Dive Brief:
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California fined Kaiser Permanente $2.2 million for failing to provide patient care data to Medi-Cal, which is the state’s Medicaid program. In January, the state fined Kaiser $2.5 million for the same reason.
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The California Department of Health Care Services uses the hospital admissions, doctor visits and prescription drugs data from payers to “help set rates, ensure adequate care is available and monitor how tax dollars are being spent in the $100 billion program.”
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Kaiser isn’t appealing the fine and said it expects to get the information to the state by September.
Dive Insight:
California Department of Health Care Services Director Jennifer Kent sent a letter to Kaiser in May telling the nonprofit healthcare system it still did not comply with Medi-Cal requirements, though the state acknowledged Kaiser was working to resolve the problem.
The fines are for failing to submit encounter data for a variety of claims as well as pharmacy encounter data and physician-administered drug data going back to 2014. Kaiser is known as an EHR pioneer, but the continued lapse showcases the complexity of healthcare data and interoperability.
Kent wrote that her department will continue to evaluate Kaiser’s progress toward providing the data and warned 'the evaluation process includes the potential to impose monetary sanctions on a quarterly basis for any period of time that Kaiser has not been previously sanctioned for the deficiencies."
Earlier this year, California fined Kaiser Permanente $1.79 million for not submitting physician administered drugs data and $742,500 for not submitting encounter data. At the time, the integrated health system said its computer systems were not designed to comply with California’s reporting requirements.
Now, seven months later, the healthcare giant is giving the same reason for not being able to collect information needed for Medi-Cal. However, Kaiser Permanente, which covers 700,000 of Medi-Cal’s 10.8 million members in Medicare managed care plans, said it recently made “significant investments” in technology that will allow for the necessary data collection.
In addition to the Medi-Cal fines, the California Department of Managed Health Care also charged Kaiser in June for not providing appropriate access to mental healthcare. In 2013, the company agreed to pay $4 million for “several deficiencies in the plan’s delivery of mental health services” in 2013.