Health Care & Reproductive Rights

SAN FRANCISCO – Attorney General Kamala D. Harris today issued the following statement in response to the U.S. Supreme Court’s announcement that it will hear Kathleen Sebelius v. Hobby Lobby Stores, Inc.:

“Under the Affordable Care Act, all Americans have the right to access affordable, quality healthcare, including contraception,” Attorney General Harris said. “For profit companies should not be able to deny women access to healthcare based on the religious beliefs of the company’s owners. The 10th circuit ruling should be reversed by the U.S. Supreme Court.”

In October, Attorney General Harris filed a friend-of-the-court brief in the U.S. Supreme Court asking the court to take up this case and was joined by ten states including Connecticut, Hawaii, Illinois, Iowa, Maine, Maryland, New York, Oregon, Vermont, and Washington.

A copy of the first brief is attached to the electronic version of this release at oag.ca.gov/news.

SAN FRANCISCO -- Attorney General Kamala D. Harris today announced the removal of ten private health insurance websites that misled Californians by imitating Covered California, the state’s official insurance marketplace for the Patient Protection and Affordable Care Act (ACA). Attorney General Harris also released tips to help consumers avoid insurance scams.

“These websites fraudulently imitated Covered California in order to lure consumers away from plans that provide the benefits of the Affordable Care Act,” Attorney General Harris said. “My office will continue to investigate and shut down these kinds of sites. I urge Californians to avoid healthcare scams by visiting coveredca.com.”

In September, the California Attorney General’s office began an investigation into websites that imitate the state’s Covered California website (www.coveredca.com). Multiple website operators were sent cease and desist letters informing them that their websites were in violation of state law and demanding the immediate removal of the website or transfer of the domain name to the state’s official exchange.

These websites were operated by private health insurance brokers or companies that were not affiliated with Covered California. The websites have domain names similar to the state’s official healthcare exchange and contain unauthorized references to the official exchange’s trademarked logo and name. In several cases, websites used the phrases “Get Covered,” “Covered California” and “California Health Benefit Advisers.”

The California Affordable Care Act forbids individuals or entities from claiming to provide services on behalf of Covered California without securing a valid agreement with the State Exchange. (Gov. Code, § 100510.) State law also prohibits solicitations that falsely imply a governmental connection (Bus. & Prof. Code, § 17533.6), the use of a domain name that is confusingly similar to another entity (Bus. & Prof. Code, § 17525), making or disseminating untrue or misleading representations with the intent of selling goods or services (Bus. & Prof. Code, § 17500) and unfair competition through untrue or misleading advertising (Bus. & Prof. Code, § 17200).

To date, all website operators who have been contacted by the Attorney General’s office have complied, and the following websites have been either deactivated or redirected to the official exchange website:

www.californiabenefitexchange.com

www.californiahealthbenefitexchange.com

www.coveredcalifornia.com

www.shopinsuranceexchange.us

www.shopinsuranceservices.com

www.healthexchangeinsurance.com

www.shopforhealthcare.org

www.taxcreditinsurance.com

www.smallbusinesshealthoptionsprogram.com

www.stateexchanges.org

The California Health Benefit Exchange is charged with implementing the ACA and is the operator of California’s online health insurance marketplace known as Covered California. California consumers who purchase health insurance policies through this marketplace receive protections guaranteed by the ACA that may not exist in policies outside of the exchange.

Health insurance plans sold outside the official exchange on the individual market before January 1, 2014 do not qualify for federal subsidies and do not have the guarantees provided by the ACA’s consumer protection provisions. Major consumer protections include: no denials based on preexisting conditions; no rating differences based on factors other than age, geography, and family size; issuers may not impose any annual dollar limits for covered services; and all qualified plans must cover essential health benefits identified under the ACA.

The California Attorney General’s Health, Education and Welfare Section, in conjunction with Covered California and the California Department of Insurance, will continue to monitor these and other potentially fraudulent sites.

