Lansing Personal Injury Lawyer - Medicare

Newspaper Discovers Many Dialysis Patients Not Told of Kidney Transplant Option

David Mittleman — Tue, 29 Sep 2009 10:00:00 GMT

The Pittsburgh Tribune-Review recently conducted a four-month review of records from the U.S. Renal Data System and discovered that some dialysis patients received at least five years of the debilitating treatment prior to being placed on a kidney transplant list. Moreover, other dialysis patients were never put on the list.

Kidney transplants are often cheaper and can lead to longer lives for patients with kidney failure. In fact, on average, a patient can live 10 years longer with a transplant. However, the Pittsburgh Tribune-Review also discovered another dirty secret: kidney transplants are much cheaper than dialysis treatments. Actually, a kidney transplant costs approximately $50,000 less than dialysis treatment.

The $65-billion-dollars-a-year dialysis industry doesn’t want to give up the revenue they generate from health insurance payouts. Specifically, the newspaper found that the largest dialysis providers “need” insured patients to offset the losses they claim they sustain when they have to treat patients covered by Medicare. Still, other doctors claim this isn’t the case. Rather, they cite the lack of available organs for kidney patients as the reason why most patients receive dialysis instead. Nevertheless, from the review of the records, the newspaper found that only 16% of patients were listed for a kidney transplant in 2006, as compared to the government’s goal of 30%. Moreover, only 32,000 out of 106,000 kidney failure patients were even told of the transplant option.

Originally posted at InjuryBoard by David Mittleman

Small Texas Border Town Serves as Proof of Why Health Care Costs Are on the Rise

David Mittleman — Sun, 20 Sep 2009 13:33:39 GMT

The small town of McAllen, Texas lies right across the border from Mexico. It’s also a relatively poor town, with a per capita income of $12,000. However, besides holding the title for “square-dancing capital of the country”, McAllen also happens to hold the top spot for the nation’s most expensive heath-care market. In fact, in 2006 alone, Medicare spent $15,000 per enrollee. To put it in another way, that’s $3,000 more than what most people in McAllen make in a year.

What makes McAllen so unique? It’s neighbor, El Paso, doesn’t have the same astronomical health care expenditures. Surely it’s the poor standard of living—including bad diets and heavy drinking—but no, that doesn’t happen to be the reason either. Indeed, El Paso, just eight miles up the border, has similar public-health statistics. In a similar vein of thought, most people want to blame the “excessive medical liability suits” in McAllen. However, tort reform doesn’t happen to serve as a very good scapegoat, either. Actually, Texas passed a tough malpractice reform law just a few years ago that capped pain-and-suffering awards at $250,000. The reality is that doctors in McAllen like to rack up charges on extra procedures, services, and tests.

In analyzing Medicare payment data from two private firms, D2Hawkeye and Ingenix, it was revealed that McAllen patients received more diagnostic testing, more hospital treatment, more surgery, and more health care than their neighbors in El Paso and across the country. Specifically:

The Medicare payment data provided the most detail. Between 2001 and 2005, critically ill Medicare patients received almost fifty per cent more specialist visits in McAllen than in El Paso, and were two-thirds more likely to see ten or more specialists in a six-month period. In 2005 and 2006, patients in McAllen received twenty per cent more abdominal ultrasounds, thirty per cent more bone-density studies, sixty per cent more stress tests with echocardiography, two hundred per cent more nerve-conduction studies to diagnose carpal-tunnel syndrome, and five hundred and fifty per cent more urine-flow studies to diagnose prostate troubles. They received one-fifth to two-thirds more gallbladder operations, knee replacements, breast biopsies, and bladder scopes. They also received two to three times as many pacemakers, implantable defibrillators, cardiac-bypass operations, carotid endarterectomies, and coronary-artery stents. And Medicare paid for five times as many home-nurse visits. The primary cause of McAllen’s extreme costs was, very simply, the across-the-board overuse of medicine.

Simply stated: most Americans want to believe that the rising cost of healthcare is due to irresonspible lawsuits and/or the general poor health of the population. Don't get me wrong, preventative medicine is very important, and is a desperately lacking feature of health care in this country. But, what is also a problem is the culture of profit. Liability costs often serve as the classic argument that doctors use for ordering excessive tests and for employing the most aggressive procedures, even when less-invasive procedures or a "watch-and-wait" approach might be the most appropriate answers. However, in the case of McAllen, Texas, lawsuit payouts were capped--a facet of tort reform--and medical costs did not miraculously go down. Why? Because doctors continued to order the unnecessary tests and procedures because it puts more money in their pockets. Adding insult to injury, patients aren't even "better off" from all these extra tests and procedures:

In a 2003 study, another Dartmouth team, led by the internist Elliott Fisher, examined the treatment received by a million elderly Americans diagnosed with colon or rectal cancer, a hip fracture, or a heart attack. They found that patients in higher-spending regions received sixty per cent more care than elsewhere. They got more frequent tests and procedures, more visits with specialists, and more frequent admission to hospitals. Yet they did no better than other patients, whether this was measured in terms of survival, their ability to function, or satisfaction with the care they received. If anything, they seemed to do worse.

