DMHC Fines Kaiser Plan $90,000

The California Department of Managed Care fined Kaiser Foundation Health Plan $90,000 earlier this month for failing to properly redact arbitration cases submitted to the agency.

The DMHC makes such cases publicly available, but requires that the litigants, provider names and other portions of the case be redacted so as to respect patient privacy rights.

According to DMHC records, Kaiser failed to properly redact seven separate cases. The health plan was fined $12,857 for each incident.

This is the second time in less than a year the Oakland-based Kaiser was fined for failing to properly redcated arbitration hearing records before submitting them to the DMHC.  Last February, Kaiser was fined $140,000 for failing to properly redact records in 12 separate cases.

Under California law, health plans are permitted to litigate disputes over patient care in binding arbitration if it makes it clear when an enrollee signs up for coverage. Such cases usually tried by a retired judge.

Health plans claim arbitration provides advantages such as a faster resolution and lower legal costs, but they also tend to prevail in arbitration cases more than 60% of the time, records show.

Kaiser is the only health plan to ever be fined by the DMHC for failing to redact the results of its arbitration cases, according to records.