L.A. Care Health Plan is pleased to announce it has reached a settlement with the State of California Department of Managed Health Care (DMHC) and the Department of Health Care Services (DHCS) related to a 2022 case involving L.A. Care’s self-reported issues with processes for administering treatment authorizations and with member appeals and grievances. L.A. Care took issue with the extreme proposed amounts for the fines, which it viewed as disproportionate to the value it brings to members and its network of safety net providers. The health plan filed a protest and successfully negotiated to divert some of the proposed fine to investment that will benefit L.A. Care’s members and the communities where they live.
L.A. Care is also pleased that the penalty portion of the fine has been substantially decreased to less than half of the initial assessment. Having the majority of the funds allocated toward community investments is a priority consistent with L.A. Care’s commitment to advancing health equity. Having already committed more than $500 million to address the social needs of the communities it serves, as a result of this settlement, L.A. Care will commit another $28 million to this effort over the next three years to support our members and their providers by strengthening the health care delivery system. This will be over and above L.A. Care’s recurring annual investments.
L.A. Care appreciates DMHC and DHCS’s willingness to come to agreeable terms that further enhance our service to our communities and is proud of our efforts to provide high quality health care to L.A. County’s most vulnerable residents. We will continue to be transparent, responsible and accountable to our more than 2.6 million members and their well-being.