Oakland, Calif.-based Kaiser Permanente faces $819,500 in fines after state officials said the organization delayed handling complaints from health plan members.
The California Department of Managed Health Care, which is responsible for overseeing health plans in the state, announced the fines April 25.
“Complaints are an important health care right to ensure members receive the care they need,” DMHC Director Mary Watanabe said in a news release. “Health plans are required by law to have a grievance and appeal system to resolve member complaints, including providing timely notice of the plan’s decision in response to member complaints, in addition to providing information about how to appeal the plan’s decision. Actions like today’s fine keep the system working for patients.”
The $819,500 in fines represents the total of enforcement actions involving 61 cases.
This includes 14 cases where Kaiser failed to acknowledge receipt of a complaint within five calendar days, as required by California law, according to the state.
The state also contends that in 54 cases Kaiser failed to respond to the member’s complaint within 30 calendar days of receipt of the complaint, as required by law.
In response to the DMHC announcement, Kaiser shared the following statement with Becker’s:
“DMHC has a responsibility for ensuring that health plans address member grievances and in a timely manner. We always strive to meet our regulatory obligations and our members’ expectations.
“The grievances covered in this DMHC announcement date back to the pandemic and its immediate aftermath. Starting in 2021, we began receiving more grievances than usual, when we and other health plans across the country were challenged to meet surging care and service needs of our members.
“While we do not agree with the size or delayed delivery of these fines, we are sorry to have missed the mark in these 61 instances in 2021, 2022 and 2023, especially with members relaying concerns or seeking additional support. Since 2021, we have added staff to the team that addresses grievances to ensure we are managing them in compliance with the state’s requirements, as well as to best resolve our members’ concerns.”
Kaiser Permanente is among the largest nonprofit health plans in the U.S., serving 12.4 million members.