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Class-Action Suit Filed Against Dental Plan

June 30, 1993|THOMAS S. MULLIGAN | TIMES STAFF WRITER

A dentist who belongs to the Denticare of California network filed a class-action suit Tuesday, accusing the embattled managed-care plan of withholding money from him and other dentists.

In the lawsuit, filed in San Diego County Superior Court, dentist Neal Andrew Lasco of Downey echoes allegations against Denticare that were contained in a stinging June 16 audit report by the state Department of Health Services.

The department accused Laguna Niguel-based Denticare of improperly delaying and denying care to Medi-Cal enrollees, charging excessive administration fees and diverting into its own coffers money that was meant for dentists.

Denticare disputes some of the allegations laid out in the audit and plans a full reply later this week, according to a spokesman for the plan's corporate parent, Foundation Health Corp. of Sacramento.

Lasco's lawsuit, which he filed on behalf of all Denticare dentists, is believed to be the first such action against Denticare. It accuses Denticare and Foundation of misleading dentists to persuade them to join the plan, delaying payments to the dentists and improperly denying claims "for no other reason other than to maximize their profits."

Lasco also alleged that Denticare diverted fees meant for the dentists into a special "unassigned internal account" known as the "999 account."

That charge is similar to a finding in the audit report, except that the audit report deals only with Denticare's Medi-Cal customers, while the lawsuit addresses practices that affect the plan's entire 490,000-member clientele.

The Department of Health Services recommended in the report that Cigna Healthplan of Southern California, prime health care contractor for 112,000 Medi-Cal recipients in Los Angeles County, drop Denticare as its dental subcontractor. Cigna and Denticare have until Friday to respond to the audit, the Foundation spokesman said.

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