Posted on Tue, Jun. 10, 2003 story:PUB_DESC 

Agency investigates Kaiser health plan
Two employees fired after letters are altered. Accreditation on hold
By Cheryl Powell
Beacon Journal medical writer

A 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.

The National Committee for Quality Assurance (NCQA) suspended the health plan's current accreditation status while it completes an investigation, according to a joint written statement released Monday.

Insurers depend on accreditation because many companies use it to help decide which health plan to choose.

However, temporarily losing accreditation won't affect Kaiser's 151,000 enrollees in Northeast Ohio, said Patricia Kennedy-Scott, the health plan's regional president.

``It does not have any impact on our members or employers or contracts,'' she said.

Kennedy-Scott said she is sure Kaiser will regain its accreditation when the review is completed.

NCQA 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.

``They self-disclosed quite promptly,'' he said. ``It's something, I think, that speaks about the integrity of the plan.''

Kaiser 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.

The wording in the letter was changed to meet NCQA requirements, not to alter Kaiser's decision to deny the members' requests, Kennedy-Scott said.

The breach was discovered in late May after someone anonymously called a company hot line set up to report improprieties, Kennedy-Scott said.

Kaiser launched an internal investigation and later fired the workers and reported the problem to NCQA, Kennedy-Scott said. The insurer has hired another company to conduct an external review as well.

NCQA is a nonprofit firm that gives voluntary accreditation to managed-care plans.

Before their accreditation was suspended, Kaiser's commercial plans had an ``excellent rating,'' the highest status available. Kaiser's Medicare HMO was rated ``commendable,'' the second-highest ranking.

The committee's review process measures such things as access to services, the quality of the provider panel and how well the plan helps members stay healthy, get better and live with illnesses.

A few of the employer groups contracted with Kaiser require NCQA accreditation, Kennedy-Scott said. The insurer is working with those companies.
Cheryl Powell can be reached at 330-996-3902 or chpowell@thebeaconjournal.com