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Regulating HMOs is a bruising job

SUNDAY PROFILE

Cindy Ehnes, the state official in charge, often gets an earful from irked doctors, insurers, hospitals and patients.

January 13, 2008|Lisa Girion | Times Staff Writer

For example, Ehnes was the first regulator to take on the health-plan practice of dropping policyholders after they get sick. In addition to proposing new rules, she sought fines -- including $1 million from Blue Cross of California -- for alleged rescission violations.

But consumer groups say the proposed rules fall short and the fines are too small to matter to big health plans.

Physicians also say she goes too easy on health plans accused of breaking rules on doctors' fees, billing and collections.

"We have been disappointed," says Richard Frankenstein, president of the California Medical Assn.

Lt. Gov. John Garamendi -- who worked in tandem with her in his previous post as insurance commissioner -- says Ehnes' heart is in the right place.

"She was always concerned about the consumer," Garamendi says. But "she didn't always have the freedom to act as aggressively as she wanted."

lisa.girion@latimes.com

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(BEGIN TEXT OF INFOBOX)

Administering care

Who: Lucinda "Cindy" Ehnes

Age: 56

Job: Executive director, California Department of Managed Health Care

Best advice for HMO patients: The HMO Help Center, (888) HMO-2219, or (888) 466-2219, will help you get the right care at the right time.

Hobbies: Skiing, dance, hiking and, since Christmas, Wii sports

Favorite ski run: Among others, the Headwall at Squaw Valley -- steep, fast.

Personal: Bachelor of arts degree from George Washington University; law degree from Columbus School of Law. Both schools are in Washington. Has two grown daughters; lives in Fair Oaks with husband Jack Ehnes.

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