Kaiser fined for poor oversight

But the fine levied by California could be reduced if Kaiser completes corrective goals.

By Pamela Lewis Dolan — Posted Aug. 13, 2007

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The California Dept. of Managed Health Care has fined Kaiser Foundation Health Plan $3 million.

The department said the fine is for Kaiser not adequately providing oversight of quality assurance programs intended to address patient complaints and physician peer review cases at its 29 medical centers in California.

The DMHC started an investigation in August 2006 after issues were identified during an investigation into Kaiser's San Francisco Medical Center kidney transplant facility, and after several complaints were received by the DMHC's HMO help center.

The department found that Kaiser did not meet state requirements in two ways. It lacked adequate health plan oversight of quality assurance programs, and it was inconsistent in its handling of quality of care cases referred for peer review.

But the plan could not verify whether serious problems were being addressed now, according to the department.

"State law requires health plans to have processes in place to hear member concerns and act upon them in a timely manner," said Cindy Ehnes, director of the DMHC, in a prepared statement.

In its own prepared statement, Kaiser said it has "a long history of evaluating and improving quality assurance processes, and monitors performance through data tracking and reporting to the highest level of management."

The statement went on to say, however, that "Kaiser Permanente recognizes that there are always opportunities to enhance consistency, clarity, and oversight of our work in this area."

The DMHC said $1 million of Kaiser's fine may be eliminated if it fully completes proposed corrective actions.

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