KEY POINTS
- Kaiser Foundation Health Plan will pay roughly $30 million in settlement with U.S. Department of Labor.
- Federal probes found inadequate mental health and substance use disorder care networks.
- Kaiser commits to network improvements and policy reforms to improve access.
Kaiser Foundation Health Plan has reached a roughly $30 million settlement with the U.S. Department of Labor. The agreement resolves multiple federal investigations into its mental health and substance use disorder care practices.
Federal officials said the probes uncovered deficiencies in provider networks for mental health services. Investigators also found improper use of patient questionnaire responses to deny coverage.
Under the settlement, Kaiser will reimburse members who paid for out-of-network care because adequate in-network services were unavailable. A significant portion of the settlement funds will go directly to those members.
In addition to reimbursements, Kaiser will pay a federal penalty as part of the agreement. The settlement lays out financial and operational commitments to address care gaps identified by investigators.
Kaiser acknowledged improvements to its mental health care system but said the settlement does not reflect current practices. The company said it has been working to enhance service delivery for members.
As part of the agreement, Kaiser agreed to adopt reforms aimed at reducing appointment wait times. The insurer also plans to overhaul care review processes to ensure members receive medically necessary treatment without undue barriers.
The Labor Department’s action stemmed from enforcement of federal mental health parity laws. These laws require that coverage for mental health and substance use disorder services be on par with medical and surgical care.
Investigators said Kaiser’s provider network issues made it difficult for members to access timely care within the plan’s network. The improper reliance on questionnaire responses to limit care was cited as another area of non-compliance.
The reforms Kaiser committed to include ongoing monitoring of network adequacy. The insurer will work to ensure that members can find in-network providers for mental health services when needed.
The settlement is separate from a larger state-level action Kaiser previously faced in California over similar mental health coverage concerns. It underscores continued federal scrutiny of behavioral health parity compliance.
Kaiser serves millions of members nationwide. The settlement’s reimbursement and reforms aim to improve access to mental health and substance use disorder care under employer-sponsored plans subject to federal oversight.
