nurse

Some employees called it the “dash for cash.”

Months after Kaiser Permanente doctors saw a patient, federal prosecutors said, administrators pushed the physicians to add new, false diagnoses to the medical record in a billion-dollar scheme to defraud the government. Kaiser in February paid $556 million to settle the allegations.

“Deliberately inflating diagnosis codes to boost profits is a serious violation of public trust,” said Scott Lambert, acting deputy inspector general for the U.S. Department of Health and Human Services.

Kaiser faced further scrutiny a month later when the nonprofit healthcare giant paid $30 million to settle another case brought by federal investigators, this one involving claims it had failed for years to provide patients with adequate access to mental health care.

Kaiser said it settled the fraud case without admitting wrongdoing. It said the mental health settlement did not involve its current practices.

Yet critics have pointed to the repeated legal payouts, saying they reflect how Kaiser has veered from its charitable mission in recent years and is now virtually indistinguishable from its for-profit competitors keenly focused on the bottom line.

That shift has also fueled recent tensions with its employees, who have complained about inadequate resources to address staffing shortages and patient delays.

“Their focus is on profit and in doing more with less,” said Kadi Gonzalez, a nurse who works in Kaiser’s obstetrics and gynecology clinic in Downey. Gonzalez was one of more than 30,000 nurses and other Kaiser professionals who walked out in a four-week strike that ended last month.

The unions said their strike was as much about staffing levels and patient safety as it was about wages.

“The more patients a nurse has, the higher the mortality rate,” Gonzalez said. “We don’t have enough providers.”

The Oakland-based giant insures almost 1 of every 4 Californians. It operates as both an insurer and a provider of care in a closed system that makes it difficult for patients to get treatment elsewhere.

Kaiser declined to make its executives available for comment, but issued a statement disputing the claims.

“Our charitable purpose guides every decision we make,” the statement said. “Driven by our mission, we offer better care and coverage to our members, invest billions of dollars in our communities every year, and work to advance high-quality, affordable, equitable, evidence-based care in communities across the country.”

The statement added that its hospitals are “among the best staffed in California” and that staffing levels always meet or exceed state requirements.

A surge in profits

Founded in 1945, Kaiser has long gained national attention for its managed care model and focus on preventative care.

The nonprofit says its mission is “to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve.”

The Kaiser system — the largest healthcare nonprofit in the country — serves 9.5 million Californians. The Times offers Kaiser insurance to its employees.

Last year, Kaiser took in more than $127 billion in revenue, earning a profit of $9.3 billion. The net income was mainly from investments, with a smaller share ($1.4 billion) from its sprawling operations as well as insurance premiums.

Kaiser has continued to hike its insurance premiums faster than inflation.

In 2025, premiums increased an average of 5.1% in Southern California and 8.2% in Northern California, according to Beere & Purves, a general insurance agency. In January, it raised them by another 6.5% in Southern California and 7.1% in the northern part of the state.

Kaiser has been rapidly expanding nationwide. It now has hospitals and clinics in at least 10 states and the District of Columbia, some operating under a separate nonprofit that it created in 2023 called Risant Health.

Kaiser said in its statement that D.C.-based Risant “is a way for us to expand access to high-quality, affordable care to millions more people, in fulfillment of our mission.”

“As a nonprofit, any returns are reinvested back into patient care, infrastructure, workforce benefits, and community health programs—not distributed to shareholders,” it said.

Kaiser said that its annual premium increases were “generally lower” than its competitors.

The surge of money has increased Kaiser’s reserve of cash and investments, which reached $73 billion in 2025 — 68% higher than in 2019, according to its financial statements.

Because Kaiser is registered as a charity, it pays no taxes on its profits or its extensive real estate holdings. After a recent buying spree, the nonprofit system said it had 847 medical offices and 55 hospitals at the end of 2025.

