National Committee for Quality Assurance (NCQA) suspended the health
plan's current accreditation status while it completes an
according to a joint written statement released Monday.
on Tue, Jun. 10, 2003 story:PUB_DESC
investigates Kaiser health plan
Two employees fired after letters are altered. Accreditation
By Cheryl Powell
Beacon Journal medical writer
national accrediting agency for health insurers is investigating Kaiser
Foundation Health Plan of Ohio after the plan reported that two workers
altered letters for an accreditation review.
depend on accreditation because many companies use it to help
decide which health plan to choose.
temporarily losing accreditation won't affect Kaiser's 151,000
enrollees in Northeast Ohio, said Patricia Kennedy-Scott, the health
not have any impact on our members or employers or contracts,''
said she is sure Kaiser will regain its accreditation
when the review is completed.
is finishing its ongoing review of Kaiser and should decide within
the next several weeks whether to accredit the insurer, spokesman Barry
A. Scholl said.
self-disclosed quite promptly,'' he said. ``It's something, I
think, that speaks about the integrity of the plan.''
notified NCQA immediately after discovering that two employees
changed the language in fewer than 10 archived letters denying members'
request for medical services, Kennedy-Scott said.
wording in the letter was changed to meet NCQA requirements, not
to alter Kaiser's decision to deny the members' requests, Kennedy-Scott
was discovered in late May after someone anonymously called
a company hot line set up to report improprieties, Kennedy-Scott said.
launched an internal investigation and later fired the workers
and reported the problem to NCQA, Kennedy-Scott said. The insurer has
another company to conduct an external review as well.
nonprofit firm that gives voluntary accreditation to managed-care
their accreditation was suspended, Kaiser's commercial plans
had an ``excellent rating,'' the highest status available. Kaiser's
HMO was rated ``commendable,'' the second-highest ranking.
committee's review process measures such things as access to services,
the quality of the provider panel and how well the plan helps members
healthy, get better and live with illnesses.
few of the employer groups contracted with Kaiser require NCQA
Kennedy-Scott said. The insurer is working with those companies.
Cheryl Powell can be
reached at 330-996-3902 or firstname.lastname@example.org