DMHC Fines L.A. Care $18,000

The California Department of Managed Health Care has fined L.A. Care Health Plan $18,000 for delays for providing an enrollee with a primary care physician closer to their home.

            The enrollee was suffering from inflamed joints and an organ system breakdown, records show. When a complaint was lodged with the DMHC, the agency asked L.A. Care for a treatment plan that included the names of at least three providers near the patient.

            “The Department requested the plan identify three in-network primary care providers and

each of their earliest dates of availability. The plan provided the names of two physicians and listed a third only as "PCP" – no name or specific address were provided. Further, the plan did not respond to the Department's request for the primary care providers' earliest dates of availability.” L.A. Care also did not provide the names of three nearby in-network rheumatologists and dermatologists, nor did it furnish appropriate documentation of the grievances, or have a plan to address the quality of care and service issues involving the enrollee's case.

            L.A. Care has agreed to a course of corrective actions, including a revamp of the department that handles enrollee grievances.

            The fine is the second L.A. Care has received in 2016, and the third largest to date. It was fined $150,000 for engaging in unjust payment patterns with providers, records show.