DMHC issues four letters of agreement totaling $331,000 against California health plans
Sep 20, 2026 edition · GC-2026-0017 · Published 2026-09-20 · Version 2 · Settled
Four named August 26 DMHC matters total $331,000 in agreed administrative penalties. They concern distinct timely-access data, cancellation-notice, grievance-initiation and surprise-billing reporting failures. The specific records do not establish complete weekly enforcement discovery or completed payment.
What happened
Four DMHC records identify August 26 administrative-penalty agreements totaling $331,000: L.A. Care matter 24-705 for $111,000, DentaQuest matter 23-768 for $150,000, Kaiser matter 24-704 for $45,000 and Community Care Health Plan matter 24-699 for $25,000. L.A. Care’s indexed record concerns timely-access reporting and methodology. Kaiser’s detailed letter describes 114 providers that remained in its measurement-year 2021 contact list despite being marked ineligible for at least three consecutive years. The Kaiser letter cites Health and Safety Code 1367.03(f)(2)/(3) and historical regulatory language under title 28 section 1300.67.2.2(g)(2)(B); it does not list every provision cited for L.A. Care. These are agreed penalties in specific matters, rather than verified receipts of payment or a complete weekly result set.
DentaQuest’s letter identifies 1,288 of 3,066 enrollees cancelled for nonpayment in 2023 who did not receive required grace-period or cancellation notices. Automated-card users received notices, while check or money-order users did not. It separately finds a failure to initiate a grievance after an enrollee complained about access and requested a refund, rather than finding that the entire grievance system lacked approval. Community Care’s indexed record addresses the number of payments to noncontracting providers at contracting facilities and related reporting data under Health and Safety Code 1371.31(a)(4), not a title 28 citation. Together, the matters illustrate how data preparation, notice generation and complaint classification can produce distinct compliance failures even when described under broad reporting categories.
Scope and timing
- Authority status
- Settled
- Applicability
- Operationally relevant
- Audience
- Health systems, Provider networks
- Jurisdiction
- California
Why it matters
Different reporting failures need different controls. A provider contact list, payment-method-dependent cancellation notices, grievance intake and noncontracting-provider payment data cannot be tested through a single generic filing-calendar check.
Recommended action
Plans and delegates should identify owners for each relevant filing, validate source-data methodology, sample required notices across payment channels, and test whether expressions of dissatisfaction become grievances when appropriate. Verify each applicable statutory/regulatory citation and the organization’s actual role rather than assigning all four plans identical violations.
Case details
- agencies
- California Department of Managed Health Care
- entities
- Local Initiative Health Authority for Los Angeles County d.b.a. L.A. Care Health Plan, California Dental Network, Inc. d.b.a. DentaQuest of California, Kaiser Foundation Health Plan, Inc., Community Care Health Plan, Inc.
- action Type
- Settlement
- event Date
- 2026-08-26
- alleged Conduct
- Distinct matters: L.A. Care timely-access reporting; Kaiser repeated retention of ineligible providers in the MY 2021 contact list; DentaQuest missing notices and grievance-initiation failure; Community Care surprise-billing data reporting.
- resolution
- Four August 26, 2026 action records/agreements with penalties of $111,000, $150,000, $45,000 and $25,000, totaling $331,000. Completed payment is not separately established; selected named records do not establish exhaustive weekly coverage.
Operational lessons
- Test each filing against its own actual data requirements and methodology.
- Sample cancellation notices across payment methods rather than only automated-card workflows.
- Test grievance initiation, not an unsupported claim that a whole system was unapproved.
- Keep Health and Safety Code 1371.31(a)(4) distinct from title 28 regulatory citations.
Related coverage
L.A. Care is a Medi-Cal managed care plan, so the timely access reporting theory is also a managed care operations signal for the payer product. Medicare & Medicaid →
Sources
- DMHC Letter of Agreement, matter 24-705 (L.A. Care Health Plan)Official · California Department of Managed Health Care · 2026-08-26 · Source review 2026-09-10
- DMHC Letter of Agreement, matter 23-768 (DentaQuest of California)Official · California Department of Managed Health Care · 2026-08-26 · Source review 2026-09-10
- DMHC Letter of Agreement, matter 24-704 (Kaiser Foundation Health Plan)Official · California Department of Managed Health Care · 2026-08-26 · Source review 2026-09-10
- DMHC Letter of Agreement, matter 24-699 (Community Care Health Plan)Official · California Department of Managed Health Care · 2026-08-26 · Source review 2026-09-10
- DMHC L.A. Care official indexed action 24-705 dated August 26Official · California Department of Managed Health Care · Source review 2026-10-15
- DMHC Community Care official indexed action 24-699 dated August 26Official · California Department of Managed Health Care · Source review 2026-10-15
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