State fines largest Medi-Cal managed care plan $55 million for serious violations

March 08, 2022

On Friday, the California Department of Managed Health Care (DMHC) and the California Department of Health Care Services (DHCS) levied $55 million in fines against L.A. Care, the state’s largest Medi-Cal managed care plan. This consists of a $35 million penalty from the DMHC and $20 million sanction from the DHCS.

The two departments conducted coordinated investigations into the plan’s violations and worked together on the respective department actions. The departments’ investigations found several serious violations by the plan, including L.A. Care’s handling of enrollee grievances, the processing of requests for authorization, and inadequate oversight and supervision of its contracted entities regarding timely access.

L.A. Care disclosed to DHCS…