The US Department of Justice (DOJ) and Kaiser Permanente are currently in ongoing settlement negotiations regarding the Medicare fraud allegations in case 3:18-cv-01347-EMC (one of several consolidated whistleblower suits under the broader action United States ex rel. Osinek v. Kaiser Permanente, No. 3:13-cv-03891-EMC).

According to a Stipulation to Stay Proceedings filed by the parties on October 17, 2025, “the parties have made substantial progress in reaching an agreement to fully resolve Case Nos. 3:13-cv-03891-EMC, 3:18-cv-01347-EMC, and 3:21-cv-03894-EMC and wish to continue those discussions.”

And based on the stipulations of the parties “the parties jointly request the Court stay proceedings and all case deadlines for ninety (90) days to continue discussions regarding potential options for resolving the case and, to the extent the parties have not reached a resolution at the end of the stay, the parties agree to submit a revised Case Management Order for consideration by the Court on or before January 15, 2026.”

The federal judge granted a 90 day stay of the proceedings in the remaining three cases (out of an original six, with three dismissed of three of them due to an overlap).

The United States has intervened in six complaints pending in Northern California federal court, alleging that members of the Kaiser Permanente consortium violated the False Claims Act by submitting inaccurate diagnosis codes for its Medicare Advantage Plan enrollees in order to receive higher reimbursements. The Kaiser Permanente consortium members are headquartered in Oakland, California.

The six lawsuits were filed under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private parties to sue on behalf of the government and to receive a share of any recovery. The Act also permits the government to intervene in such lawsuits, as it has done here.

Ronda Osinek was the first-filed case and was followed by five other cases: Taylor, Arefi, Stein, Bryant, and Bicocca.The cases were consolidated in June 2021.

Osinek alleged that starting around 2007, Kaiser Permanente began a “scheme to upcode diagnoses to ensure Medicare payments for reimbursable, high-value conditions.” This was done was by use of data mining for high value cases, and then determining the diagnoses its doctors would need to make to support the Medicare reimbursement.

She then alleges that there is “an escalation process for physicians who do not agree with the data mining prompts”; “[p]hysicians will have to meet one-on-one with Data Quality Trainers if they refused to make diagnoses changes that are presented by data mining”; “physicians have personal report cards based on how they perform in certain areas [including response to refreshing and data mining prompts], which are tied to their compensation”; and there are “mandatory meetings called ‘coding parties,’ where physicians are gathered in a single room with computers and asked to review past progress notes for addenda related to revised medical diagnoses.”