Managed care scores victories in California

A state regulator voluntarily drops part of a dispute against Kaiser and loses a round in court against Blue Shield.

By Julie A. Jacob, AMNews staff. Feb. 4, 2002.

Two managed care companies have scored victories in their disputes with the California Dept. of Managed Health Care regarding the state agency's authority to regulate plans.

On Jan. 14, the state agency voluntarily dropped one of its allegations, withdrawing its charge that Kaiser failed to contact an ambulance, but stuck to its allegations that the health plan failed to provide access to care and continuity of care.

The agency's investigation of Kaiser's emergency procedures stemmed from the death of a Kaiser patient from a ruptured abdominal aortic aneurysm in 1996. Originally fined $1 million by the DMHC's predecessor, the California Dept. of Corps., the agency added the cases of two other patients and upped the insurer's fine to $1.1 million.

Kaiser appealed the fine and unsuccessfully tried to have the DMHC's director, Daniel Zingale, found in contempt of court for overstepping his authority. A state administrative court is currently hearing the appeal.

A Kaiser spokesman said the health plan was pleased with the agency's decision to drop one of its charges and will continue to present evidence refuting the other charges at its appeal hearing.

Zingale, however, minimized the significance of the agency's decision to drop one charge against Kaiser. [...]