NUHW calls on Justice Department to investigate Kaiser Permanente’s long wait times, paper wait lists, and falsified appointment records

Delays in care continue despite $4 million fine by state regulatory agency
Lawsuits demonstrate link between suicides, lengthy delays for patients seeking mental health care treatment

One key difference between the V.A. scandal and the mental health care crisis at Kaiser is that lawsuits have demonstrated links between patient deaths and delays in care.

Kaiser, with 9.3 million members, is the nation’s largest nonprofit HMO and has been touted by President Obama as a model for quality and efficiency in health care. Yet Kaiser’s record on mental health services shows that private-sector health care is just as rife with scandal as the public-sector V.A. In 2013, California’s Department of Managed Health Care (DMHC) affirmed claims by whistleblowers and levied a $4 million fine — the second largest fine in the agency’s history — against Kaiser for violating state healthcare laws. According to the DMHC’s director, the agency’s actions were “a result of the seriousness of the deficiencies and the failure of Kaiser to promptly correct them.” The HMO also has been hit with two class-action lawsuits for violating patients’ rights and denying them access to mental health care, which allegedly contributed to the suicides of some Kaiser members.

Despite the DMHC fine, Kaiser patients and clinicians report that Kaiser continues to force patients to wait weeks and sometimes months to receive basic care. In 2013, two class-action action lawsuits were filed against Kaiser alleging that patients seeking mental health care treatment committed suicide while waiting for care. In a separate action in 2013, Kaiser agreed to pay $9 million to the families of children with autism spectrum disorders after Kaiser illegally denied them access to appropriate therapy.

In addition, NUHW has filed a lawsuit against Covered California, which violated its own rules when it allowed Kaiser to participate in the state health exchange despite Kaiser’s serious violations. Under the Affordable Care Act, Kaiser has added nearly a quarter million new members to its rolls, exacerbating its failures to provide timely and appropriate mental health care.

Kaiser’s own mental health clinicians — psychologists, therapists, and psychiatric social workers — first blew the whistle on these unconscionable practices in 2011 and documented Kaiser’s practices in a comprehensive report, “Care Delayed, Care Denied.” After a 15-month investigation, the DMHC affirmed the clinicians’ findings and cited Kaiser for multiple violations of California law, including the following:

• Kaiser committed “systemic access deficiencies” by failing to provide its members with timely access to mental health services. Instead, thousands of Kaiser’s patients were required to endure lengthy waits for appointments in violation of California’s “timely access” regulations.

• Kaiser’s internal record-keeping system contained numerous problems — including a parallel set of paper appointment records that differed from the HMO’s electronic records — that hid patients’ lengthy wait times from government inspectors.

• Kaiser failed to adequately monitor and correct its violations of state law. Records show that Kaiser was aware of its violations, but failed to take action to correct the problems.

• Kaiser provided “inaccurate educational materials” to its members that had the effect of dissuading them from pursuing medically necessary care and violated state and federal mental health parity laws.

While Kaiser Peramanente is systematically understaffing its mental health services and denying appropriate care to its paying members, the HMO is enjoying record profits — more than $2 billion a year for the past five years, $12.5 billion since 2009, and $1.1 billion in the first quarter of 2014 alone. And Kaiser lavishes huge compensation packages on its top executives: the CEO’s salary is $11.4 million and 22 executives make more than $1 million and have nine retirement plans each.

For more information, see NUHW.org/caredenied.­­­