Supreme Court: Will Five and a Half Hours Be Enough?

Fate of the Patient Protection and Affordable Care Act Lies in Hands of Supreme Court

According to the National Law Journal, the Supreme Court justices granted review in three of the five petitions that it had before them regarding the Patient Protection and Affordable Care Act, all from the 11th Circuit Court of Appeals. That court had struck down the mandate that individuals who can afford health insurance must purchase coverage or pay a penalty.

The Journal article lists the issues on which the Court would hear arguments and the amount of time allotted to each issue, for a total of five and one-half hours.

Oral arguments will be made by the United States Solicitor General, 26 state attorneys general (handled by a single lawyer from a Washington firm), and the National Federation of Independent Business (NFIB).

Typically, Supreme Court oral arguments are scheduled for two hours of argument. Arguments are likely to be held in March.

Undoubtedly, with all of the questions raised by the health care act, five hours will not be sufficient time to answer all of them.

Electronic Health Records: Could Your Practice Be at Risk?

The federal government’s efforts at incentivizing medical providers to use electronic health records (EHRs) may be putting some practices at risk.

In “Electronic Records May Increase Malpractice Lawsuit Risk,” Neil Versel with Information Week refers to a white paper published by the AC Group, a Montgomery, Texas, health IT research and consulting firm. The white paper describes the kinds of risks that medical practices may face if they try to implement EHRs too quickly without the appropriate vendors.

Even vendors who have been certified by the Office of the National Coordinator for Health Information Technology (ONC) have been found lacking in the area of “medico-legal training.” For example, according to Versel, it has been discovered that ONC certification may not require providers “to check drug orders against laboratory results or take into account social and family medical history in creating alerts,” such as the need for more frequent mammograms for a female patient with a mother who has had breast cancer.

Here are just a few other issues that have arisen :

• Critical safety alerts are being missed due to incomplete medication lists;
• Problems with time synchronization of records between electronic charting systems; and
• A high percentage of EHRs do not run drug interaction checks when filling prescriptions.

So to the medical practice community: buyer beware.

Workers Can Now Sue Each Other for Negligent Acts Committed Against Each Other

There are some unfortunate unintended consequences of the August 28, 2005 Missouri Workers Compensation Reform.

I wrote Workers Can Now Sue Each Other for Negligent Acts (just published by Associated Industries of Missouri) because I believe the case (mentioned within) sets a terrible precedent from a public policy standpoint.

Do we really want employees suing each over simple negligence when there is a remedy for the injured worker via workers compensation?

Employees probably have no insurance to protect themselves over these types of issues. This could have a devastating effect on small and medium size businesses so I believe it needs to be overruled by the Missouri Supreme Court or the legislature and the Governor need to fix this issue quickly.

ERISA, FEHBA, Medicare (CMS) and Personal Injury claims

Whether you are a plaintiff or defendant with regard to a personal injury claim, it is important to determine whether there are any issues with respect to ERISA, FEHBA and Medicare.

Employee Retirement Income Security Act of 1974 (ERISA)is federal law which establishes minimum standards for pension plans in private industry and includes extensive rules with regard to federal income tax effects of transactions associated with employee benefit plans. Congress established this law with the intent to protect the interests of participants in employee benefits plans and their beneficiaries by requiring financial disclosure to them, establishing fiduciary duties with respect to the plans and allowing access to federal courts to obtain remedies. ERISA addresses pension plans in detail but also effects health care plans. Thus, ERISA applies to all employee welfare benefit plans offered by private sector employers or unions whether offered through insurance or a self-funded arrangement. ERISA’s preemption clause states that ERISA “shall supersede any and all state laws insofar as they relate to any employee benefit plan” which would include a health care plan.

Under an ERISA plan such as a self-funded health and welfare fund, i.e. union health insurance, a plaintiff can recover benefits due under the terms of the plan, enforce rights under the plan and receive a clarification of rights to future benefits under a plan. These health care plans outline when a participant must repay them. These plans typically include language such as when “you or your Dependent achieve any recovery whatsoever, through a legal action or settlement in connection with any sickness or injury alleged to have been caused by a third-party, regardless of whether or not some or all of the amount recovered was specifically for medicalor dental expenses for which Plan benefits were paid.” Moreover, it is not uncommon for the ERISA plan fiduciaries to require a beneficiary to sign additional documents before making any payment to a health care provider with respect to medical care for alleged injuries from a personal injury claim. These additional documents typically contain language which includes “I understand that the Fund must be reimbursed for medical benefits or for any benefits paid as a result of an injury or illness if any recovery is made for that injury or illness.” For example, a plaintiff in a state claim may have health insurance through a self-funded health and welfare fund. Continue reading »