Bungled Filings Cost Kaiser $190,000
The Department of Managed Health Care has levied $190,000 in penalties and fines against Oakland-based Kaiser Foundation Health Plan for its mishandling of arbitration case records.
The agency levied $140,000 in fines for 12 cases provided to the agency when it failed to redact names of enrollees, witnesses, attorneys, providers, health plan employees and health facilities so the decisions could be made part of the public record.
Patients and health plans often enter private binding arbitration if there is a dispute over plan benefits or other issues. Most health plans require arbitration as a condition of providing coverage to enrollees.
The outcome of the cases, which are usually determined by retired judges, are posted on the DMHC's website.
A DMHC spokesperson said the unredacted cases were not posted on its website and no breaches of patient privacy occurred.
The agency levied another $50,000 in fines against Kaiser for failing to provide the decisions in seven arbitration cases to the DMHC within 30 days of their receipt by the health plan.
All of the arbitration cases appear to have been decided in 2013, according to the record numbers referred to in DMHC correspondence. Kaiser was fined $11,667 for each of the 12 improperly redacted filings and $7,143 for each of the seven late filings.
Kaiser agreed to a set of corrective actions. A statement issued by the health plan noted that “we agreed to strengthen our clerical oversight in redacting the names of providers, facilities...in our arbitration decisions before filing them with the Department of Managed Health Care. In a few instances, the department found that words like “Kaiser” or the names of specific facilities had not been fully redacted from footnotes and other sections in arbitration documents spanning several dozen pages.” Kaiser also agreed to improve the timeliness of arbitration filings, according to the statement.
It's only the second time the DMHC has fined a health plan for not properly filing arbitration cases. It fined Cigna California $2,500 in 2009 for a single instance of mishandling a case, records show.
The DMHC spokesperson said penalties are levied based on the health plan’s good or bad faith, its willfulness in the case, its history of prior penalties, and whether it was an isolated incident, among other factors.
The enforcement actions by the DMHC have picked up considerably in recent months, particularly after the appointment of Carol Ventura as the agency's top enforcement officer last spring. She replaced Anthony Manzanetti, who was assigned to another post within the DMHC.
Since the start of 2014 the agency has issued 40 separate enforcement actions with fines totaling $363,500. That compares to no penalties or fines during the same period in 2013.
The DMHC issued a total of 90 penalties and $451,000 in fines for all of 2012.
Kaiser has received a total of 288 penalties and related fines from the DMHC since 2005.
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