Kaiser’s health plan to pay $82M in emergency reimbursement dispute

 A California judge entered a final judgment that called on Kaiser Foundation Health Plan, part of Oakland, Calif.-based Kaiser Permanente, to pay more than $82 million to the state’s Pomona Valley Hospital Medical Center over concerns of insufficient emergency care reimbursement, according to a June 23 state superior court document.

Along with the $82 million, the insurer must pay another $12,675 per day after the June 23 decision until entry of the judgment.

“Pomona Valley Hospital is extremely pleased that the Court of Appeal affirmed the jury’s award and that the hospital can finally be paid the reasonable value of the high quality services it provided to Kaiser members,” the hospital’s legal team told Becker’s June 25.

The action was first filed following a Kaiser contract termination in 2017, and the case faced a jury trial in 2023. The hospital said Kaiser only paid about $39.8 million out of $136.6 million in total billed charges from October 2017 through March 2020.

After Pomona Valley Hospital Medical Center won the jury trial, the court conditionally granted Kaiser’s motion for a new one. While the hospital accepted a reduced verdict to avoid the new trial, both parties appealed. The appellate court eventually reinstated the original $66 million jury verdict in 2026, just with a lower prejudgment interest rate. The California Supreme Court denied Kaiser’s petition for review.

Several hospitals have sued Kaiser Permanente’s health plan based on similar allegations, including Renton, Wash.-based Providence hospitals in California.

Kaiser told Becker’s it works within California law to address emergency care outside of its health plan’s network and uses hospital financial reports to determine fair payments.

“When hospitals sue for higher payouts, they generally seek far more than what they receive from other health plans. Kaiser Permanente’s payments to Pomona Valley Hospital exceeded what the hospital typically accepted from other health plans and were substantially above its costs,” Kaiser told Becker’s June 25. “Other court and arbitration cases have found that our payment methodology resulted in payments that met or exceeded the fair market value of services.”

https://www.beckershospitalreview.com/finance/kaisers-health-plan-to-pay-82m-in-emergency-reimbursement-dispute/