Three elderly San Fernando Valley women who say they were duped by two salesmen for one of the nation's largest health maintenance organizations filed a lawsuit Thursday charging the firm with fraud.
The lawsuit, filed on their behalf by Bet Tzedek Legal Services, a public-interest law firm, alleges that door-to-door salesmen for FHP Inc. told them they represented Medi-Cal and Medicare and that the women could continue to be cared for by their longtime doctors if they joined the FHP health plan.
The women had been receiving health-care coverage through Medi-Cal or Medicare but after joining found that their doctors could no longer treat them because they were not FHP service providers, the suit alleges.
The suit was brought by Ada Solorzano, 81, and America Rodriguez, 78, both of North Hollywood, and Dolores Morales, 68, of Van Nuys. All three dropped from the FHP plan within one to five months.
While in the program, the women had to seek new doctors who were FHP providers or face unreimbursed medical bills. The suit, filed in Van Nuys Superior Court, seeks an injunction prohibiting FHP from misrepresentation and more than $25,000 in damages for emotional distress.
FHP officials denied any misrepresentation and said the three women, none of whom reads or speaks English, signed documents that stated in Spanish exactly what was offered in the FHP plan, the nation's 12th largest. Bruce Bodaken, a senior vice president for FHP, said the documents the women signed also state that members may only go to physicians who are FHP providers.
"We feel the allegations are simply untrue," Bodaken said. He said none of the women complained to FHP.
Solorzano said that, for 18 years, she has gone to the same doctor, whose office is only a block from her North Hollywood apartment. But after joining the FHP plan in September, she learned he could no longer treat her unless she paid outright for the services.
"The person from FHP told me I could go to the doctor I wished to," Solorzano said Thursday at a news conference announcing the lawsuit. "But I went to my doctor, and he told me I could no longer come to see him."
With no car, she also had no way of getting to doctors who were included in the FHP plan, she said.
Kurt Eggert, one of the Bet Tzedek attorneys that filed the lawsuit, said the women do not live near each other and contacted Bet Tzedek on their own. He said each complained of similar misrepresentations by FHP salesmen, indicating the problem is not an aberration.
"We believe it is a significant problem statewide," Eggert said. "If this many people have approached us, it gives us reason to believe that."
Eggert said the elderly may be easily victimized by such fraud because they are most concerned with health care. He said they rely on continuing care from physicians who know their health histories.
"I think the most serious consequence is these elderly and infirm people who rely on their doctors suddenly feel wrenched away from their doctors," Eggert said. "They feel tricked and victimized."
But FHP officials vigorously defended the Fountain Valley-based company.
Bodaken said the Spanish-speaking sales representatives who contacted the women wore FHP identification tags. He said that, after the women were enrolled, another FHP representative--who does not receive a sales commission--contacted them to verify that they understood the plan and wanted to enroll.
FHP provided copies of disclosure forms signed by the women that in Spanish say, "I understand all care must be performed or arranged by an FHP doctor."