The Department of Justice, Office of Public Affairs released a notice on Jan. 14, 2026 stating that the government had entered into a settlement with Kaiser Permanente, et al for false claims related to HCC coding. The government contended that Kaiser had overbilled CMS by a billion dollars over a nine-year period. Kaiser agreed to pay the government $558 million dollars for claims submitted during this time period related to its joint function as a Medicare Advantage Organization (MAO) and health care provider.  It should be noted that the notice from the DOJ states “The claims resolved by the settlement are allegations only and there has been no determination of liability.”

• The investigation was the result of whistleblowers
• When you read the quotes from the complaint, it’s clear that the government didn’t think these were simple diagnosis coding errors
• Taken with OIG reports of audits of MAO organizations, it’s a blueprint of mistakes and practices to avoid in order to compliantly report diagnoses in risk-based contracts