Kaiser Medicare Fraud Whistleblower Qui Tam Lawsuit

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.

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. 

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. 

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 Kaiser would get paid from Medicare.  

Submitting claims based on unsupported add-ons is a violation of Medicare rules. 

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. The problem is expected 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. 

Gibbs Mura, A Law Group 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 over a billion 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.”