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Kaiser Medicare Fraud
Case Overview
Whistleblower Qui Tam Lawsuits
Our team was the first to file a whistleblower qui tam suit with particular allegations against Kaiser Permanente. The lawsuit alleged that Kaiser defrauded Medicare, pocketing more taxpayer money than it was fairly entitled to.
Kaiser agreed to pay $566 million to resolve the case. Our whistleblower client will also receive a money reward.
We are experienced in handling whistleblowers cases in healthcare fraud, protecting and guiding whistleblowers through every step of the process.
If you’ve witnessed healthcare fraud, speak with our attorneys to learn more about your legal rights as a whistleblower.
Witness Medicare fraud by private insurers?
Speak with our whistleblower qui tam attorneys for a confidential evaluation of your claims.
$556 Million Settlement Reached in the Kaiser Medicare Fraud Whistleblower Lawsuit
On January 14, 2026, Kaiser Permanente agreed to pay $556 million to settle the lawsuit over alleged Medicare fraud, according to the U.S. Department of Justice.
This is proof that whistleblowers make a real difference, shining a light on healthcare fraud and safeguarding taxpayer dollars.
This is one of the largest recoveries ever involving claims that a Medicare Advantage company submitted false or misleading information to receive higher payments from Medicare.
What is the Kaiser “Qui Tam” Lawsuit?
If a person knows about fraud against the federal government, they can report it. They file a type of whistleblower lawsuit called a qui tam lawsuit, under the False Claims Act.
In these cases, the whistleblower who reports the fraud may receive a portion of any money the government wins back.
When the lawsuit is first filed, it is kept secret so the government has time to investigate and decide whether to join the case.
Our whistleblower attorneys filed a Kaiser whistleblower qui tam suit alleging Kaiser fraudulently inflated Medicare claims.
After investigating claims made by our whistleblower client and others, the Attorney General’s office and the Department of Justice decided to join this Kaiser Qui Tam lawsuit. The case is no longer secret and is now public.
Kaiser Medicare Fraud Explained: Whistleblowers Exposed Improper Billing Practices
The whistleblower, a certified medical coder who trained Kaiser physicians on coding guidelines, alleged that Kaiser pressured physicians to go back and change patient medical records. These changes added or adjusted diagnoses to higher value conditions that were allegedly never actually made or considered during the original treatment. This practice allegedly allowed Kaiser to improperly increase the amount billed to Medicare, which would then provide higher payments to Kaiser.
For example, the whistleblower lawsuit claimed that Kaiser encouraged physicians to add to their notes months after a patient visit and change their diagnosis from “diabetes without complications” to an unsupported “diabetes with mixed hyperlipidemia.” This change boosted how much Medicare would pay Kaiser.
Submitting claims based on unsupported add-ons is a violation of Medicare rules.
Kaiser Medicare Fraud Qui Tam Lawsuit News
August 22, 2013:
We filed our whistleblower’s complaint claiming that Kaiser Permanente engaged in a scheme to bill Medicare for false charges.
October 25, 2021:
The United States government filed its consolidated complaint. This combined lawsuit is created when multiple people file separate complaints for a similar issue on Kaiser.
January 14, 2026:
Kaiser Permanente agreed to pay $556 million to settle the lawsuit over alleged Medicare fraud.
Evidence Suggests Others Committed Medicare Fraud
As private Medicare Advantage plans grow, the government has found billions of dollars in improper payments to other private insurers as well.
According to 2025 news reports by Axios, federal officials uncovered healthcare fraud schemes involving over $14.6 billion in improper charges, including $10.6 billion in fraudulent healthcare claims submitted to Medicare.
This means that private insurers may be taking billions of taxpayer dollars from Medicare through improper billing. We expect the problem to grow over time.
When the government announces its plans to audit Medicare claims, insurance lobbyists strongly push back. Axios reported that insurance companies list audits of their Medicare claims as a major “risk factor” to their profits when speaking to their investors.
In addition to Kaiser, the US government has investigated or filed lawsuits against other major insurance companies like Anthem, Humana, UnitedHealth, and Sutter Health for improper coding in Medicare claims.
If you have information of Medicare fraud, you can help stop misuse of taxpayer money by coming forward. Our whistleblower attorneys can help evaluate your claims and protect your rights from retaliation.
Wynne represents consumers and investors, with a focus on representing plaintiffs harmed by financial fraud.
About Us
Gibbs Mura is a California-based law firm committed to protecting the rights of clients nationwide who have been harmed by corporate misconduct. We represent individuals, whistleblowers, employees, and small businesses across the U.S. against the world’s largest corporations. Our award-winning lawyers have achieved landmark recoveries and billions of dollars for our clients in high-stakes class action and individual cases involving consumer protection, data breach, digital privacy, and federal and California employment lawsuits. Our attorneys have received numerous honors for their work, including “Top Plaintiff Lawyers in California,” “Top Class Action Attorneys Under 40,” “Consumer Protection MVP,” “Best Lawyers in America,” and “Top Cybersecurity/ Privacy Attorneys Under 40.”
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If a person has knowledge of fraud against the federal government, they can become whistleblowers and file a qui tam lawsuit for the government’s losses under the False Claims Act. These whistleblowers are known as “relators,” and they may receive a portion of the amount ultimately recovered as a reward for bringing the claim. The False Claims Act requires a relator to file their lawsuit under seal, giving the government an opportunity to investigate the allegations and decide whether to intervene.
Gibbs Mura, A Law Group files qui tam suit alleging Kaiser fraudulently inflated Medicare claims
Filed August 22, 2013, our relator’s complaint alleged that Kaiser Permanente engaged in a sophisticated scheme to bill Medicare for fraudulent claims. The relator, a certified medical coder who trained Kaiser physicians on coding guidelines, outlined Kaiser’s process of pressuring physicians to retroactively amend patient medical records to add in or change diagnoses to higher value conditions that weren’t actually made or considered at the time of treatment. This practice allowed Kaiser to improperly inflate their claims submitted to Medicare, resulting in increased revenue. For example, Kaiser prompted physicians to addend their notes months after a patient visit to change their diagnosis from “diabetes without complications” to an unsubstantiated “diabetes with mixed hyperlipidemia,” allowing Kaiser to receive greater compensation. Submission of claims based on unsubstantiated addenda is a clear violation of Medicare rules.
The United States is to file its consolidated complaint by October 25, 2021.
As private Medicare Advantage plans expand, government finds billions in improper payments
According to news reports by Axios, the US government estimates billions of dollars of taxpayer money are being stolen by private insurers from Medicare and the problem is expected to grow over time. In 2017 alone, the Centers for Medicare & Medicaid Services estimated there were $14.4 billion in improper payments from the federal government.
Even when the government announces its intent to merely audit Medicare claims for impropriety, public comment letters show insurance lobbyists have objected vigorously. (According to Axios, insurance companies list audits of their Medicare claims by the federal government as a top “risk factor” to their profits when reporting to their investors.)
In addition to Kaiser, Axios reports the US government has also probed or filed lawsuits against other large insurance companies like Anthem, Humana, UnitedHealth, and Sutter Health for improper coding in Medicare claims.
If you have knowledge of Medicare fraud, you can help end theft of taxpayer money by coming forward. Our whistleblower attorneys can help evaluate your claims and enforce your right to protection from retaliation.