That’s because nothing in medicine is without risks. Complications can arise from hospital stays, medications, procedures, and tests, and when these things are of marginal value the harm can be greater than the benefits. In recent years, we doctors have markedly increased the number of operations we do, for instance. In 2006, doctors performed at least sixty million surgical procedures, one for every five Americans. No other country does anything like as many operations on its citizens. Are we better off for it? No one knows for sure, but it seems highly unlikely. After all, some hundred thousand people die each year from complications of surgery—far more than die in car crashes.

Maybe we just need to take a step back, stop listening to all the finger-pointing used by insurance, pharmaceutical companies and the like. Are all doctors inherently consumed by this "culture of profit"? Of course not. I'm arguing no such thing--doctors are a vital and necessary group of people. What I am arguing against is bad medicine--kickbacks and conflicts of interest alike--that is, medicine that wants to go that "extra mile" simply because it means more money in someone's pocket.

Originally posted at InjuryBoard by David Mittleman

Getting down to the nuts and bolts of health care reform in Michigan

David Mittleman — Sat, 05 Sep 2009 12:34:14 GMT

As media coverage surrounding proposed Health Care legislation fluctuates back and forth from one highly charged emotional issue to another, many Michigan residents are left wondering, how would any of this stuff affect me and my life? How would health care reform shape the economy of my community? What would this do to improve the quality of health care where I live?

The Committe on Energy and Commence has developed district by district profiles to highlight for each and every citizen how this legislation would affect them in a real-life manner. Let's go through it, and you can decide for yourself whether or not you'd like your Congressional Representative to support the bill or not. Some things to consider... if businesses would get tax credits, would that be good for business and jobs? If doctors suddenly start getting paid for services that otherwise would have gone unpaid, will that improve the quality of health care in my community? If men, women, and children can finally get treated when they need it, how will that affect job productivity, community strength, and personal happiness?

Upper Peninsula. You folks in the UP are represented by Bart Stupak in the 1st District. In this beautiful part of Michigan 16,500 small businesses (PDF) could receive a tax credit for providing health care for their employees. 900 families might avoid crippling and demoralizing bankruptcies due to unaffordable health care costs. Health care providers, such as doctors and hospitals, would get $185 million dollars they would have never received for services rendered. Perhaps most importantly, 82,000 uninsured Michigan residents would have access to affordable and quality health care.

Muskegon. You folks along the shores of Lake Michigan are represented by in Pete Hoekstra the 2nd District. This breathtaking part of Michigan (PDF) 14,000 small businesses could receive a tax credit for providing health care for their employees. 12,400 seniors could avoid the donut hole in Medicare Part D. 1,200 families might avoid crippling and demoralizing bankruptcies due to unaffordable health care costs. Health care providers, such as doctors and hospitals, would get $75 million dollars they would have never received for services rendered. Perhaps most importantly, 72,000 uninsured Michigan residents would have access to affordable and quality health care.

Grand Rapids. You folks in the western part of the state are represented by Vern Ehlers in the 3rd District. In this growing area of Michigan 14,300 small businesses could receive a tax credit (PDF) for providing health care for their employees. 9,900 seniors could avoid the donut hole in Medicare Part D. 1,200 families might avoid crippling and demoralizing bankruptcies due to unaffordable health care costs. Health care providers, such as doctors and hospitals, would get $114 million dollars they would have never received for services rendered. Perhaps most importantly, 71,000 uninsured Michigan residents would have access to affordable and quality health care.

Mount Pleasant and Big Rapids. If you live by Central Michigan University of Ferris State Univewrsity, you are represented by Dave Camp in the 4th District. In this expansive area of Michigan 14,800 small businesses could receive a tax credit for providing health care (PDF) for their employees. 10,300 seniors could avoid the donut hole in Medicare Part D. 1,400 families might avoid crippling and demoralizing bankruptcies due to unaffordable health care costs. Health care providers, such as doctors and hospitals, would get $92 million dollars they would have never received for services rendered. Perhaps most importantly, 82,000 uninsured Michigan residents would have access to affordable and quality health care.