The arm of Kaiser that operates its hospitals and clinics avoided $784 million in federal income tax, $372 million in state income tax and $204 million in property tax in 2024, according to an analysis by the Lown Institute, a healthcare think tank.

In all, Kaiser Foundation Hospitals received nearly $1.5 billion in tax and other benefits by registering as a charity, the institute calculated.

Laws exempt nonprofits from paying taxes with the assumption they will give back to the community.

In 2024, Kaiser Foundation Hospitals provided $963 million in patient financial assistance and contributions to community health programs, but that still fell short of its tax benefit by more than $500 million, according to the Lown Institute.

Dr. Vikas Saini, the institute’s president, said that amount of money could help solve a myriad of California’s social problems.

“If they closed that gap, what would that $500 million get you?” he asked.

In a 2024 study, the institute found that Kaiser had the largest gap between its tax benefits and charitable spending of any of the nation’s nonprofit hospital systems.

Kaiser said in its statement that its combined charitable spending was far more than the institute’s calculation for its hospital arm. It said it not only provided patients with financial assistance, but also spent money on affordable housing, food access, community health and disaster recovery — efforts that totaled $5.3 billion last year.

After the January 2025 wildfires, Kaiser said it provided 2,400 households with financial assistance, opened evacuation centers, deployed mobile health vehicles and provided mental health services to victims.

“We have never been prouder of how we are delivering on our mission for the public good,” the statement said.

As Kaiser has grown, so has compensation for its top executives, which is among the highest of all California nonprofits.

In 2024, Greg Adams, Kaiser’s chief executive, was paid nearly $13 million, according to its filings. At least 40 other executives received total compensation of more than $1 million that year.

The nonprofit has a board of directors of more than a dozen members, with all but a few receiving $250,000 or more a year, according to the filing.

The board helps to oversee Kaiser’s fast-growing operations as well as its $73-billion financial reserve, which healthcare advocates and experts have said is far higher than its competitors and the level the state requires.

“I’m flabbergasted,” Saini said when told of the reserve’s size. “Who decides how big of a reserve is enough?”

Kaiser said it maintained the large financial reserve “to ensure long-term stability, manage emergencies, support major capital investments, and support our people’s retirement benefits.”

And it said senior managers were paid less than most for-profit health plans.

Patients delays, staffing shortages

Some longtime Kaiser members have left for other insurers, citing a decline in care.

Mark Schubb, a Santa Monica resident, had been a Kaiser member since 1995. He said he left in 2022 after experiencing months-long delays to visit his primary care doctor and specialists.

When he complained, Schubb said, “the answer was, ‘Well, you can always go to urgent care.’ “

Gonzalez, the nurse in Downey, said patients often wait three months for an appointment. And when they finally get in, the 20-minute appointment may be double-booked, she said, leaving the physician assistant with 10 minutes to see them.

“They can wait months for an appointment and then they are rushed through,” she said. “Kaiser has the resources to fix these things.”

In one case, 53-year-old Francisco Delgadillo arrived at the Kaiser ER in Vallejo, Calif., in December 2023 with severe chest pain. After an initial assessment, he waited eight hours for care, according to state regulators.

He died in the lobby.

A state and federal investigation found multiple violations, including that Kaiser failed to have a licensed nurse monitoring the dozens of patients in the ER’s waiting room.

Kaiser didn’t respond to a request to comment on the death but has disputed claims of inadequate staffing at its hospitals.

Complaints about a lack of available mental health care go back more than a decade.

In 2023, Kaiser agreed to a $200-million settlement after the state found it had canceled tens of thousands of mental health appointments and failed to provide timely care. The settlement included a $50-million fine — the largest the state had ever levied against a health plan.

Garie Connell, a Kaiser therapist and licensed clinical social worker in Encino, said the system had been rationing mental health care for years, while earning big profits.

“They’ve really lost their way,” she said.

Kaiser said it had “made significant investments to expand choice and access to mental health care over the past several years.” The healthcare provider said it now has more than 35,000 employed and contracted clinicians delivering mental health and addiction care.

