L.A. County health plan fined for delays in treatment

A cancer patient enrolled in a health insurance plan serving Los Angeles County’s poorest and most vulnerable residents was left untreated as their health rapidly deteriorated, according to state regulators.

Another enrollee was left “suffering extreme pain” for weeks while waiting for treatment.

Treatment for a third patient, diagnosed with lymphoma and given less than a year to live, was delayed for more than two months. That patient left the plan, L.A. Care, for other insurance in a desperate attempt to save their life.

All three cases stem from “deep-rooted” failures that continue to threaten the health of patients whom L.A. Care is entrusted to serve, according to state health regulators. On Friday, the state announced $55 million in fines against the publicly operated health plan that insures more than 2 million Medi-Cal patients and other low-income recipients. It is by far the largest such penalty in state history, outstripping the previous record fine of $10 million.

The historic fines follow a state investigation sparked by a September 2020 Times article that found that patients at L.A. County run hospitals and clinics — many of whom are covered by L.A. Care — faced agonizing, sometimes deadly delays to see specialists.

While health plans are required to offer their patients specialist appointments within 15 days, The Times found the average wait at L.A. County Department of Health Services facilities was 89 days following a referral from a primary care provider.

Even patients waiting to see doctors whose prompt care can mean the difference between life and death — neurologists, kidney specialists, cardiologists — endured delays that stretched on for months, according to The Times’ analysis of 860,000 requests for specialty care at county health services department facilities from 2016 through 2019.

State regulators not only found that L.A. Care is failing to ensure that patients have timely access to care, but it is failing to authorize needed treatment and address patients’ complaints. The health plan had a backlog of 67,000 formal grievances that had not been resolved, according to documents made public Friday.

“The scope and breadth of [L.A. Care’s] 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, one of two agencies announcing sanctions.

“My hope is that this sends a strong message to the entire industry that the state takes very seriously protecting all consumers, but particularly our most vulnerable enrollees,” said Mary Watanabe, director of the Department of Managed Health Care, which imposed the largest fine, $35 million.

In an emailed statement, L.A. Care officials acknowledged some of the deficiencies found by state regulators but said it took issue with the unprecedented fines, which it described as “unreasonable and not based on facts.”

The backlog of grievances will be resolved this month, and L.A. Care is working with the L.A. County Department of Health Services to bring them into “full compliance,” the statement read.

The statement described the…