To avoid scams related to California’s health insurance marketplace, Attorney General Harris has released the following tips for consumers:

• California’s only official health insurance marketplace is www.coveredca.com, which is where individuals, families and small businesses can get information, compare plans and enroll.
• Be wary if you receive a call from a representative claiming to be a government official asking for your personal information like Social Security number or Medicare card number. You should not provide personal or financial information over the phone and should instead contact Covered California directly.
• If you are approached by someone offering assistance from Covered California, verify that they are a Certified Enrollment Counselor by asking to see their required ID badge or by contacting Covered California directly.
• Never pay someone for assistance with healthcare enrollment. Free enrollment assistance is available by contacting Covered California directly.
• If you believe that you have been the victim of a scam, please report it by contacting Covered California directly or by filing a consumer complaint with the California Attorney General’s office at: http://oag.ca.gov/contact/consumer-complaint-against-business-or-company

To contact Covered California directly, call (800) 300-1506 or email consumerprotection@covered.ca.gov

Assistance by phone is also available in the following languages:

Arabic: 800-826-6317

Armenian: 800-996-1009

Chinese: 800-300-1533

Farsi: 800-921-8879

Filipino: 800-983-8816

Hmong: 800-771-2156nie

Khmer: 800-906-8528

Korean: 800-738-9116

Lao: 800-357-7976

Russian: 800-778-7695

Spanish: 800-300-0213

Vietnamese: 800-652-9528

SAN FRANCISCO -- Attorney General Kamala D. Harris today issued the following statement, following the announcement that California joined with 45 states, the District of Columbia and the federal government in a $2.2 billion settlement with Johnson & Johnson and its subsidiary, Janssen Pharmaceuticals, Inc., over allegations of the companies’ unlawful marketing practices, including off-label promotion and kickbacks, to promote the sales of their atypical antipsychotic drugs, Risperdal and Invega.

California’s share of the national settlement is $89 million, which is the largest recovery ever for California from a national civil settlement regarding atypical antipsychotic drugs.

“Motivated by profit, these companies made false claims that jeopardized the health of California’s most vulnerable patients, including children and senior citizens—and left California taxpayers with the bill,” said Attorney General Harris. “Today’s record settlement reinforces the California Department of Justice’s commitment to rooting out this kind of greed wherever we find it.”

As part of this global resolution, the companies have agreed to resolve civil liabilities for their alleged unlawful conduct, which caused false and/or fraudulent claims to be submitted to Medi-Cal and improper Medi-Cal purchases. The complaint highlights practices by Johnson & Johnson and Janssen, including marketing to patient populations (children, adolescents and the elderly) for whom the drugs were not FDA approved and making false and misleading statements about the efficacy of these drugs.

To compensate the Medicaid programs, the companies will pay $1.114 billion as the combined federal and states’ share of the civil settlement for both drugs. After a statutory relator’s share is paid to the whistleblowers who brought the fraud to the attention of the government, the Department of Health Care Services will be reimbursed $44.5 million for losses incurred from the fraud; the remainder will go to support Medi-Cal fraud and enforcement efforts.

In addition, Janssen Pharmaceuticals, Inc. plead guilty to a criminal misdemeanor charge of misbranding Risperdal in violation of the Food, Drug, and Cosmetic Act.  As part of the criminal plea, Janssen has agreed to pay an additional $400 million in criminal fines and forfeitures.

The Attorney General’s Bureau of Medi-Cal Fraud and Elder Abuse investigates and prosecutes claims of Medi-Cal civil and criminal fraud, as well as allegations of elder abuse, such as physical assaults or financial theft.

SAN FRANCISCO – Attorney General Kamala D. Harris today filed a friend-of-the-court brief in the U.S. Supreme Court asking the court to review whether for-profit businesses may claim religious exemptions from a requirement under the Affordable Care Act (ACA) that employee health plans cover contraception. 

Attorney General Harris’ brief urges the U.S. Supreme Court to hear Kathleen Sebelius v. Hobby Lobby Stores, Inc., and asks the Court to overturn a lower court’s ruling that would allow two for-profit corporations to avoid full compliance with the law.

“Access to contraceptive services is critical to the health of women and infants; women’s economic and social wellbeing; and women’s opportunities to participate fully in society,” the amicus brief states.

Further, the brief argues that a lower court’s determination that for-profit corporations may assert religious exemptions to certain laws could interfere with enforcement of other important regulations that protect public safety, civil rights, social welfare, housing, employment and public health.

“The freedom of individuals to exercise the religion of their choosing is one of the most important values in our society, as reflected by its enshrinement in the federal Constitution. The federal government’s contraceptive coverage regulations under ACA respect that freedom through inclusion of appropriate exemptions, while also advancing the similarly compelling interests in public health and gender equality in access to health care. The court of appeals’ decision would upset that balance and threaten far-reaching impacts on the States beyond the issues presented by this action,” the amicus brief states.

Ten states joined Attorney General Harris’ brief, including Connecticut, Hawaii, Illinois, Iowa, Maine, Maryland, New York, Oregon, Vermont, and Washington.