Unsupported diagnoses

Kaiser said that it settled the alleged $1-billion fraud case last month to avoid the “cost of prolonged litigation” and that the findings of federal investigators involved “a dispute regarding certain documentation practices.”

In their complaint, prosecutors alleged that Kaiser mined data to find possible diagnoses that could be added to patients’ records to make them look sicker than they were. The patients were in Kaiser’s Medicare Advantage plan, which received bigger government payments for patients with multiple ailments.

Doctors were praised and given gifts, including bottles of champagne, the complaint said, for agreeing to the administrators’ requests to add the diagnoses.

As one Kaiser slide in an internal training session explained, “Medicare Queries: Why Now?”

The slide then provided the answer: “Diagnoses = Revenue.”

This article contains spoilers for Season 2, Episode 9 of “The Pitt.”

Midway through Season 2, “The Pitt” has taken on the perils of the digital age and given me a reason to love the show as much as everyone else does.

Don’t get me wrong — I understand perfectly why so many people, including recent Emmy and Golden Globe voters, have lost their minds over the HBO Max medical drama: The propulsive day-in-the-life of a Pittsburgh ER conceit, the dazzling ensemble cast, the writers’ heroic attempts to showcase our perilously broken healthcare system, the healing power of empathy and, of course, the Noah Wyle-ness of it all. His brilliant and gentle-voiced Dr. Michael “Robby” Robinavitch is as aspirational a character on television as we’ve ever seen.

But having recently spent almost six hours passing out and vomiting from pain in the waiting room of my local ER (which was empty except for one other man), while being told there was nothing anyone could do until the next shift arrived, I confess I have watched “The Pitt” with a jaundiced eye. The regular crowd shots of the waiting room too often reduce the afflicted into a zombie-like horde bent on making life more difficult for our beloved medical staff.

Sure it’s tough to work in an ER when you are worried about your mother’s expectations, grieving your dead mentor, struggling with addiction or worrying about your sister, but no doubt many of those in the waiting room are experiencing similar issues while also in terrifying and hideous pain.

I’m just saying.

In this second season, however, “The Pitt” gave me reason to cheer. It chronicles the day before Robby is set to leave on a three-month sabbatical, and in the early hours, we meet his temporary replacement, Dr. Baran Al-Hashimi (Sepideh Moafi). Having already attempted to force those suffering in waiting rooms to create their own “patient portals,” Dr. Al-Hashimi goes on to advocate for an AI-supported system to aid the doctors with pesky paper work.

Robby, of course, does not think any of this is a good idea and since he is always right (and no television writer is going to openly promote AI), her plan backfires almost immediately. First, with a medical notes transcription that gets Very Important words wrong and then after a complete digital blackout.

After a nearby hospital is hacked and ransomed, the higher-ups decide to defend its system by shutting it down, which means business must be conducted in the old-fashioned, paper-and-clipboards way.

The result is chaos, and a few too many jokes about young people not knowing how to work a fax machine or manage paper. Some of the more seasoned staff, including and especially the indefatigable charge nurse Dana Evans (Katherine LaNasa), remember the days before everyone carried an iPad well enough to keep things moving. Even so, Dana wisely calls upon the services of “retired” clerk Monica Peters (Rusty Schwimmer).

When the computer system at the Pitt is shut down, Dana (Katherine LaNasa), center, calls in Monica (Rusty Schwimmer), far right, who arrives to help.

(Warrick Page / HBO Max)

“Laid off by the digital revolution, not retired,” Monica corrects her. “And how’s all this digital s— working out for you now?”

This is where I cheered. I love the digital world as much as the next person currently typing on a computer to file a story that I have discussed with my editors on Slack and that I will not see in hard copy until it appears in the physical paper. But like pretty much everyone, I have suffered all manner of digital breakdowns and mix-ups, not to mention the inevitably increased workload that comes with the perception that I can do the work of previous multitudes with a few additional strokes of a keypad.

