DMHC Fines L.A. Care $20,000

L.A. Care Health Plan has been hit with two fines from the Department of Managed Health Care late last month totaling $20,000.

            The insurer, which provides Medicaid managed care coverage to about 2 million individuals in Los Angeles County, was fined $10,000 for two separate incidents that occurred in 2014 and 2015, primarily for delays in responding to enrollee grievances.

            In the 2014 incident, an enrollee was inadvertently transferred from a hospital to a an out-of-network skilled nursing facility and was originally stuck with the bill. According to the DMHC, L.A. Care did not respond to the enrollee's grievance in the mandated period of time.

            In the 2015, an enrollee with a broken wrist had a nearly four-month delay in being able to obtain surgical treatment for the injury. The DMHC determined that L.A. Care was several days late in responding to a request for information regarding the matter.

            L.A. Care has agreed to a plan of correction in both instances

            The fine was the third levied in September by the DMHC, with a total of $38,000.

            Given the size of its enrollment, L.A. Care has been lightly penalized by the DMHC over the years. It has never received more than three administrative penalties in a year. It was fined a total of $155,000 last year, records show.