Patients alleged that Kaiser Permanente shared personal health information with third parties like Google and Microsoft without consent, violating HIPAA and state privacy laws.

Tracking codes on Kaiser's website and apps allowed unauthorized sharing of sensitive data with tech companies. Plaintiffs claimed breaches of implied contract and negligence under consumer protection laws in multiple states. The lawsuit is part of broader litigation against healthcare providers for using tracking software.

Kaiser's unauthorized data sharing practices breached patient trust and violated privacy laws.

Kaiser Permanente settled two class-action lawsuits for $18.9 million over allegations of racial discrimination against Black and Latinx employees.

Black employees received $11.5 million for claims of unequal pay and lack of advancement opportunities. Latinx employees were awarded $7.4 million for similar claims, including disproportionate assignment to lower-paying positions. Kaiser agreed to implement workplace reforms, including pay equity reviews and career development programs.

Kaiser's discriminatory practices hindered career growth and perpetuated wage gaps among minority employees.

A young woman won a $28.2 million verdict after a delayed cancer diagnosis led to the loss of her leg, part of her pelvis, and spine due to Kaiser's failure to perform an MRI promptly.

The delay was deemed medical negligence by the court. Testimony revealed that timely imaging could have prevented the catastrophic outcome. This case highlights systemic issues with Kaiser's diagnostic practices.

Kaiser's negligence in diagnostics resulted in life-altering consequences for patients.

Multiple lawsuits have alleged substandard care at skilled nursing facilities operated by Kaiser Permanente or its affiliates, leading to patient harm or death.

Families reported neglect, poor staffing ratios, and delayed medical interventions. One case involved a wrongful death claim where inadequate monitoring led to fatal complications. These cases have drawn attention to Kaiser's oversight of long-term care facilities.

Kaiser's negligence in long-term care facilities resulted in preventable patient harm and fatalities.

Whistleblowers alleged that Kaiser Permanente submitted false diagnosis codes for conditions like sepsis and malnutrition to inflate Medicare reimbursements. These allegations suggest a broader scheme across multiple regions.

The Ninth Circuit consolidated related cases into a single action against Kaiser Foundation Health Plan. Allegations included improper financial incentives for physicians to add unsupported diagnoses, increasing Medicare Advantage payments unjustly.

Kaiser's upcoding practices inflated Medicare reimbursements, defrauding the government and taxpayers.

A nurse’s testimony about a botched delivery where a mother was denied a requested C-section played a key role in her retaliation lawsuit against Kaiser Permanente.

The incident highlighted systemic failures in Kaiser's obstetrics practices. Testimony revealed unsafe staffing levels contributed to poor outcomes. This case became emblematic of broader concerns about patient safety at Kaiser hospitals.

Kaiser's obstetrics failures endangered mothers and infants, showcasing critical patient safety issues.

In March 2018, a Northern California man died from pneumonia complicated by MRSA after being misadvised by Kaiser Permanente staff over the phone instead of being directed to an ER.

Kaiser's nurse and doctor failed to recognize the severity of his symptoms during phone consultations. By the time he was admitted, his infection had progressed too far for treatment. His family was awarded nearly $3 million for medical malpractice.

Kaiser's negligence in emergency response protocols led to preventable death.