Except, of course, that’s a lie — a keypad is capable of nothing on its own. Neither are fingers, for that matter. They must be manipulated by someone whose brain has to figure out and execute whatever needs to be done. This requires an ability to navigate the ever-changing tech systems that store and distribute information (often in ways that are not at all intuitive) while also understanding the essentials of the actual work being done.

In “The Pitt,” that is the emergency medical treatment of human beings, which requires all manner of physical tasks. As this storyline makes clear, many of the medical staff do not quite understand how to order or handle these tasks without a screen to guide them.

Hence the need for Monica, representative of a large number of support workers who do understand because it was once their job to keep everything moving, to answer all manner of questions, prioritize what needs to be fast-tracked and make sure nothing falls through the cracks while also engaging with all and sundry on a human level.

The shutdown is obviously an attempt to underline the limits of AI but it also serves as a fine and necessary reminder of how readily we have surrendered people like Monica, with their knowledge and experience, to keyboards and touch pads (which, of course, don’t require salaries, benefits or lunch breaks).

But — and this is important — computers are tools not workers. Alas, that has not kept companies in virtually every industry from drastically cutting back on trained and experienced employees and handing large portions of their work (mental if not physical) to people, in this case doctors and nurses, who already have demanding jobs of their own.

But hey, you get a company iPad!

Nurse Dana (Katherine LaNasa), left, and Dr. Baran Al-Hashimi (Sepideh Moafi) have to resort to paper, clipboards and white boards to keep track of patients after the hospital’s systems are shut down.

(Warrick Page / HBO Max)

Often, including with those patient portals, what was once paid labor lands in the lap of the consumers, who in “The Pitt” are people sitting in an emergency room and likely not at the top of their game when it comes to filling out forms about their medical history or coming up with a unique password.

ER dramas, like the “The Pitt,” are inevitably fueled by the tension between the demands for speed and the need for humane care, something that is increasingly true, if not as intrinsically necessary, in all facets of our culture.

With computers in our pockets, we now expect everything to be available instantly. But when something in our online experience goes wrong, we need an actual human to help us fix it. Unfortunately, as the overwhelmed staff of the Pitt discover, those people are increasingly difficult to find because they have been laid off — even nurse Dana can’t do everything!

Dr. Al-Hashimi, like many, believes that patient portals and AI-assisted medical notes will save time, allowing the doctors and nurses to spend more of that precious commodity with their patients. But, as Dr. Robby and Dana repeatedly argue, what they really need is more staff.

There’s no point in saving a few minutes at the admittance window, or on an app, if you are then going to have to spend hours waiting for or trying to find someone who can actually help you when you need it.

That is certainly true in the medical sector, where digital technology has done little to eradicate long wait times for medical appointments or in emergency rooms. Being treated in a hospital hallway by people who can barely stop to talk to you is not an uncommon occurrence for many Americans. The U.S. is facing a critical shortage in hospital staff, with the ranks of registered nurses and other medical personnel having plummeted post-pandemic, often due to burn out.

The amount of time the staff of “The Pitt” spend with each patient, while dramatically satisfying, is almost as aspirational as the wisdom and goodness of Dr. Robby.

None of these problems is going to be solved by AI or any other “time-saving” device. We have not, as far as I know, figured out a way to extend an hour beyond 60 minutes or modified the human body so that it does not require seven to nine hours of sleep each night.

Medical institutions aside, I can’t think of any place I have visited lately that wouldn’t have benefited from more paid and experienced workers, especially those who know how to do things when computers glitch or fail.

The minute Monica sits down and starts barking orders in the ER, everyone feels much better. Here is someone who understands what needs to be done, why, and how to make it happen. Moreover, she has eyes, ears, hands and human experience enough to know that, in the end, people are less interested in saving time than getting the care they need.

In the ER and everywhere else.