Nation’s Largest Publicly Operated Health Plan Hit with Huge Fine for Delays in Treating Patients

By Consumers for Quality Care, on March 30, 2022

L.A. Care, the nation’s largest publicly operated health plan, was fined $55 million by California’s health regulators for alleged operational failures that resulted in “harm to members,” according to Healthcare Dive.

The issues were first brought to light by an investigation in 2020 that detailed patients’ long waits for care, some of which resulted in deaths. Reporters from the Los Angeles Times were able to obtain medical records of six patients who faced delays of at least three months to see specialists and who died of the illnesses they were waiting to have treated.

These patients include a 61-year-old woman whose bladder and kidney problems were so bad she became incontinent while waiting 10 months to see specialists. She died of chronic kidney disease before she got an appointment.

In addition to a backlog of more than 9,000 prior authorization requests, L.A. Care failed to properly address more than 67,000 grievances or appeals from its members.

CQC urges lawmakers, regulators, and insurers to eliminate burdensome, unnecessary processes that prevent consumers from receiving the medical care they need and deserve.