$4 Million Fine is Second Largest in DMHC’s History; Action Results from Caregivers’ Complaint to the Agency â€¨â€¨Today, the California Department of Managed Health Care (DMHC) announced a $4 million fine against California’s largest HMO for limiting patients’ access to mental health care. 

The fine affirms the findings of an exhaustive complaint filed by Kaiser Permanente’s frontline mental health clinicians, who are represented by the National Union of Healthcare Workers (NUHW). In November of 2011, NUHW filed a 34-page complaint with the DMHC and has cooperated with the agency’s ensuing 19-month investigation.

In addition to the $4 million fine, the DMHC also filed a “Cease and Desist Order” against Kaiser that emphasizes the risks posed to patients: 

“The Department finds that the Plan’s deficiencies are serious and may put some of its members at risk of harm. Therefore, as set forth in this Order, the Department of Managed Health Care hereby directs the Plan to Cease and Desist from any further violation of the foregoing statutes and regulations in order to protect the interests of enrollees.” (p. 7, Cease and Desist Order)

In a press release, DMHC Director Brent Barnhart reiterated the seriousness of the DMHC’s findings: 

“The Department’s actions are a result of both the seriousness of the deficiencies and the failure of Kaiser to promptly correct them. The Department is taking this action to ensure that Kaiser promptly corrects these deficiencies and provides its patients with the mental health care promised to them by their health plan.”

"This action confirms what every Kaiser clinician knows," said Dr. Andris Skuja, PhD, a psychologist at Kaiser Oakland. "Kaiser doesn't take mental health care for its patients seriously. Our patients have serious needs. The last thing they need is for their care to be illegally curtailed by an HMO that's already making billions in profits, just so Kaiser can make a few more pennies on the dollar at patients' expense."

The DMHC fined Kaiser due to its violations of four areas of state law. 

• Kaiser committed “systemic access deficiencies” by failing to provide its members with timely access to mental health services. Under California’s “timely access” regulations, HMOs are required to provide appointments to patients within 14 days of their request for mental health services. Instead, large numbers of Kaiser’s patients were required to endure lengthy waits. For example, the DMHC identified three Kaiser medical centers in Southern California where “less than half” of the patients were seen within the required timeframe. (p. 13-14) At some facilities, these failures persisted for ten consecutive months and were so grave that two-thirds of Kaiser’s patients were not seen in a timely fashion during certain months. (p. 14) In Northern California, one Kaiser facility treated fewer than 40% of its patients within the required timeframe. This failure continued for five consecutive months ending January 2012. (p. 14)

• Kaiser’s internal record-keeping system contained numerous problems — including a parallel set of “paper” appointment records that differed from the HMO’s electronic records — that hid patients’ lengthy wait times from government inspectors. 

• Kaiser failed to adequately monitor and correct its violations of state law. Records show that Kaiser was aware of its violations, but failed to take action to correct the problems. 

• Kaiser provided “inaccurate educational materials” to its members that had the effect of dissuading them from pursuing medically necessary care and violated state and federal mental health parity laws. 

The impact of Kaiser’s violations is massive. With more than 7 million enrollees, Kaiser is the largest HMO in California and is the largest private-sector provider of mental health services in the state. It delivers care to patients with conditions that range from depression, anxiety disorders and autism to bi-polar disorder, schizophrenia and suicidal ideation.

Kaiser's failure to meet state standards results in significant and unnecessary suffering by patients, many of whom are coping with serious trauma, are in severe emotional distress and are in acute need of timely care.

According to the DMHC’s report:

"If the Plan [Kaiser] does not effectively monitor wait times and ensure that enrollees are not waiting excessively for an initial appointment or between appointments with their provider, significant numbers of enrollees with untreated or prolonged health conditions may suffer harm.” (p. 10)

Read more about Kaiser's mental health care deficiencies: http://www.nuhw.org/caredenied