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These failures described in the report are serious enough to merit extensive investigations by federal and state authorities. There have also been various lawsuits filed by private and public customers. The report also found that in spite of receiving over ten 10 billion dollars per year from Medicare in order to provide various medical services, Kaiser was improperly coding evaluation procedures for patients, resulting in potentially fraudulent claims being made to Medicare.
This same report, in addition to various investigations undertaken by state authorities, found that Kaiser often violated California health laws that require HMOs to provide their customers with prompt and timely access to necessary medical services. These violations were largely reported by clinicians within Kaiser who acted as whistleblowers.
They reported that patients were frequently made to wait at least four 4 weeks for follow-up appointments. This is in direct violation of a California law that mandates a waiting period of no more than ten 10 days for follow-up and initial visits. When the medical evaluations finally did take place, the clinicians reported that they were generally cursory, limited, and insufficient, even though Kaiser required them to code the evaluations to claim they were comprehensive and thorough.
It is important to note that these clinicians were subject to employment contracts and productivity expectations that effectively required them to perform the evaluations as delineated by the HMO. A particularly distressing statistic is that in a survey conducted of three-hundred and five Kaiser physicians, almost ninety 90 percent of them claimed that they could not provide timely access to medical services due to chronic and widespread understaffing at their clinics.
Furthermore, in the regulatory agency known as the California Department of Managed Health Care also referred to as the DMHC cited Kaiser for failing to provide its clients and patients with timely access to mental health care.
Following an investigation, the DMHC determined that this failure to provide a timely diagnosis was a breach of contract with the patient and client and that it was inherently unreasonable to delay a vital diagnosis for so long.
This is particularly true if there has been a pattern of behavior established in which the company frequently fails to perform its basic duties as a healthcare provider. Investigations have also indicated that Kaiser has allegedly falsified scheduling records for patients. This unscrupulous practice was undertaken in an effort to avoid citations from state regulators for medical service and lengthy appointment delays.
These same whistleblower clinicians have also indicated that not only does Kaiser falsify scheduling records, but that the company has frequently required clinicians to perform patient evaluations as well as other services that fall far short of accepted clinical standards. There have been extensive allegations, particularly in the city of San Diego, that Kaiser has allegedly required its treatment providers to spend half the recommended amount of time for assessing, diagnosing, and examining patients.
Further investigation of these allegations has resulted in whistleblower clinicians claiming that these unsavory practices are repeated in clinics all over the state of California. It is important to note that these clinicians are protected under California labor laws from being retaliated against.
If you believe that you are the victim of one of these unscrupulous practices, then you may need to seek out the professional counsel of a law firm that specializes in healthcare denial. They may be able to present a compelling case that Kaiser, as your HMO, failed in its fundamental duty to provide you with adequate and timely access to medical services. If the investigation deems that Kaiser did effectively violate one or both of these statutes, then the Attorney General may file a lawsuit on behalf of aggrieved customers or independently seek to impose punitive measures on the HMO.
If it is determined that these accusations have merit, then the contract between Kaiser and the Medi-Cal and Healthy Families program may be terminated. This would be a major punitive measure as Kaiser makes a great deal of its profit from providing services to the state of California.
The accusation is that Kaiser made false claims for mental health services under the Medicare Advantage program. If these accusations also have merit, then the HMO may find this working relationship terminated as well. This has also spurred California congress, most notably the Assembly and Senate Health Committees, to review the findings of these various studies and investigations.
Depending on their conclusions, they may enact additional safeguards to more stringently protect California consumers in the future.
Other public and private entities who pay for health insurance from Kaiser are initiating comprehensive audits to determine if the company has defrauded or failed its customers. Depending on what these audits find, these entities may become involved in litigation against the healthcare provider.
In this case, the company categorically refused to provide coverage for reconstructive surgery to remove excess skin following massive weight loss. Kaiser stated that they would only approve the claims if the patients suffered from functional problems. These various patients were repeatedly denied their insurance claims and found themselves with no choice but to file a lawsuit.
This law is officially codified as Health and Safety Code, Section As a result of Gallimore v. Furthermore, any patients who are hoping to sue the HMO for medical malpractice must also go through this same arbitration process.
In most cases, the results of the arbitration process will be upheld by the court. There may, however, be some narrow and specific exceptions to that rule. Any customer who purchases coverage from Kaiser enters into a contract with the company by which they are subject to the arbitration contract. However, due to the binding arbitration, if a patient feels that they are being unfairly or unjustly denied coverage, then they can choose to go through the entire arbitration process.
Arbitration is a commonly used and widely accepted alternative to conventional court-based litigation. It is essentially a private moderation of some conflict, the results of which are almost always upheld by the public courts. This arbitrator then rules on the case and determines if the plaintiff is entitled to any kind of compensation or damages. Let us work to secure the compensation you deserve.
Kaiser Permanente has more than , employees. This is a massive employer, particularly here in the Los Angeles and surrounding areas. Just because a company is large and established does not mean they are free from wrongdoing. In fact, it means that they are often better at covering it up. In many cases, Kaiser Permanente workers face discrimination , harassment, and wrongful termination. That is where our Los Angeles Kaiser Permanente attorneys come in. We have in-depth knowledge of the structure of their organization, their union issues, and arbitration clauses.
We are well aware of the tactics this company uses against its employees, especially in wrongful termination cases. We have seen them make false claims against workers for charting issues, HIPAA violations, improvement plan failures, and disciplinary policy issues. State and federal laws protect employees from discrimination and harassment in the workplace. Our team is ready to step in and help any employee of Kaiser Permanente, including doctors, surgeons, nurses, IT professionals, and more.
Workers in the healthcare industry must be able to raise concerns about patient safety and unsafe work environments. There are three areas of law that we will use to protect workers who raise concerns their safety and the safety of patients:. When an employee of Kaiser Permanente draws attention to unsafe conditions or unethical practices, there are various ways in which the company might retaliate against them. The following are just a few common examples:. Those are just a few examples. We can help you better understand if you have grounds to take legal action.
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