Flint. The great folks south of Saginaw Bay are represented by Dale Kilee in the 5th District. In this industrial area of Michigan 11,700 small businesses (PDF) could receive a tax credit for providing health care benefits for their employees. 7,100 seniors could avoid the donut hole in Medicare Part D. 380 families might avoid crippling and demoralizing bankruptcies due to unaffordable health care costs. Health care providers, such as doctors and hospitals, would get $157 million dollars they would have never received for services rendered. Perhaps most importantly, 52,000 uninsured Michigan residents would have access to affordable and quality health care.

Lansing. If you're a Spartan faithful, you are represented by Mike Rogers in the 8th District. The home of the world famous Cadillac CTS is also home to 15,100 small businesses that could receive a tax credit for providing health care benefits for their employees. 7,600 seniors could avoid the donut hole in Medicare Part D. 1,700 families might avoid crippling and demoralizing bankruptcies due to unaffordable health care costs. Health care providers, such as doctors and hospitals, would get $53 million dollars they would have never received for services rendered. Perhaps most importantly, 49,000 uninsured Michigan residents would have access to affordable and quality health care - that's more than two fully packed Breslin Centers cheering on the Green and White.

If you didn't see your district listed, don't worry, you can find all the information on the Committee's website found here.

Originally posted at InjuryBoard by David Mittleman

Osteoporosis Treatment No More Effective Than Placebo, Two Studies Show

David Mittleman — Thu, 13 Aug 2009 10:00:00 GMT

Vertebroplasty was once one of the most revered treatments for easing the pain caused by osteoporosis. During the treatment, acrylic cement is injected into cracks in the spinal column. Doctors began performing the procedure in the 1990s and many patients reported instantaneous relief from their terrible pain. The only problem was that no clinical trials were ever performed to see whether the treatment really worked, or if could potentially cause worse problems in the future. In fact, the procedure does have risks—while rare, complications can be serious, including damage to the heart and lungs and even death if the cement leaked into surrounding blood vessels. Moreover, there are also unresolved questions about whether cementing one cracked vertebrae can caused stress on other vertebrae and lead to more breaks in the future. If vertebroplasty is not as effective as it claims to be, then the risks are not justified if there is no real benefit.

Indeed, two new studies cast serious doubt on the effectiveness of the treatment. Studies began several years ago at medical centers in the U.S. and in Australia. Working independently of on another, the two research teams randomly selected patients to either receive the real injection or a placebo. The American team assessed the patients one month after the procedure and the Australian team assessed their patients at one week and then at one, three and six months after the procedure. The results of the study showed that vertebroplasty failed to dramatically improve patients’ pain any better than the placebo.

One of the researchers in the American team, Dr. Kallmes, helped develop vertebroplasty and has been performing the treatment for 15 years. He says he is “shocked at the results”, but knows that other doctors will not be so quick to stop performing the procedure. Specifically, he stated: “the only way medical practice would change would be if Medicare and other insurers were to stop covering vertebroplasty or to cover it only when it was part of a study.” Other doctors, such as Dr. Robert R. Recker of the National Osteoporosis Foundation, said that there needs to be more studies before his foundation abandons vertebroplasty as a viable treatment option. Moreover, Dr. Marcel E. Salive, a director in the Medicare division said Medicare has no national policy on vertebroplasty and has been letting the states decide whether or not cover the treatment—most states have. Dr. Salive also said there are a lack of randomized, controlled studies to provide enough evidence to affect Medicare coverage.

The new studies are indicative of the type of research that health policy experts and President Obama have been calling for, to find out if the nation is spending its health care dollars wisely, on treatments that actually work. A bill passed by Congress this year provides $1.1 billion for effectiveness research.

Originally posted at InjuryBoard by David Mittleman

Estech settles lawsuit over bogus Medicare claims and false advertising for $1.4 Million

David Mittleman — Fri, 17 Jul 2009 14:50:00 GMT

Endoscopic Technologies, Inc. or Estech recently settled a lawsuit for $1.4 million after the Food and Drug Administration accused the company of violating the Food, Drug and Cosmetic Act and the False Claims Act. Specifically, the FDA accused Estech of falsely marketing its product, and of encouraging bogus Medicare claims as well as paying kickbacks to healthcare providers.

