The California Department of Managed Health Care (DMHC) has imposed an $819,150 fine on Kaiser Permanente for delays in addressing health plan member complaints—most of which occurred during the post-COVID care surge.

According to the DMHC, 61 cases triggered the fine after investigations revealed systemic delays, including failure to acknowledge grievances within five days (14 cases) and failure to respond within the mandated 30-day window (54 cases).

“Complaints are a critical healthcare right,” said DMHC Director Mary Watanabe. “Health plans are legally obligated to resolve grievances promptly and inform members of their appeal rights.”

Kaiser Permanente acknowledged the issue, citing pandemic-era care demands that overwhelmed their system starting in 2021. “We are sorry to have missed the mark,” said a Kaiser spokesperson. “Since then, we’ve expanded our grievance team to better serve our members and meet regulatory expectations.”

Why It Matters
Timely complaint resolution is not just a regulatory requirement—it’s a vital aspect of patient-centered care. California law mandates health plans to provide written acknowledgment of complaints within five days and a resolution within 30, along with clear information about appeal rights.

What Members Should Know
If a health plan fails to resolve a non-urgent complaint within 30 days—or if a member disagrees with the resolution—they may escalate the issue to the DMHC Help Center. For urgent concerns, members can bypass the plan’s process and contact the DMHC directly.