L.A. Care Faces Record $55 Million Fine

The state of California has announced $55 million in fines against Los Angeles County’s publicly operated health plan, L.A. Care, which provides health insurance for more than 2 million Medi-Cal patients and low-income earners. It is the largest such penalty in state history, according to the Los Angeles Times, eclipsing the previous record of $10 million.

According to state regulators, L.A. Care is failing to provide timely access to care and is not addressing patients’ formal grievances. Patients with serious ailments including cancer wait months to be seen by specialists, even though health plans are required to offer their patients specialist appointments within 15 days. The health plan also has a backlog of 67,000 formal complaints that have yet to be resolved.

“The scope and breadth of violations indicate deep-rooted, systemic failures that threaten the health and safety of its members,” said Michelle Baass, director of the state Department of Health Care Services.

“The magnitude of L.A. Care’s violations, which has resulted in harm to its members, requires immediate action,” state regulators said in a news release.

L.A. Care officials have acknowledged some of the problems flagged by regulators, but described the large fines as “arbitrary and unnecessarily punitive.” While L.A. Care will fight the penalty, it has also vowed to resolve the backlog of grievances this month as it works with the L.A. County Department of Health Services to achieve “full compliance.”