The San Ramon, California company makes medical devices for surgical ablation, where focused energy is used to create scar tissue on a patient’s heart or other organs. However, Estech also marketed its product to treat atrial fibrillation (the most common type of heart arrhythmia), which was not a use of the device that was approved by the FDA. Furthermore, Estech promoted costly heart surgeries to increase use of their product, when other less invasive treatments were more appropriate. The company also advised doctors to classify surgical procedures using the devices to increase Medicare payments and paid kickbacks to health-care providers who used it devices.

The allegations were made in a lawsuit filed in the U.S. District Court for the Southern District of Texas by a private citizen, under the qui tam provisions in the False Claims Act. Under these specific provisions of the act, private citizens may act as “relators” who can bring lawsuits on behalf of the U.S. and receive a portion of the settlement award. In this case, the relator will receive $210,000 as their share of the settlement. However, Estech denies the accusations and has not admitted any wrongdoing in the settlement.

Originally posted at InjuryBoard by David Mittleman

Department of Justice Cracks Down on Insurance Fraud

David Mittleman — Fri, 26 Jun 2009 17:34:25 GMT

The U.S. Department of Justice has announced that the former managing pharmacist of a New Jersey pharmacy has pleaded guilty to submitting fraudulent claims to health insurers. Ruben Aguilar admitted to conspiring with others to submit claims for prescriptions that the pharmacy never dispensed over a five-year period spanning from 2002 to 2007. Aguilar could serve up to five years in prison and be forced to pay a hefty fine.

Among the many insurers that fell victim to the fraud was the federal Medicaid program, which insures low-income individuals in conjunction with certain state Medicaid programs. Medicaid and Medicare, which insures those over 65 years old and certain other qualifying individuals, are frequent targets of attempted fraud. The Department of Justice has partnered with the U.S. Department of Health and Human Services to prevent waste and abuse in the system. The goal is to keep the cost of these federal programs down, thus saving money and improving the quality of services provided.

Aguilar’s plea came on the same day as a major health care fraud sting operation resulted in the arrests of 53 individuals, including doctors, executives, and beneficiaries, in the Detroit area. In addition, eight Miami-area residents were arrested today on similar charges.

These recent arrests are a clear indication of the administration’s aggressive policy of attacking Medicaid and Medicare fraud. If you become aware of fraudulent activity, you can report it by e-mailing HHSTips@oig.hhs.gov or by calling 1-800-HHS-TIPS.

Originally posted at InjuryBoard by David Mittleman

Who Pays When Elderly Patients Fall at the Hospital?

David Mittleman — Tue, 16 Jun 2009 13:48:31 GMT

A hospital fall is a common problem, particularly with the elderly, and falls lead to injuries, longer hospital stays and potential lawsuits. In fact, the authors of a recent article published in the New England Journal of Medicine found that as many as one out of five patients fall at least once during their hospital stay. Those falls can result in as much as $4,000 in extra bills.

To remedy this problem, the federal government decided last October to stop payment on Medicare for extra hospital care if a fall is deemed preventable. Doctors feel that this unfairly forces them to use restraints to keep patients from falling, since falls still remain a problem despite their best efforts to prevent them. Many times, doctors argue, falls are caused by impairments that patients already have, or by the treatments or medications they receive.

Whatever the reason for hospital falls, doctors do no want to see a rise in using restraints, particularly since they are cited as the major cause for agitation or delirium in patients, as well as bedsores and breathing problems. The director of the Institute for Aging Research at Hebrew Senior Life has spent 20 years studying ways to prevent delirium and resulting hospital falls amongst the elderly. Her research has shown that minimizing certain medications that increase dizziness or wooziness, scheduling frequent bathroom trips, using lowered hospital beds, and maintaining regular movement, all helped to reduce hospital falls in patients and has kept the use of restraints to a minimum.

Other doctors corroborate her viewpoint, arguing for well-established guidelines to help prevent hospital falls, rather than resorting to restraints. A medical officer and senior adviser in the Center for Medicare and Medicaid stated that the non-payment policy on Medicare actually encourages doctors to use “best practices”, rather than forcing them to rely heavily on restraints to prevent hospital falls.

Originally posted at InjuryBoard by David Mittleman

BCBS of Michigan Picked A Terrible Time to Increase Rates

David Mittleman — Tue, 03 Feb 2009 09:51:59 GMT

It is no secret that times are tough in Michigan. The state has the highest unemployment rate in the country which has forced thousands of people to purchase individual health insurance plans that were once employer-sponsored. As if Michigan residents haven’t suffered enough from the recessionary state of the economy, Blue Cross Blue Shield of Michigan is attempting to make things worse.

