KAISER PERMANENTE: REACHES AN AGREEMENT WITH TEXAS
One day after state Attorney General Dan Morales (D)This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
threatened to "revoke" Kaiser Foundation Health Plan's "license
because of violations of state regulation," (see AHL 4/18) Kaiser
and the state settled the dispute, DALLAS MORNING NEWS reports.
The settlement was announced Friday by state Insurance
Commissioner Elton Bomer and Kaiser Permanente Texas President
Bill Gillespie. Under the agreement, Kaiser will pay a $1
million fine for problems uncovered by a state Department of
Insurance investigation last year. In addition, California-based
Kaiser Foundation Health Plan will provide Texas Kaiser with $80
million in "financial aid" this year "to improve patient care."
Kaiser will also be required to pay for an "independent
consulting firm to review and recommend changes in the HMO's
emergency care, claims processing, quality assurance, physician
peer review and other problem areas." Kaiser must also achieve a
"high degree of accuracy in processing emergency care claims,"
promptly pay legitimate claims and make "emergency care brochures
'user friendly.'" The insurer has 30 days to submit a plan to
the state insurance department detailing what steps it will take
to meet the settlement requirements. The settlement contains no
admission of wrongdoing on the part of Kaiser.
KISS AND MAKE UP: Bomer said, "I have concluded that Kaiser
is fully committed to addressing every issue raised." He added,
"Revocation would have been an extreme step that might have
disrupted medical treatment for many patients. Kaiser's
agreement to submit a business plan and take steps to strengthen
its finances without cutting corners on patient care eliminated
any possibility that I would consider revocation." Kaiser is
expected to drop today its suit against the state insurance
department that attempted to block the release of the agency's
report. However, the insurer still contends that the report
contains confidential and incorrect information (Stutz, 4/20).