Kaiser Permanente has agreed to pay $3.75 million in settlement of claims that it falsely billed Medicare and Medi-Cal.  The announcement was made in early December by U.S. Attorney Joseph P. Russoniello in San Francisco.

In a press release, Russoniello stated that Kaiser falsely billed for services provided by housestaff rather than the attending physicians. “The government alleges that, from 1996 through 2002, Kaiser falsely reported that services had been provided by teaching physicians when in fact the services were provided by resident physicians without the supervision of teaching physicians. Teaching physicians must be physically present during key portions of services rendered by residents in order to insure that patient care meets a certain level of quality.” The U.S. attorney went on to say that the medical record must document that the teaching physician was present “in order to bill for that type of service.”

In a December 3 press release, the U.S. Attorney’s office noted that Kaiser voluntarily disclosed the misconduct to the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) in San Francisco, pursuant to the voluntary self-disclosure protocol of HHS-OIG. “The self-disclosure protocol is intended to resolve matters that, in the provider’s self-assessment, potentially violate federal criminal, civil or administrative laws. It is an effective government tool for combating healthcare waste and abuse without litigation. The disclosing entities are Kaiser Foundation Hospitals, Kaiser Foundation Health Plan, Inc., The Permanente Medical Group and Southern California Permanente Medical Group.”

According to the San Francisco Chronicle, $3.4 million of the settlement will go to the federal government and $350,000 will go to the state of California.