On January 30, 2009, the company filed a rate of increase request with the Michigan Office of Insurance and Regulation to hike monthly premiums of over 400,000 Michigan residents who are on individual policy plans. The request outlines increases of 31% to 56%, depending on the type of policy. The increase only affects those residents who have an individual plan or who have supplemental Medicare coverage - in other words, the increase is going to disproportionately raise the rates of those people who are already struggling.

BCBS claims the increase is necessary to offset a projected $1 billion loss from 2009 to 2011. According to a statement posted on the BCBS website, the losses are due to a failed and outdated regulatory system which places the burden on BCBS of insuring the costliest individuals. In addition to increasing rates, the company plans to cut 1,000 employees throughout 2009 and has placed a freeze on executive and non-union worker salaries.

Originally posted at InjuryBoard by David Mittleman

Medicare Refuses to Pay For Medical Mistakes And Doctor's Negligence

David Mittleman — Thu, 09 Oct 2008 15:46:48 GMT

Starting October 1, Medicare announced it will no longer pay for treatment resulting from medical errors which occurred during a hospital stay. What does this mean to the over 44 million Americans depending on the program for benefits? Basically, if you are further injured while in your doctor’s care, Medicare will not cover the additional costs associated with the treatment.

Medicare’s new policy is based on a list of "never events," which are theoretically never supposed to happen. When one of these events does occur, Medicare will no longer bear the burden and instead will require the hospital to report and pay for the error. The problem with these so-called "never events" is that over the years they have become more and more accepted by doctors as conditions that can and will occur. In fact, "never events" account for between 44,000 and 98,000 deaths each year. The "never events" list includes malpractice and negligent behavior such as foreign object left in body after surgery, operating on the wrong body part, falls and trauma, bed sores, infections at the surgical site, and other preventable problems.

This bizarre policy does not just apply to individuals under government aid, rather, several large private insurers including Blue Cross Blue Shield, Aetna, Cigna, and WellPoint have considered or implemented a similar "never events" system. The theory driving this policy is a pay-for-performance trend. Prior to this policy, there were practically no financial penalties for hospitals when a preventable "never event" occurred. Now, the hospitals are responsible for the costs associated with extended stay and extra procedures; the regulations forbid the hospitals from charging patients.

Although this policy is expected to save dollars and lives, the real question remains as to who will pay for the innocent patients’ additional pain and suffering and unnecessary time off work. Should the hospitals, doctors, or both be accountable? After all, if a doctor's action (or lack thereof) meets one of the 28 conditions on the "never events" list, which in turn forces the hospital to cover the costs, is this evidence of negligent behavior or medical malpractice?

Originally posted at InjuryBoard by David Mittleman

Whistleblowers Expose Untested and Off-Label Prescription Uses By Drug Manufacturers

David Mittleman — Fri, 03 Oct 2008 13:21:00 GMT

“Off-Label” use is a practice of prescribing drugs for uses other than those approved by the Food and Drug Administration (FDA). Once a prescription drug has been FDA approved, the FDA does not regulate how a physician uses the drug for the treatment of their patients.

The practice of “Off-Label” prescribing is very common in the United States and around the world. Upwards of one-fifth of all drugs are prescribed for uses other than the original purpose of the drug. For psychiatric drugs, the level rises above 30%.

However, this practice has lead to the miss-use of potent painkillers such as Actiq. Manufactured by Cephalon, Actiq is used when the patient develops a tolerance to other opioid pain medication. If used withing 14 days of other drugs or if the patient over-doses, life-threatening side effects can occur. In fact, Actiq was prescribed to patients who did not have a tolerance to opiates.

The drug manufacturer, Cephalon, agreed to pay $375 million global settlement with the U.S. Department of Justice in order to settle claims brought under the False Claims Act by the Medicare and Medicaid trust funds.

The action also included abuses of the drugs Gabitril and Provigil. Gabitirl was approved only for epilepsy, and ended up being prescribed as an anti-anxiety drug. Provigil was approved to treat daytime sleepiness associated with narcolepsy, sleep apnea, and shift work sleep disorder. Cephalon disregarded a 2002 FDA order not to market Provigil for its off-label use as a non-stimulant drug for sleepiness, fatigue, lack of energy, and decreased activity.

Cephalon plead guilty to the misdemeanor charge of distribution of misbranded drugs and agreed to pay $50 million in fines and forfeiture. $46.4 million was awarded to the four whistleblowers. A whistleblower is someone who reports misconduct at his or her place of employment. A famous whistleblower in recent history is Jeffery Wigand. He exposed the Big Tobacco scandal and was portrayed by Russell Crowe in the 1999 film The Insider.

Originally posted at InjuryBoard by David Mittleman