DMHC Fines Kaiser $205,000

Penalties Levied For Failing to Respond to Enrollee Grievances

The California Department of Managed Health Care has fined Kaiser Foundation Health Plan $190,000 for improper responses to enrollee grievances, records show.

            According to correspondence between the DMHC and Kaiser, the Oakland-based health plan on  41 separate occasions either failed to adequately consider and rectify an enrollee’s grievance; failed to provide an adequate response to a grievance; failed to provide a timely written acknowledgement of receiving a grievance; failed to respond to a grievance within 30 days; failed to respond to a DMHC request for information in a timely manner, failed to provide information to the DMHC in a timely manner, or failed to provide to the DMHC its response to the enrollee. The penalties for each violation ranged from $2,500 to $15,000.

            Along with paying the fine, Kaiser has agreed to a corrective action plan that includes holding quarterly staff meetings to address emerging quality issues; hold additional staff training; and file a report detailing how it responded to grievances filed by enrollees during the first half of 2017.

            In a separate action, the DMHC fined Kaiser $15,000 for an incident earlier this year when an enrollee who spoke only Spanish attempted to get coverage and pricing information for a prescription. The enrollee on her original application to Kaiser asked that all communications occur in Spanish. Instead, Kaiser left voice mail messages to the enrollee in English. She was charged a $422.28 co-payment, leading to her filing a grievance. Kaiser’s response to the grievance was also sent five days later than statutorily required, and its response to the DMHC was incomplete. The DMHC determined that Kaiser violated state regulations by not communicating to the enrollee in Spanish and not providing information to the agency in a timely manner.

            Kaiser agreed to a corrective action plan that including reviewing the incident with relevant employees and reminding them to provide interpretation services when needed.

            Along with the fine levied against Kaiser, the enrollee’s payment was refunded.

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