NUHW investigation sparks complaint against Kaiser

NewsMarch 14, 2024

In recent years, it’s become clear that Kaiser Permanente treats its mental health clinicians and patients worse in Southern California than in Northern California.

Despite Kaiser’s chronic understaffing and documented parity violations, its Southern California management team has insisted on paying clinicians lower salaries with poorer benefits, while illegally cutting Patient Management Time and refusing to collaborate in previous Model of Care committees.

Now, as we await Kaiser’s written plan for fixing the serious violations detailed in its$200 million settlement with the California Department of Managed Health Care, NUHW has identified additional violations in Southern California.

Last month, we filed a 54-page complaint with the agency alleging multiple violations of state law. The apparent violations relate to an outside contractor that provides virtual mental health therapy to thousands of Kaiser members in Southern California.

Here’s what our investigation found:

In 2022, Kaiser began contracting with a company called Path Mental Health to provide therapy to Kaiser members with anxiety, depression, PTSD and other diagnoses. (Path recently changed its name to “Rula Health.”)

As part of its contract, Kaiser requires Path to perform clinical care reviews after each Kaiser member has received a certain number of appointments in order to determine whether they meet medical necessity criteria to receive ongoing treatment. If not, Kaiser members must pay cash to continue receiving therapy.

We believe these arrangements violate state and federal laws:

  • Path is not licensed to perform such reviews.
  • The employees Path selected to perform the reviews also aren’t licensed to perform them.
  • The criteria Path uses to perform the reviews, such as PHQ, GAD and AUDIT-C, are illegal under state law. Instead, our laws require providers to use the criteria developed by the nonprofit professional association for the relevant clinical specialty, such as LOCUS, CALOCUS, ASAM and CASII.

But it gets worse.

In violation of patients’ rights, Path apparently instructed its therapists not to inform Kaiser members of negative medical necessity determinations and not to place notes in their medical charts about the determinations. That makes it nearly impossible for Kaiser members to challenge the determinations.

We’ve asked state authorities to perform retrospective reviews of every patient whose care was terminated by Path, investigate Kaiser’s requirements for its other contractors, and punish Kaiser for any violations – including refunding money that Kaiser members paid out of pocket for care that Kaiser should have funded.

We’ll keep everyone informed about the investigation.