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Kaiser Permanente fined $2.2 million over data reporting

The health plan failed to comply with a corrective action plan and it did not meet additional deadlines to submit the required data.

Susan Morse, Senior Editor

The California Department of Health Care Services has levied a $2.2 million fine against Kaiser Permanente on a charge the health system failed to meet its regulatory and contractual obligations for reporting encounter data.

California Department of Health Care Services Director Jennifer Kent informed Kaiser Vice President Nathaniel Oubre of the monetary sanctions for failure to comply with a corrective action plan in a May 25 letter.

[Also: Kaiser Permanente first in Medicare Advantage consumer satisfaction, study finds]

"DHCS takes very seriously its commitment to ensure contract compliance from Medi-Cal managed care health plans so members can get the care they need," the department said by statement. "DHCS has been working with Kaiser since 2014 on data submission issues."

Encounter data are used by DHCS to set health plan rates and assess access to care and utilization. The department accepted a corrective action plan from Kaiser in spring 2016, which required compliance by January 1, 2017.  Kaiser failed to comply with the CAP, and it did not meet additional deadlines to submit the required data, the department said.

[Also: Kaiser Permanente boasts roughly $300 million boost in operating revenue in Q2 2017 over 2016]

DHCS continues to have discussions with Kaiser, and additional sanctions/penalties could be levied if Kaiser fails to come into compliance with contract requirements.

The department acknowledged that Kaiser is making efforts to resolve the deficiencies and has complied with deadlines in the January 6 corrective action plan.

Kaiser said it was committed to full compliance and has been working to meet new administrative reporting requirements since they were introduced in 2010.

"We have recently made significant investments in new technology to help us comply with the new administrative data reporting requirements," said Nathaniel Oubre, California vice president of MediCal, CHIP and Charitable Care at Kaiser Permanente. "It is important to note the fine announced on May 25, 2017 is administrative in nature. The data involved is used by DHCS in the administration of Medi-Cal, and is in no way related to quality, patient care or access, and does not affect care or quality in any way."

Kaiser previously informed the department that it would be unable to meet the January 1 deadline for historical data reporting, Oubre said.

"DHCS acknowledged our efforts to complete historical reporting, and that we met the deadlines we committed to in our Corrective Action Plan, which has us in compliance by September 2017," he said.

The latest fine follows a $2.5 million fine levied in January against Kaiser.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com

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