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LAW ENFORCEMENT INVESTIGATION REGARDING DENIAL OF HEALTH INSURANCE CLAIMS OR COVERAGE DUE TO UNLAWFUL, FRAUDULENT OR UNFAIR PRACTICES

Dear Friends:

The Office of the Los Angeles City Attorney has launched a law enforcement investigation into potentially unfair business practices by health plans and health insurers, particularly with respect to their improper denial of claims for coverage made by consumers, or their cancellation of consumers’ coverage altogether.

Recent news reports indicate that certain companies in the health insurance industry may be engaging in business practices that violate numerous civil consumer protection, and possibly even criminal, laws. Such practices are devastating to consumers who are led to believe that they have health coverage, only to have that coverage suddenly denied after they are diagnosed with serious medical conditions. Additionally, these business practices may victimize health care providers, such as doctors and hospitals, who reportedly have been denied payment for medical services provided to patients under the reasonable belief that the patients were fully insured.

If you have information regarding what you believe are unlawful, fraudulent or unfair business practices of a health plan or health insurer, we request your assistance in this investigation.

If you believe your health insurer has wrongfully denied or delayed your claim and/or canceled your coverage, we urge you to provide us with a description of your complaint.

If you are a health care provider who has had payment withheld, payment delayed or has been retroactively denied payment for services rendered under a health plan or insurance policy, we welcome your assistance in this investigation, to the extent consistent with your legal and ethical obligations to maintain patient confidentiality.

If you have other information relevant to this investigation, we welcome your assistance, as well.

Please click on the appropriate complaint form to tell us what you know about these practices.

Thank you for your interest in our investigation.

 

Who We Are

The Criminal and Special Litigation Branch of the Los Angeles City Attorney’s Office represents the People of the State of California in the prosecution of criminal misdemeanor cases and civil Unfair Competition Law (“UCL”) actions. In a criminal case, the City Attorney may seek jail time, fines and penalties, probation and restitution to the victims of the crime. In a UCL action, the City Attorney may obtain an injunction prohibiting a defendant from doing something, restitution for victims of the defendant’s activities and civil penalties.

The Los Angeles City Attorney’s Office does not and cannot represent individuals, nor can we refer an individual to a private attorney for representation. This website is intended solely to gather information that may be helpful to a law enforcement investigation. This is not an invitation to join a class action or any other type of private litigation to be brought on behalf of one or more individuals.

Also, if you are having problems with your health insurance or health plan, you have the ability to file a complaint with and seek assistance from the California Department of Insurance or the California Department of Managed Health Care. These regulatory agencies are separate and distinct from the Los Angeles City Attorney’s Office. Providing information to the Los Angeles City Attorney’s Office through this website will not constitute filing a complaint with these two state agencies.

This is a secure website. If you choose to provide information on this website, it may be used for law enforcement purposes only, which could include legal and court proceedings that may result from this investigation. If you prefer not to use the website, you may contact us via U.S. mail at:

Office of the Los Angeles City Attorney
Health Insurance Investigation
500 City Hall East
200 North Main Street
Los Angeles, CA  90012

Complaints MUST be submitted through website forms or by regular mail to the address listed above. However, if you have specific questions or comments regarding this site, please email atty.healthinvestigation@lacity.org.

The Office of the Los Angeles City Attorney will make every reasonable effort to maintain the privacy and confidentiality of the information you provide. In the event that a criminal case or a civil unfair competition action is filed against a health care plan or health insurer, your information may need to be disclosed as part of the legal proceedings, but only to the extent required by law.