Health Maintenance Organizations

State health officials have accused a Southern California HMO that serves indigent Medi-Cal members of marketing fraud, mishandling of consumer complaints and making it hard for members to quit the health plan. The state warned Tower Health Services that it may ban the HMO from enrolling new members for 90 days unless the firm moves quickly to fix numerous problems cited in a June 10 audit report.

A leading health insurer is trying to quell a growing chorus of critics who accuse managed-care plans of padding their profits by gagging doctors from telling their patients about more expensive treatment options. US Healthcare, a health maintenance organization with more than 2.2 million members, said Friday that it is replacing a clause that restricted what doctors could say with a clause that protects their freedom of speech. The Blue Bell, Pa.

From large employer alliances to small senior citizen groups, an increasing number of consumers want to know how California's health maintenance organizations are spending their health-care dollars. They want to know how much goes to providing medical care as opposed to paying for salaries, advertising, paperwork and profits. How much an HMO spends on doctors, hospital and other direct medical expenses is not, by itself, an accurate gauge of of overall medical quality, health-care experts say.

A Los Angeles consumer group said its study of managed-care health plans that serve the poor raises new concerns about the quality of medical care in these plans and the effectiveness of oversight by state regulators. A report released this week by the Center for Health Care Rights concludes that health maintenance organizations can vary widely in the amount of care they provide Medi-Cal patients.

PacifiCare Health Systems Inc. is pushing legislation that would limit the state's power to investigate health maintenance organizations. The measure, SB 2061, set for a state Senate committee vote today, would limit state access to confidential health-plan documents, including patient records, those involving review of physician activities and plan decisions, and its internal financial and administrative operations.

State regulators are failing to protect the interests of 12 million Californians who belong to health maintenance organizations because of weak oversight of the fast-growing managed-care industry, a consumer watchdog group said Thursday. Consumers Union charged in a report released by its regional office in San Francisco that the California Department of Corporations is "failing to fulfill one of its primary responsibilities: educating and informing consumers about HMOs."

You see them at the grocery store and again at the swap meet: petitioners gathering signatures for a statewide initiative on the November ballot to curb unpopular activities of the managed care industry. Trouble is, various sponsors, including consumer and labor groups, couldn't agree on language for one initiative. So there are two out there. Both contain similar protections for consumers.

The American Assn. of Retired Persons is laying the groundwork for endorsing certain health maintenance organizations for the first time, which could mean big business for HMOs seeking to attract the lucrative market represented by consumers who will never see 50 again. The proposed HMO program could also generate big returns for the 33-million-member AARP, which already garners more than a third of its annual income from the royalties paid by health and other insurers.

The state of California said Tuesday that it will investigate whether PacifiCare of California is violating state law by refusing to recommend a chicken-pox vaccine to its members. The HMO, a statewide subsidiary of PacifiCare Health Systems Inc. in Cypress, has come under fire from a consumer group for failing to endorse the widely accepted preventive measure.