Kaiser Foundation Health Plan fined $819,500 for delays in handling member complaints.

The Kaiser Foundation Health Plan is facing fines of $819,500 for not handling members' complaints in a timely manner as required by law, the California Department of Managed Health Care announced on April 25.

The DMHC's Office of Enforcement conducted an investigation after receiving complaints from Kaiser members beginning in 2021. The agency found 61 cases where the medical system did not follow laws regarding written acknowledgement of receiving grievances within five calendar days or failing to respond to standard grievances within 30 calendar days.

Kaiser officials agreed to the fines, according to DMHC documents, although a written statement from a Kaiser spokesperson states that they "do not agree with the size or delayed delivery of these fines, we are sorry to have missed the mark in these 61 instances in 2021, 2022 and 2023, especially with members relaying concerns or seeking additional support."

The statement mentioned that the grievances began during the Covid-19 pandemic, "when we and other health plans across the country were challenged to meet surging care and service needs of our members."

More staff have been added to the Member Services team since 2021, the statement said, to meet the state's requirements, as well as resolve members' concerns. The team completed 8.5 million interactions with California members, according to the statement.

There were three enforcement actions total, each with its own letter of agreement between the DMHC and Kaiser.

One letter states that Kaiser "is obligated to maintain a compliant, reliable and accurate grievance and appeals system," under the Knox-Keene Act. Even one grievance violation "deprives an enrollee of Knox-Keene Act consumer protections that ensure an enrollee's access to quality medical care," it said.

There are over 9.4 million members in Kaiser in California, although it did not arrive in Monterey County until Jan. 2, opening a clinic in North Salinas.

Kaiser purchased a 10-acre lot near The Dunes shopping center in Marina for $8,712,000 on April 22, according to Monterey County Assessor/Recorder Marina Camacho.

When asked for confirmation of the purchase, a Kaiser spokesperson sent a written response that did not confirm or deny it. 

"Kaiser Permanente exists to provide high-quality, affordable health care and to improve the health of our members and the communities we serve," it said.

"We continue to explore all possible options to serve individuals and employers in Monterey County who over the years have expressed their desire to have Kaiser Permanente’s high-quality care available to them.

"At this time, we have no further information to share."