The brief addresses a ruling from the United States Court of Appeals for the Tenth Circuit. 

A copy of the brief is attached to the electronic version of this release at oag.ca.gov/news.

SAN FRANCISCO -- Attorney General Kamala D. Harris today released guidelines on preventing and remedying medical identity theft, including best practice recommendations for the health care industry and tips for consumers.  The guidelines are part of a report, Medical Identity Theft: Recommendations for the Age of Electronic Medical Records, which frames the escalated migration to electronic medical records as an opportunity for the healthcare industry to address this problem.

“Medical identity theft has been called the privacy crime that can kill,” said Attorney General Harris. “As the Affordable Care Act encourages the move to electronic medical records, the health care industry has an opportunity to improve public health and combat medical identity theft with forward-looking policies and the strategic use of technology.”

Medical identity theft occurs when an individual uses someone else’s personal information to obtain medical goods or services. For example, a thief may use stolen information to submit fraudulent bills, a doctor or provider may use patient information to write fraudulent prescriptions or an individual may use someone else’s information to obtain treatment.

The report focuses on the impact of identity theft on the accuracy of medical records and argues that the serious risk that inaccuracies pose is not always adequately addressed by existing healthcare industry procedures.

A companion information sheet for consumers, First Aid for Medical Identity Theft, describes the signs of medical identity theft and provides tips on what to do in response. The signs of possible medical identity theft include notice of a data breach from a health care provider, an unknown item in an Explanation of Benefits from a health insurer, a call from a debt collector about an unfamiliar medical bill and questions about your identity or health conditions at intake in a doctor’s office or hospital.

Key recommendations for health care providers:

• Implement an identity theft response program with clear written policies and procedures for investigating a flagged record.
• Offer patients who believe they may be victims of medical identity theft a free copy of the relevant portions of their medical records to review for signs of fraud.

Key recommendations for insurers:

• Make Explanation of Benefits statements patient-friendly. Include information on how to report any errors discovered.
• Use automated fraud-detection software to flag suspicious claims that could be the result of identity theft.

The report can be found here: http://bit.ly/1eup6NO

The guide for consumers can be found here: http://bit.ly/1gnDICS

SACRAMENTO -- Attorney General Kamala D. Harris today applauded Governor Jerry Brown’s signature of legislation she sponsored to upgrade and expand California’s prescription drug monitoring program.

The Department of Justice’s Controlled Substance Utilization Review and Evaluation System (CURES) program and Prescription Drug Monitoring Program (PDMP) allow authorized prescribers and pharmacists to quickly review controlled substance information and patient prescription history in an effort to identify and deter drug abuse and diversion.

“I applaud Governor Brown for signing this important piece of legislation, which allows us to strengthen a critical tool to fight prescription drug abuse in California," Attorney General Harris said.

Senate Bill 809 by Senator Mark DeSaulnier (D-Concord) will require all prescribers and dispensers to enroll in and use the system.

“SB 809 is an important step in fighting the prescription drug abuse epidemic,” Senator DeSaulnier said. “Governor Brown’s signature ensures sustainable funding for one of the Department of Justice’s most powerful tools in fighting prescription drug abuse. SB 809 prevents California going from first to worst when it comes to monitoring prescription narcotics. The funding for an upgraded CURES program is a small price to pay when so many lives are at stake.”

Attorney General Harris has worked hard to save the CURES program, which had its funding slashed to almost nothing when the Department of Justice took a $71 million budget cut two years ago. She formed a working group with interested parties to push for an improved prescription drug monitoring system.

SB 809 includes a small increase in the provider license fee of 1.16 percent to pay for the annual cost to operate the program and a one-time assessment on health care plans for the upgrade, which will modernize and improve the information gathering and sharing.

Current funding sources are insufficient to operate and maintain CURES.  If another source of funding is not identified, the program will be eliminated on July 1, 2013.

SACRAMENTO -- Attorney General Kamala D. Harris today praised the passage of a bill she is sponsoring to upgrade and expand California’s prescription drug monitoring program as an important step in combating a serious public health and law enforcement issue. The bill passed out of the Senate Business and Professions Committee on a 7 to 2 vote.

The Department of Justice’s Controlled Substance Utilization Review and Evaluation System (CURES) program and Prescription Drug Monitoring Program (PDMP) allow authorized prescribers and pharmacists to quickly review controlled substance information and patient prescription history in an effort to identify and deter drug abuse and diversion.

