Delgadillo contends that, to save money, Blue Shield routinely fails to pull records and verify information on applications.
Augustine Simoes said he was not aware he had an elevated cholesterol level. He said his doctor prescribed Lipitor, a cholesterol controller, and explained only that men his age often needed it.
"The records of everything were at the doctor's office," he said. "I don't know why they are accusing me of lying. I didn't make anything up."
Blue Shield's Epstein said the insurer acted properly throughout. "When all the evidence is in, it will be clear that both Simoeses misrepresented significant facts on their applications," he said.
William Shernoff, a lawyer for the Simoeses and other policyholders, is cooperating with Delgadillo's office on the litigation. He criticized regulators at the Department of Insurance and the Department of Managed Health Care for "simply not doing their job."
But Cindy Ehnes, director of the Department of Managed Health Care, defended that agency's actions.
"We have protected consumers and restored coverage quickly to more than 1,200 consumers to date," Ehnes said.
Noting Anthem Blue Cross' and Blue Shield's failure to reissue coverage on rescinded policies, she said, her agency was "going back through each of their approximately 2,170 rescission cases to pursue individual fines in each case."
"The terrible practice of rescissions has caused irreparable harm . . . by making some individuals responsible for large medical bills and hindering their ability to get and keep health coverage," she said.
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lisa.girion@latimes.com
