PacifiCare Errs With Diabetes Notices
PacifiCare Health Systems Inc. mistakenly sent letters to 19,000 members inviting them to participate in a special program for diabetic patients after a computer-coding error incorrectly identified them as being diagnosed with the disease.
The embarrassing snafu occurred last month after a programmer flagged a group of patients as being diabetic because they had undergone retinal exams, an indicator the plan said should not have been used to identify diabetics.
Santa Ana-based PacifiCare, the No. 1 U.S. operator of HMOs for elderly people insured through the government’s Medicare program, made the gaffe as it moves to enroll members in its Taking Charge of Diabetes program. It’s one of four the HMO is implementing in a bid to distinguish itself from competitors and help prevent fatal complications from ailments such as diabetes, heart disease and breast cancer.
“It’s an area we want to go into--doing more preventive and health-improvement kinds of work,” company spokeswoman Susan Simon said Thursday. “Clearly, we need to do some fine-tuning.”
PacifiCare has identified about 100,000 diabetics among the 150,000 members in California that it invited to enroll in the program. It’s the most advanced of the company’s so-called disease-management programs, which also cover women’s and children’s health, cardiac care and depression.
The mailing that the HMO incorrectly sent out included a wallet card to help patients keep track of exams and tests needed to prevent complications of diabetes, a questionnaire to “learn about how well you are managing your diabetes” and background materials on diabetes.
Patients and doctors called PacifiCare after they received these materials, which were mailed out Nov. 8 and 9, to complain about the mix-up.
The HMO operator on Nov. 16 sent apology letters to members, doctors and medical groups, pledging to implement oversight measures to make sure such a mistake isn’t repeated.
Separately, a medical group that treats patients insured through PacifiCare has sued the company, saying it deserves part of rebates and discounts that drug makers gave the HMO.
The suit by Monarch Healthcare Medical Group charges the HMO with fraud, unfair business practices and breach of contract. It seeks compensation in excess of $1 million and punitive damages in excess of $10 million. Monarch is one of 270 medical groups that treat PacifiCare patients in California.
The suit alleges that PacifiCare did not tell the medical groups it does business with about rebates and discounts on drugs. It says such rebates and discounts are worth about $5 per member per month for Medicare patients.
Both companies declined to comment on the status of the lawsuit, which was filed Oct. 20 in Orange County Superior Court.
