Group Sues DMHC, Alleging Inadequate Investigation of Patient HMO Complaints
A California consumer advocacy group filed a lawsuit last week alleging that the Department of Managed Health Care has inadequately investigated several patients' complaints and has not offered explanations about its arbitration decisions in favor of health plans, the Los Angeles Times reports. The lawsuit against the agency was filed by the Oakland-based California Consumer Health Care Council on behalf of nine people who had disputes with their health plans, each of whom filed a complaint with the DMHC. According to council Chair John Metz, the agency ruled in favor of the insurer in every case and failed to turn over documents used to make its decision that were requested by the patients. "This department is being held up as a model for the rest of the country. But our experience has been that they aren't enforcing the law," Metz said. DMHC Director Daniel Zingale "expressed surprise" at the lawsuit and said he would review all of the cases in question. "We've had over 100,000 people seek help from us and this is the first time I've heard of problems like this. These nine may represent areas where we need to do better or to expand patients' rights laws," he said (Carey, Los Angeles Times, 9/17).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.