Group Decries HMO Practice of Monitoring Prescriptions

A consumer advocacy organization has mounted a legal challenge to the managed-care industry’s practice of monitoring doctors’ prescription patterns, claiming that the practice pressures physicians to hold down costs.

Consumers for Quality Care has joined a lawsuit in Orange County in which a physician claims he was illegally ousted from a large Newport Beach medical network in March after prescribing expensive medications for his elderly patients.

The advocacy group also added PacifiCare Health Systems Inc.’s California health plan as a defendant, claiming it provided data on the ousted physician’s prescribing patterns.

In a move that attempts to discourage the managed-care industry from the controversial practice of monitoring prescriptions, the group seeks an injunction banning such efforts by HMOs.

Santa Monica-based group contends that the physicians group and PacifiCare broke a state law requiring that medical decisions be made without regard to costs.

In the original lawsuit, Dr. Donald E. Rickabaugh claims he was removed from Greater Newport Physicians Medical Group Inc., a network of about 200 Orange County physicians under contract with managed-care plans, for authorizing too many costly prescriptions.

Peter Rich, a lawyer for the medical group, said Rickabaugh’s termination had nothing to do with prescribing patterns. “He was terminated because his office was run in a grossly substandard manner,” Rich said. A PacifiCare spokesperson wouldn’t comment.