The director of the state’s Department of Managed Health Care was ordered Wednesday to appear in federal court to answer charges that he violated federal law by fining Kaiser Foundation Health Plan $1.1 million for poor emergency room care.
Daniel Zingale will appear in U.S. District Court in Los Angeles on Dec. 10.
The state department fined Kaiser for failing to provide adequate emergency room service and in its case cited three incidents in which patients died or were harmed. That case is scheduled to return to state court next week.
One of those cases involved a Medicare patient, Zingale said. Federal law pre-empts state law, and Medicare patients are covered by federal law, he said.
“If this were a malpractice suit on behalf of this Medicare patient, they’d be right,” Zingale said. “But we’re using the experiences of a Medicare patient, and some non-Medicare patients, to show that there’s a deficiency in Kaiser‘s system that could affect all patients.”
Kaiser used an August ruling in federal court that said the state couldn’t impose certain rules on health plans for their Medicare enrollees.
That case was brought by the California Association of Health Plans, a lobbying group for HMOs.
Walter Zelman, the association’s executive director, said his organization filed the original lawsuit against the state regulators, asking that the state not be allowed to make regulations for HMOs concerning Medicare enrollees.
Zelman called the case a “friendly lawsuit” to clarify the state’s regulation. The association was not involved in the court action Wednesday, Zelman said.
Kaiser officials didn’t immediately return calls for comment.
Consumer advocate Jamie Court said Kaiser was “saying the state doesn’t have the right to bring up evidence” from Medicare patients’ experiences when it decides to fine a health plan.
“The state is making the case that Kaiser didn’t have adequate access,” said Court, of the Foundation for Taxpayer and Consumer Rights. “It just happens that some of the people were Medicare recipients.”