“This legislation will modernize and strengthen the program and provide doctors and law enforcement with a powerful tool to fight prescription drug abuse,” Attorney General Harris said. “CURES is about making government smarter and more efficient. Senate Bill 809 will help save lives.”

Senate Bill 809 by Senator Mark DeSaulnier (D-Concord) will require all prescribers and dispensers to enroll in and use the system.

“SB 809 allows us to not only save, but strengthen, the CURES program,” said Senator DeSaulnier. “This must be a top priority for California. The technology exists for us to make a real difference in the prescription drug epidemic, and too many lives have been lost for us not to take action. The price to pay is small when there are thousands of lives on the line.”

“Criminal street gangs use the sale of prescription drugs to fund their operations in the United States,” said Chief Dan Drummond of the West Sacramento Police Department. “CURES is a multi-faceted tool that can be used for intervention, prevention, education and ultimately enforcement.”

Attorney General Harris has worked hard to save the CURES program, which had its funding slashed to almost nothing when the Department of Justice took a $71 million budget cut two years ago. She formed a working group with interested parties to push for an improved prescription drug monitoring system.

SB 809 includes a small increase in the provider license fee of 1.16 percent to pay for the annual cost to operate the program and a one-time assessment on health care plans for the upgrade, which will modernize and improve the information gathering and sharing.

In addition, an annual fee on narcotic drug manufacturers who do business in California will pay for two State of California Regional Investigative Prescription Teams. These teams will increase investigation into incidents of prescription drug abuse, pursue organized crime and provide oversight and auditing of prescription pad printers.

Current funding sources are insufficient to operate and maintain CURES.  If another source of funding is not identified, the program will be eliminated on July 1, 2013.

Video of the press conference can be seen here: http://www.youtube.com/watch?v=WV33itjsrxE

BAKERSFIELD -- Attorney General Kamala D. Harris today announced the sentencing of the former Director of Nursing of a Kern Valley Healthcare District hospital with a skilled nursing facility, a rare case in which a medical professional has been criminally charged and sentenced under elder abuse laws for the illegal chemical restraint of patients. 

Gwen D. Hughes, 59, the former Director of Nursing, was sentenced to three years in state prison Wednesday in Kern County Superior Court. Hughes pled no contest on October 11, 2012 to one felony count of elder abuse with a special allegation that the abuse contributed to the victim’s death.

Hughes ordered the administration of psychotropic medications to 23 elderly residents of the skilled nursing facility not for therapeutic reasons, but instead to control and quiet them for the convenience of staff. The drugs were given to patients who were noisy, prone to wandering, who complained about conditions or were argumentative. The drugs hastened three patients’ deaths, according to the investigation, and all 23 suffered some form of adverse physical reaction as a result. Many of the patients were under care for Alzheimer’s or dementia.

“Elder abuse in skilled nursing facilities is a particularly heinous crime because vulnerable victims and their families have placed their trust in the facilities to provide quality care, preserve their dignity and enjoy a better quality of life,” Attorney General Harris said. “This defendant maliciously and dangerously drugged patients for her own personal convenience. This is clearly outrageous conduct that justifies a state prison sentence.”

This case was investigated and charged by the Justice Department’s Bureau of Medical Fraud and Elder Abuse (BMFEA). Reflecting Attorney General Harris’ career-long commitment to elder abuse prosecutions, BMFEA has created specialized teams in Sacramento and Los Angeles composed of legal and medical professionals to investigate cases involving systemic elder abuse.

The California Department of Public Health began an initial investigation in 2007, following complaints from an ombudsman that a patient in the skilled nursing facility had been held down and injected with psychotropic medicine by force. They found evidence of patient harm, and issued a Certificate of Immediate Jeopardy against the facility, before turning the case over to the Justice Department.

Evidence indicated that Hughes directed the hospital’s director of pharmacy to write doctor’s orders for the unnecessary psychotropic medications.   

The orders were signed at a later time by the medical director. Pamela Ott, former chief executive officer of the Kern Valley Health District, pled no contest to one felony count of conspiracy to commit an act injurious to the public health based on her failure to adequately supervise the Director of Nursing. Ott was sentenced to three years formal probation, 300 hours of volunteer service, restitution pending conclusion of civil lawsuits. She is required to comply with all orders from the Registered Nursing Board, which is conducting its own investigation into the matter. 

In July 2012, Dr. Hoshang Pormir, the Medical Director, was also sentenced to 300 hours of volunteer service, restitution pending conclusion of civil lawsuits, and a requirement to comply with all orders from the Medical Board. Pormir failed to conduct examinations of patients or monitor their reactions to medications.

