San Diego Union-Tribune Examines Legal Battles Facing Daniel Zingale and DMHC
The San Diego Union-Tribune today reports on the "legal challenges" facing Department of Managed Health Care Director Daniel Zingale. While Zingale has received "high marks" in the past from both physicians and health plans for his "even-handed, diplomatic" approach to regulating the managed care industry, now "his department and the industry it regulates are heading into a more contentious phase," the Union-Tribune reports. "[T]hese days," the agency is often "tied up" in legal battles over the scope of the department's authority. Recent court cases are briefly described below.
- A state Superior Court ruled that the agency cannot fine Blue Shield of California for not covering a weight-loss drug for an obese plan member.
- A federal court ruled that the agency has "limited regulatory control" over Medicare+Choice plans.
- Kaiser Permanente is currently attempting in state court to overturn a record $1.1 million fine brought by the DMHC for inadequate care at its hospitals.
- Kaiser Permanente aksed a federal court judge to place Zingale in contempt of court for attempting to regulate Medicare HMOs, but that request was denied.
- The California Medical Association sued the agency to prevent it from publicizing the financial records of state medical groups.
Zingale and the HMO industry say there is "no real pattern" to the lawsuits. Walter Zelman, CEO of the California Association of Health Plans, said the industry "is not attempting to undermine the department's role as a regulator," adding, "The kind of legal issues that have arisen are generally one plan versus the department. I know there's no overall strategy here." Still, Zingale said he would "rather have [the department's] lawyers working on patient-care issues" than on fighting lawsuits with HMOs.
While Zingale said that each challenge by a managed care organization has the "potential to erode the department's power," the Union-Tribune reports that a case before the U.S. Supreme Court could "eliminate" much of the agency's authority. The case, Rush Prudential HMO Inc. v. Moran, will determine whether states can require health plans to cover patient care that is recommended by an outside independent party. The case involves an HMO that has been "battling in court" since 1998 with Illinois over an order by an independent review board for the HMO to provide a $98,000 operation for a patient. A court ruling that HMOs do not need to honor decisions by independent reviews would "gut" California's 1999 patients' bill of rights, which grants Californians the right to such reviews, Zingale said (Fong, San Diego Union-Tribune, 2/6).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.