Kaiser Permanente Fined $2.5 Million Over Missing Medicaid Data

February 15th, 2017

The California Department of Health Care Services has fined Kaiser Permanente $2.5 million for failing to divulge data on patient care required by the state’s Medicaid program, according to a report from Kaiser Health News (KHN).

Kaiser Permanente, according to state officials, failed to submit data on out-of-network care provided to Medi-Cal recipients for a two-year period and did not file data on “all physician-administered drugs” for a four-year period. Physician-administered drugs are given to patients in a doctor’s office or clinic.

According to KHN, the reporting lapses are atypical because Kaiser Permanente is a leader in the field of health data collection via electronic medical records. KHN reports that because Medi-Cal represents a small portion of Kaiser’s overall business, industry experts have speculated that Kaiser may have been hesitant to alter its information technology systems solely to meet requirements of the state of California.

In order to set appropriate rates and ensure that adequate care is being delivered to the state’s Medicaid population through its Medi-Cal program, the state relies on data provided by individual healthcare entities. Medi-Cal pays a fixed rate per enrollee for comprehensive care and, therefore, accurate data on services provided is required to accurately set the fixed rate. According to KHN, Kaiser’s failure to submit the appropriate data could result in fines to the Centers for Medicare & Medicaid Services (CMS), which provides funding for Medi-Cal. Kaiser Permanente received warnings concerning these data breaches and failed to meet compliance deadlines.

Kaiser Permanente is California’s dominant HMO with 22 health plan participants in the Medi-Cal managed care program, which covers about 80% of Medi-Cal enrollees in the state. Kaiser Permanente runs 38 hospitals across the country and hundreds of clinics, but nearly 80% of its 10.6 million members are in California.