SACRAMENTO, Calif.--()--The original “whistle blower” who blew the lid off corruption in the City of Bell continued his work as a community advocate, this time at the state level. City of Bell Councilmember Nestor Enrique Valencia and Our SALUD activist Elba Romo took on the Department of Managed Health Care’s Financial Solvency Standards Board (FSSB) Thursday to shine a light on wrongdoing and conflicts of interest that are injuring people in the Los Angeles region.
“It’s not a solvency issue. It sounds to me like it’s a licensing issue.”
Today’s FSSB meeting takes up the issue of Accountable Care Organizations (ACO) and the manner in which ACOs should be regulated by the Department of Managed Health Care. The Financial Solvency Standards Board makes important decisions on the expansion of healthcare, yet FSSB Board Chair Keith Wilson, M.D., is the Regional Medical Director for HealthCare Partners (HCP), a pioneer ACO operating as an unlicensed HMO, putting profits before patients.
“It is outrageous, it puts the fox in the hen house, and lets the fox write the rules for the chickens!” said City of Bell Council member and Our SALUD advocate Nestor Enrique Valencia.
At the time of public remarks, Mr. Valencia addressed the board, insisting the board conduct an internal review to discover what is already apparent to Our SALUD.
“On behalf of Our SALUD, we demand the removal of Dr. Wilson from the board as it is a significant conflict of interest for him to advise state regulators on any matters that concern determining the standards by which ACOs, medical groups, or any other entities can or should be licensed,” said Mr. Valencia.
“Patients’ lives are at stake. We are shining a light on decisions that are putting people at risk,” said SALUD’s Elba Romo.
As a result of a recent protest in Los Angeles and demands by Our SALUD, the Department of Managed Health Care has initiated an investigation into HCP’s illegal and substandard hospital network and the fact that the medical group is operating as a health plan without a license.
“At a minimum the appearance of impropriety and conflict of interest merit Dr. Wilson’s removal until the DMHC concludes its investigation, anything less taints the process,” said Elba Romo of Our Salud.
Specifically, the Political Reform Act, Gov Code section 87100 prohibits a government official from making decisions on subjects in which he has financial interest. In Clark v. City of Hermosa Beach (1996) the court found that the common law (against appearance of impropriety) is violated if the government official is even tempted by his own financial interest.
Our SALUD advised DMHC Director Brent Barnhart that if he is unwilling to remove Dr. Wilson from the FSSB Board they will take this issue to the Attorney General and request that the AG remove Dr. Wilson until she concludes her investigation. These requests include immediately turning over, per the Public Records Act, all communications between the FSSB and Dr. Wilson and DMHC and Dr. Wilson so that the public and the Legislature can scrutinize what is going on. The Attorney General asserts in AG Opinion 70 that where a conflict exists, the official shall be removed.
Allowing Dr. Wilson to stay gives the public the perception DMHC is covering up HCP’s unlawful operation. In fact, DMHC’s FSSB roster on its website identifies Dr. Wilson as Talbert Medical Group. The DMHC does not address the fact that Talbert Medical Group was acquired by HCP but rather allows Dr. Wilson to serve under a misrepresentation.
These fundamental enforcement obligations have been neglected by the board and therefore by the DMHC. This includes the recent merger between the unlawful entity, HealthCare Partners and DaVita that was recently finalized.
A class action lawsuit filed on behalf of HealthCare Partners’ patient Juan Carlos Jandres is an example of the human toll of the DMHC’s lack of oversight of HCP. A young man, who received care through Health Net’s commercial product and HealthCare Partners’ medical group, spent months trying to have a growth in his mouth diagnosed and treated. He was told by HCP’s doctors and substandard community hospital network that he was fine and to stop worrying. He finally went to a high quality hospital and paid out of pocket for his care. The physicians found a malignant tumor in the roof of his mouth and performed major surgeries to remove the growth and many of the bones in his face. He required prosthesis to rebuild his face so he could return to work.
Juan Carlos Jandres’ injuries were a direct result of being denied appropriate care by HCP. Through the suit he has essentially taken on DMHC’s role in part, investigating just how many other patients were impacted the way he was.
“We in the Los Angeles community and we in the Latino community say NO MORE. We will no longer stand idly by while our families are given second class care by unlicensed HMOS like DaVita-HCP and their DMHC coddlers! No more Juan Carlos Jandres who lost half his face and almost his life to a cancer because Health Care Partners accepted too much risk and then put their profits ahead of his care!” said Valencia.
After remarks were made by Mr. Valencia and Ms. Romo, Dr. Wilson denied his affiliation as an officer of HCP and excused himself from the room as the board discussed the placement of this issue on future agendas.
Board members commented they were confused as to what exact topic item would be up for discussion stating, “It’s not a solvency issue. It sounds to me like it’s a licensing issue.” Others noted the gravity of the statements saying, “Serious allegations have been raised here.” The board agreed to defer the decision of placing this issue on an agenda to the DMHC.
“Everything on the agenda Thursday is a fool’s errand. The rules, or potential rules don’t matter if they are not equally enforced. The DMHC is whistling past the graveyard, suggesting more rules when it does not even enforce the most basic rules they have had on the books for four decades,” explained Ms. Romo.
Our SALUD is a grassroots coalition and healthcare watchdog representing civic, community, and business leaders from the Southern California Latino communities. Our members are just some of the patients impacted by the unlawful operation of a Torrance-based medical group, HealthCare Partners. A recent class action alleges that Health Care Partners, managing 675,000 patient lives, is illegally accepting global risk without a health plan license and that this unlicensed operation has harmed the care of members.