BAKERSFIELD -- Attorney General Kamala D. Harris today announced the sentencing of the former hospital administrator of Kern Valley Health District, a rare case in which a hospital administrator is being held criminally responsible for conduct by a lower-ranked employee.

Pamela Ott, former hospital administrator of the Kern Valley Health District, pled no contest to one felony count of conspiracy to commit an act injurious to the public health based on her failure to adequately supervise the Director of Nursing. During Ott’s tenure as administrator, Director of Nursing Gwen Hughes administered psychotropic medications to 23 elderly residents in order to chemically restrain them for staff convenience. Three patients died.

“Ott neglected her responsibility to monitor the practices of her employees and, in doing so, she endangered the health and well-being of vulnerable residents,” Attorney General Harris said. “California has strong laws to prevent elder abuse and we will enforce them so we can protect the most vulnerable among us.”

Ott was sentenced to three years formal probation, 300 hours of volunteer service, restitution pending conclusion of civil lawsuits. She is required to comply with all orders from the Registered Nursing Board, which is conducting its own investigation into the matter.  

In July 2012, Dr. Hoshang Pormir, the Medical Director, was also sentenced to 300 hours of volunteer service, restitution pending conclusion of civil lawsuits, and a requirement to comply with all orders from the Medical Board. Pormir failed to conduct examinations of patients or monitor their reactions to medications.

In January 2007, the Department of Public Health began an investigation into complaints stemming from the Healthcare District and found that 23 residents suffered adverse reactions as a result of chemical restraints and unnecessary medications. The Department of Justice’s Bureau of Medical Fraud and Elder Abuse took over the case after the Department of Public Health completed its report.

Ott received complaints, some as early as September 2006, concerning Hughes’ conduct towards staff.  Several staff members also had previously informed Ott that residents were forcefully restrained and injected with medications. Ott disregarded the complaints and directed staff to comply with Hughes’ instructions.

Hughes will face a jury trial beginning October 29, 2012 in Kern County Superior Court. She is being charged with multiple felony counts of elder abuse resulting in death, elder abuse resulting in great bodily injury, and assault with force likely to cause great bodily injury. 

SACRAMENTO -- Attorney General Kamala D. Harris today announced a $323.67 million settlement with a Los Angeles-based health maintenance organization over excess Medi-Cal and Medicare payments.

The settlement with SCAN Health Plan, Senior Care Action Network, and Scan Group (collectively known as SCAN), which provides health care and support services in Southern California to the elderly and disabled, constitutes the largest Medi-Cal recovery in the state’s history.

“Californians have lost millions of dollars that should have been going toward the health care of our most vulnerable citizens,” said Attorney General Harris. “This settlement will bring a significant amount of those funds back to the state when it is dearly needed, and I commend all of those involved in this action.”

The matter was initially investigated by the State Controller's Office.  The state Attorney General’s Bureau

of Medi-Cal Fraud and Elder Abuse then commenced its own investigation in cooperation with the United

States Attorney’s Office in Los Angeles. The investigation was conducted with the assistance of the California Department of Health Care Services (DHCS), which administers the Medi-Cal program.

A small component of the settlement resolves certain federal Medicare allegations brought by James M. Swoben in a lawsuit filed in July 2009 in federal court in the Central District of California. Mr. Swoben is a former employee of SCAN.  The lawsuit was filed pursuant to the federal and state False Claims Acts, which provide that any person with information about a false claim can file a sealed lawsuit on behalf of the government to recover the government’s losses.

The federal government will be receiving $3.82 million for the Medicare portion of the settlement. For the Medi-Cal portion of the settlement, $319.85 million will be split between the federal government and California, with the federal government receiving $129.38 million and the state $190.47 million. 

The settlement resolves the state’s allegations that SCAN failed to provide contractually required financial information to DHCS, thereby impairing the department from revising capitation rates for SCAN.

“This settlement is a victory for the Medi-Cal beneficiaries we serve,” said DHCS Director Toby Douglas.

“Using the scarce resources available in the most efficient way possible is a top priority for the state. We will continue our ongoing efforts to strengthen programs that protect the integrity of Medi-Cal.”

A copy of the Third Amended Complaint and copies of the settlement agreement; Joint Notice of Election to Intervene in Part; and the Notice of Dismissal and Order Thereon are attached to the online version of this release at www.oag.ca.gov.