Kaiser Permanente Fined Millions Again
Not the first time
This is not the first time that the Department has assessed a fine against Kaiser Permanente. In August 2006, Kaiser was fined $2 million for its improper handling of kidney transplant patients. In that instance, the company transferred patients from established kidney transplant centers to its own center. Hundreds of patients waited for months to receive new kidneys, but many never did because Kaiser mishandled the paperwork. Many patients died waiting and many others health was put at risk due to prolonged periods of dialysis. Kaiser closed its Northern California kidney transplant program in May, 2006.
Latest investigation and fine
According to the DMHC, the investigation of Kaisers quality assurance oversight programs, which are responsible for investigating and resolving quality of care complaints from its members, was partially prompted by issues identified in the Departments examination of Kaisers San Francisco Medical Center kidney transplant facility and consumer complaints received.
The investigation reviewed programs designed to investigate complaints and conduct physician peer review at nine of Kaisers 29 medical center programs in California, including Woodland Hills, Fontana, Baldwin Park, West Los Angeles, south Sacramento, San Rafael, South San Francisco, Fresno and San Francisco.
California law requires health plans to establish procedures to review the quality of care, performance of medical personnel and utilization of services and facilities. Specifically, plans must have a proper oversight mechanism in place to ensure that any quality assurance or peer review functions it may delegate to another entity, such as a medical group, are adequately performed.
The Departments investigation found that Kaiser lacked adequate health plan oversight of quality assurance programs and had significant variation and inconsistent handling of quality of care cases referred for medical center peer review.
The Department reviewed 228 randomly selected peer review and quality assurance case files and found that one third of the files were deficient, such as making sure that corrective action was carried out on a quality complaint, timely and prompt handling of a quality concern or that a doctors complaint history was appropriately applied in evaluating a peer review matter.
In addition to the $3M fine, the DMHC is requiring Kaiser to establish, among other things, new reporting processes at all 29 of its medical centers, a uniform set of standards for to evaluate peer review programs and a new regional Member Concerns Committee in southern California to report to the health plan on specific member complaints. There are additional requirements and the DMHC will follow up to make sure that Kaiser is complying. If they do comply, the DMHC has said that it may waive $1 million of the fine something that is creating controversy in and of itself as the companys income was over $30 billion dollars last year.
To view the information from the Department of Managed Health Care, go to: http://www.dmhc.ca.gov/library/reports/news/prkaiserqap.pdf.