PRESCRIPTION MONITORING: Consumer Group Joins Suit Targeting Common Managed Care Practice
Consumers for Quality Care has joined a lawsuit "challeng[ing] ... the managed care industry's practice of monitoring doctors' prescription patterns," and has added PacifiCare Health Systems Inc. as a defendant in the suit, the Los Angeles Times reports. The Santa Monica-based consumer advocacy group announced Tuesday that it is joining a lawsuit originally filed by Orange County physician Donald Rickabaugh, who contends that the Greater Newport Physicians Medical Group fired him for prescribing "too many costly" drugs to elderly patients. Consumers for Quality Care added PacifiCare's California division to the suit, on the basis that "it provided data on the ousted physician's prescribing patterns." The Times reports that the advocacy group is also seeking an injunction that would ban HMOs from "the controversial practice of monitoring prescriptions." The consumer group's director, Jamie Court, said, "We are challenging a pernicious practice that every HMO in the state and most likely in the nation relies on to squeeze patients." Court claimed that the medical group and HMO "broke a state law requiring that medical decisions be made without regard to costs."
Back 'N Forth
Rickabaugh's suit, filed June 30 in Orange County Superior Court, says the medical group sent him a memo stating: "Those physicians who do not modify their behavior to be more consistent with their peers will bear some financial risk rather than penalizing all doctors with reduced compensation." But Peter Rich, the medical group's attorney, "said Rickabaugh's termination had nothing to do with his prescribing patterns and the lawsuit is unfounded." Rich said, "He was terminated because his office was run in a grossly substandard manner," adding that Consumers for Quality Care is trying to "blow this up into something that it's not." PacifiCare did not comment on the case, saying it had not "seen the lawsuit yet." However, PacifiCare spokesperson Susan Whyte-Simon said the HMO "tracks pharmacy costs for all the medical groups that serve its members" and if a medical group wants information on a doctor's prescription patterns, as did Greater Newport, PacifiCare would be obliged to release the data. Defending the monitoring practice, Rich said, "Medical groups in managed care have a job to provide medical services within a fixed budget and to do so in a way that's quality care" (Marsh, 8/12).