Kaiser Permanente faces $2.5M fine for failing to provide required Medicaid data

The California Department of Health Care Services has fined Kaiser Permanente $2.5 million for failing to provide required patient care data to Medi-Cal, the state's Medicaid program, reports California Healthline.

Here are six things to know.

1. Oakland, Calif.-based Kaiser Permanente, one of more than 20 health plans that participate in the Medi-Cal managed care program, was notified of the sanctions in a Jan. 13 letter obtained and cited by California Healthline.

2. State officials contend Kaiser Permanente did not meet the deadline to submit data on out-of-network care that Medi-Cal patients received from November 2014 to September 2016, according to the report. That resulted in a fine of $742,500.

3. The state said Kaiser Permanente also did not meet the deadline to submit data on physician-administered drugs from March 2010 to March 2015. That resulted in a fine of $1,792,500.

4. Sarah Brooks, deputy director of healthcare delivery systems at the California Department of Health Care Services, told California Healthline her department is discussing the issue with Kaiser Permanente, and Kaiser Permanente may face additional fines depending on the company's actions and whether Kaiser Permanente's violations put the department out of compliance with CMS rules.

5. In a statement, Kaiser Permanente said its top priority is "ensuring access to safe, high-quality care for our members and patients." It also noted the sanction is related to capturing certain administrative data, which is used by the California Department of Health Care Services in the administration of Medi-Cal, and is not related to quality, patient care or patient access.

"Kaiser Permanente is an integrated delivery system, therefore our systems and technology — such as our electronic health record and online capabilities on kp.org — are focused on quality, access, and integration of care. While our administrative systems and processes had not been originally designed or fully updated to collect and report certain data in the format specified by DHCS, we are taking steps to change this. We are making investments in technology that will facilitate compliance with the state’s data reporting requirements," Nate Oubre, California vice president for Medi-Cal, Children's Health Insurance Program and charitable care at Kaiser Permanente, said in the statement.

"We have been working with the DHCS for many months to communicate our progress on providing the required patient encounter data. We are working toward compliance with the data requirements of DHCS," he added.

6. The California Department of Health Care Services said the fine imposed against Kaiser Permanente was the first fine imposed on one of its Medicaid managed care plans since at least 2000, according to the report.

For more on this story, read Chad Terhune's full report in California Healthline.

 

 

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