NUHW investigation uncovers new Kaiser mental health violations

NewsMarch 24, 2024

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As Kaiser prepares its written plan for fixing the serious violations detailed in its $200 million settlement with the California Department of Managed Health Care (DMHC), NUHW has identified potentially more violations of state mental health law.

NUHW recently filed a 54-page complaint detailing violations in connection 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 conditions. (Path recently changed its name to Rula Health.)

As part of its contract, Kaiser requires Path to evaluate each Kaiser member’s medical condition after they’ve had a certain number of appointments, and then to determine whether or not they should continue receiving insurance coverage for their treatment. If not, Kaiser members must pay the full cost of each appointment in order to continue receiving therapy.

NUHW believes these arrangements pose several problems:

  • 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 are illegal under state law.

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 the DMHC 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 been funded.

“The findings of our investigation are alarming because they call into question whether Kaiser truly intends to honor last year’s Settlement Agreement,” NUHW President Sophia Mendoza said. “We expect state regulators to take strong action to protect patients and ensure that state oversight of Kaiser extends to all Kaiser members, including those who are sent outside of Kaiser’s provider network for mental health care.”