Kaiser Permanente faces more than $2.5 million in penalties over Medi-Cal data

Kaiser Permanente faces more than $2.5 million in penalties for its alleged failure to supply California state regulators with properly formatted claims data from Kaiser’s Medicaid managed-care plans.

The missing records include data on patient demographics, the provider’s national identifier as well as coded information such as encounter type, diagnosis and various procedures, according to Sarah Brooks, deputy director of healthcare delivery systems for the California Department of Health Care Services.

Kaiser was already in hot water with the state last year over failing to meet a June 30, 2016, data submission deadline, according to a letter the DHCS sent to Kaiser.

The following September, the state agency imposed a corrective action plan on Kaiser, giving it until Jan. 1, 2017, to comply.

It didn’t, according to the state, and, per the corrective action plan, the DHCS sent Kaiser a formal notice it intended to seek the penalties for noncompliance.

The penalties cover two areas of concern. One, for $742,500, involves encounter data for external medical claims formatted for submission via the agency’s Post Adjudicated Claims and Encounters System for 2014 through 2016. The other, for $1.79 million, covers late claims in the same PACES format for physician-administered drugs for March 2010 through March 2015.

The department, California’s largest payer of healthcare claims, oversees programs that cover 13.5 million Californians, according to its website.

About 80% of enrollees in Medi-Cal, the state’s Medicaid program, receive care from a Medicaid managed-care plan.

According to the letter, Kaiser has taken corrective action.

The state missive said it reserved the right to impose additional penalties for other data reporting deficiencies, and suggested Kaiser could face those additional penalties if the CMS orders the state to repay reimbursements due to the data shortfall.