Michigan Personal Injury Blog - medicaid

Michigan Sued for Cutting Off Medicaid Dental Benefits to Poor and Disabled

David Mittleman — Sat, 31 Oct 2009 10:00:00 GMT

Along with other devastating cuts, Governor Granholm has been forced to cut Medicaid dental benefits for low-income and disabled adults. However, a lawsuit was recently filed on behalf of 400,000 adult Medicaid recipients who are affected by the cut.

With an already extremely strained budget, Governor Granholm proposed a tax on doctors to restore some Medicaid funding. However, the state Senate vehemently rejected the idea. As a result, there was no funding available to provide the vitally important Medicaid dental coverage.

The lawsuit was spurred by the recent death of a developmentally disabled Alpena County woman covered by Medicaid, who died last week after an infection in her mouth went untreated. The suit contends that the State of Michigan is legally bound to provide dental coverage to low-income and disabled adults because it failed to notify the federal government of the change in policy. Granholm issued the executive order in May that eliminated funding for adult dental coverage effective July 1.

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

Waiting Room Tragedies And The Need For Universal Health Care

David Mittleman — Wed, 05 Nov 2008 14:06:09 GMT

Candida Diego fractured her skull in a fall in September of 2004. After being cleared for a brain scan to check for bleeding, she became partially paralyzed because she spent two hours in a waiting room before the hospital performed the scan. On October 3, 2008, she was awarded $10.7 million in compensation for the hospitals negligence.

Similarly, Beatrice Vance went into Vista East Medical Center in Waukegan, near Chicago, in July of 2006 complaining of chest pains. She checked in at 10:15 p.m. only to wait, and wait, and wait until she collapsed at 12:25 a.m., dead of a heart attack at the age of 49.

Unfortunately, tragedies like this have become common place due to increased demand, staff shortages, and hospital closings. In the Vance case, a coroner’s jury called her death a homicide, partly due to the long wait in the ER. A coroner’s jury determines the cause of death in certain cases, but do not try cases.

The number of U.S. emergency rooms declined 12% between 1993 and 2003, while there has been an increase of 26% in the number of patients seeking emergency room care. In an effort to correct the problem, many hospitals have created "fast-track" programs to help patients who do not require hospitalization and lack health insurance. These patients account for much of the increased demand, and tend to have to wait the longest for care because they go to the ER instead of a regular doctor.

Until more of these "fast-track" programs are implemented on a national scale, these issues will likely persist. The election of President-Elect Barack Obama may be the first step towards curing some of the health industry’s ills. Under the Obama-Biden plan, an investment in electronic health information technology systems will help doctors coordinate care, reduce medical errors, and help process claims quicker which can speed up the process in the ER waiting rooms.

Universal health care coverage is the key to reducing the over crowding of waiting rooms with the uninsured for non-emergency health issues. "The Obama-Biden plan provides new affordable health insurance options by: (1) guaranteeing eligibility for all health insurance plans; (2) creating a National Health Insurance Exchange to help Americans and businesses purchase private health insurance; (3) providing new tax credits to families who can’t afford health insurance and to small businesses with a new Small Business Health Tax Credit; (4) requiring all large employers to contribute towards health coverage for their employees or towards the cost of the public plan; (5) requiring all children have health care coverage; (5) expanding eligibility for the Medicaid and SCHIP programs; and (6) allowing flexibility for state health reform plans."

Only by directly addressing all of these issues in a comprehensive health care reform package can we implement the kind of change that we need in the health care system. We should not allow the tragedies like that of Candida Diego and Beatrice Vance to continue in the most prosperous nation in the world.

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