My view of this medical professional liability program (program) administrated by CAP continues to be favorable. My review of the selected claim files revealed no deficiencies in either their reserving practices or in the management of the claims. The claims continue to be managed solely by CAP’s Sr. Claims Specialist, Steve Weitzer who has been overseeing this program for the past 19 years. Mr. Weitzer along with HAPI’s Executive Vice President, Norm Slaustas are highly engaged with on another and work in a true partnership to produce a quality claims product on behalf of HAPI. We can expect HAPI along with CAP to have a positive impact on our treaty’s performance.
In the plaintiff’s suit, he alleged the surgery did not go well because the hospital had hired a surgeon, who was not competent or qualified enough to perform the surgery therefore; the hospital was just as negligent as the doctor was. Before the trial date, Dr. Salinsky and his insurance company, Employers Mutual Liability Insurance Company of Wisconsin, settled with plantiff out of court on the basis they will be released from the suit upon payment of $140,000 (Johnson v. Misericordia Community Hospital). Although, Salinsky settled with plaintiff prior to trial, there was still “question of whether he was negligent in the manner in which he performed the operation on July 11, 1975, remained an issue at trial, as it was incumbent upon the plaintiff to prove that Salinsky was negligent in this respect to establish a
“One of those obligations is that it must exercise a proper degree of care for its patients, and, to the extent that it fails in that care, it should be liable in damages as any other commercial firm would be
Claims sent to the insurance companies could be rejected or denied. A health care facility is there to help people with their health, but they are a business that needs income to stay in business. If a medical facility or physician files a claim that is incorrect the Center for Medicare and Medicaid Services may get involved, this could mean audits, fines, or worse. Medical coding and billing are very precise and detailed work where mistakes can cause serious problems.
There are defenses against negligence lawsuits for sports medicine professionals. The first of which is assumption of risk, where the athlete voluntarily and knowingly assumes the risk of an activity through an expressed or implied agreement. This can be done by having a form signed during pre-season paperwork. This does not forgive a clinician of reckless conduct, however. Assumption of risk is for the usual risks, and the athlete by singing assumes responsibility for injury that occurs as a result of the inherent dangers of sport. It is crucial that athletes be informed that risk for injury exists and understand the nature of that risk. Another defense is an act of God, which are events that are outside of human control. This includes natural disasters, weather, and other environmental concerns in which no one can be held responsible. If the incident was not foreseeable, this is another defense a clinician could use against a negligence lawsuit. Foreseeability is based upon whether the clinician at fault could have realistically anticipated the consequences that would result because of their conduct. In order for the clinician to be held liable, the harm must foreseeably arise from the negligent act. Good Samaritan laws provide limited security against legal liability should an accident arise while providing care during an emergency, in good faith, without expected compensation, and without misconduct or gross negligence. This usually does not apply to someone providing care during regular employment. It was created for situations in which a volunteer comes to the aid of an injured person during an emergency in order to reduce bystanders ' hesitation to assist because of the fear of a lawsuit. The individual providing care must ...
In the summer of 2003, Gary Shephard learned that he needed to have surgery on his left knee. In accordance with the requirements of his insurance plan, Mr. Shephard obtained prior approval for the surgery from Blue Cross/Blue Shield and made plans to have the surgery on or about August 5, 2003. On August 1, 2003, a few days before his scheduled surgery, Mr. Shephard was laid off due to lack of work. (Shephard v. O'Quinn Case No. 3:05-CV-79, 2013) Defendant John O'Quinn, Gary Shephard’s boss, told him that the layoff would be temporary and that his insurance coverage was paid for one month after his layoff. Therefore, Mr. O'Quinn assured Mr. Shephard that his health insurance would still be effective the following week when he had knee surgery.
