July 29, 2021

Kaiser Permanente disputes risk adjustment allegations

We are confident in our compliance with Medicare Advantage risk adjustment program requirements.

Kaiser Permanente’s mission is to provide high-quality, affordable health care services to improve the health of our members and the communities we serve.  

We are confident that Kaiser Permanente is compliant with Medicare Advantage program requirements and we intend to strongly defend against the lawsuits alleging otherwise.   

Our medical record documentation and risk adjustment diagnosis data submitted to the Centers for Medicare & Medicaid Services comply with applicable laws and Medicare Advantage program requirements. Our policies and practices represent well-reasoned and good-faith interpretations of sometimes vague and incomplete guidance from CMS. For nearly a decade, Kaiser Permanente has achieved consistently strong performance on Risk Adjustment Data Validation audits conducted by CMS. With such a strong track record with CMS, we are disappointed the Department of Justice would pursue this path.  

While Kaiser Permanente plans to vigorously defend against these allegations, we will not allow this litigation to distract from our mission. Our dedicated health care teams will remain focused on continuing to provide our patients and members with leading-edge treatment, prevention, and the whole-person care that is the cornerstone of our integrated health system.