California Regulator Slaps Kaiser Permanente with Fines for Slow Response to Member Complaints

A California regulatory body responsible for protecting patients' healthcare rights announced that they penalized Kaiser Permanente with a fine of $819,500 due to their failure in addressing numerous member complaints promptly.

The Department of Managed Health Care stated on Friday that their enforcement division had concerns with how Kaiser addressed complaints in 61 instances.

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Complaints are a vital healthcare right that guarantees members get the necessary care," stated DMHC Director Mary Watanabe. "By law, health plans must maintain a grievance and appeals process to address member concerns, ensuring prompt notification of decisions regarding these complaints and offering guidance on how to contest those decisions. Measures such as today's penalty help sustain this system for patient benefit.

As per the rules, health plans are required to confirm receiving a standard complaint within five calendar days, settle the issue within thirty days, and additionally provide a written notification of the resolution to the member.

Health plans must also notify their members about their right to contest the decision if they disagree with how the plan has handled their case.

The DMHC reported that after investigating numerous member complaints, they discovered 14 instances where Kaiser failed to deliver the mandatory written confirmation of receiving a grievance within five calendar days. Additionally, in 54 cases, Kaiser did not adhere to the requirement of responding to the member’s grievances within 30 calendar days, according to the regulatory body.

Kaiser responds

KCRA 3 contacted Kaiser Permanente seeking their comments on the penalty and asking if the organization had made any modifications to its systems following the inquiry.

A representative from Kaiser stated that these complaints trace back to the time of the pandemic and shortly after it began.

In 2021, we started experiencing an increase in complaints compared to previous years as both our organization and numerous other health plans nationwide struggled to address the heightened demand for member services and healthcare,” stated Kaiser. “Although we disagree with the extent and timing of these penalties, we regret failing to meet expectations in 61 cases between 2021, 2022, and 2023, particularly since some members had voiced their issues or required further assistance.”

Kaiser mentioned that starting from 2021, they have expanded their team responsible for handling complaints. This was done to guarantee adherence to the state’s regulations when dealing with these issues and also to effectively address member concerns. The Member Services division is committed to delivering exceptional assistance every time members contact them. In 2024 alone, this team handled an impressive total of 8.5 million engagements with members based in California.

How should one proceed if they have an issue to report?

The DMHC indicates that it promotes individuals experiencing problems with their health plans to initially lodge a complaint directly with the plan itself. Typical concerns encompass delays in obtaining necessary medical attention, incorrect billing, or postponements and refusals of therapy.

If you disagree with how your complaint was handled or you're dealing with an emergency situation, you may contact them as well. DMHC’s Help Center .

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