In the case of United States ex rel. Geraldine Petrowskivs. vs Epic System Corporation, Geraldine Petrowski worked as a the Supervisor of Physician’s Coding at WakeMed Health from 2008 until 2015. She was then trained to be a charge capture analyst for Epic’s billing charge capture system. After that she went on to work as a hospital liasion for the implemention of Epic at WakeMed Health. In 2015 Petrowski alleged that a glitch in Epic’s billing system had caused hundreds of millions of dollars in overbilling. Soon after, Petrowski filed a lawsuit with Florida’s U.S district. In the complaint Petrowski wrote “ Epic’s billing software defaults to charging for both the applicable base units for anesthesia provided on a procedure, as well as
In the United States, healthcare fraud and abuse are significant factor associated with increasing health care costs. It is estimated that federal government spends billions of dollars on the health care cost (Edwards & DeHaven, 2009). Despite the seriousness of fraud and abuse offenses, increasing numbers of healthcare providers are seeking new and more profitable ways to build business relationships. These relationships include hospital mergers, hospital-physician joint ventures, and different types of hospital-affiliated physician networks to cover the rising cost of health care (Showalter, 2007, p 111-114). When these types of arrangements are made, legal issues surrounding the relationship often raise. There are five important Federal fraud and abuse laws that apply to the relationship and to physicians are the False Claims Act (FCA), the Anti-Kickback Statute (AKS), the Physician Self-Referral Law (Stark law), the Exclusion Authorities, and the Civil Monetary Penalties Law (CMPL) and (Office of Inspector General (OIG), 2010). Out of five most important laws that apply to the relationship and the physicians, we are going to focus on the Anti-Kickback Statute (AKS) and the Physician Self-Referral Law (Stark law).
Medical malpractice has become a controversial social issue. From a doctor’s standpoint, decisions and preventative actions can alter the medical malpractice lawsuits filed against them. In order to protect their career and professional life medical malpractice insurance is available. Medical professional liability insurance, sometimes known as medical malpractice insurance, is one type of professional liability insurance. “Professional liability refers to liability that arises from a failure to use due care and the standard of care expected from a person in a particular profession, in this case a doctor, dentist, nurse, hospital or other health-related organization” (Brandenburg, 2014).
Another downfall to HMO coverage is selective-contracting. This is a process where hospitals deny treatment to patients because their...
“HHS:HMO’s Ignore Medical Incompotence.” International Council fpr Health & Human Services 5.21 (2001): 1-2 par. 17.
Aspen . (2008, September 1). Managed Care. Managed Care Outlook, 21, 1-6. Retrieved from http://web.ebscohost.com.ezproxy.graceland.edu
Given the difficulties in the present tort system, we often become victims of the failures of medicine as opposed to beneficiaries of its many successes. Physicians have lost in that they have changed, limited, or closed their practices after having spent the most vigorous years of their lives training for such work. Patients have lost in that the physicians of their choice, with whom they have developed trusting relationships, are no longer available to care for them. It is certain that the system requires sensible reform (p.525).
When evaluating medical malpractice, this can be performed by any healthcare professional. It is easy to classify this to be misdiagnosis, delayed diagnosis, delayed treatment, even not taking the time to evaluate a patient properly. When practicing medicine it is important that all measures be taken when a patient is showing signs of infection or having any adverse reaction to medication. In the case study below this is a prime example of the importance of checking patient progression.
The statute of limitation refers to the length of time in which a plaintiff can file a claim. The principle behind statute of limitation is that lawsuits cannot be improved as time passes by. For one, clear details of the facts can be blurred as memories can fade and witnesses may die, go away, or lose interest of the case. Ideally, court prefers to settle the case as soon as disputes develop (Warner, 2010). However, for professional and product liabilities, with injuries may take time to manifest, many courts adapted different rules such as postponing the running of the statute until the injury has been reasonably discovered. The length of time differs among states and branches of law (Danzon, 1985). The long and deferred statutes of limitations lead to long tail of claims and contributed majority of medical malpractice and product liability (Danzon, 1985). In this section, statutes of limitations for medical malpractice in two states are compared.
The concept of Case management has was first introduced in the 1970’s by insurance companies as a way to monitor and control costly health insurance claims, commonly created by a catastrophic accident or illness (Jacob & Cherry, 2007). Today almost every major health care organization has a case management program managing and directing the use of health care services for their clients. Also, case management by payer organizations is recognized as external case management.