Articles Posted in health insurance claims

The federal government will pay $2.3 million to settle a medical malpractice lawsuit involving a child born with neurological damage at Portsmouth Naval Medical Center. U.S. District Judge approved the settlement between the Justice Department and a family in Virginia Beach, according to a court filing made public. The plaintiffs sued the United States early last year, seeking $15 million in damages. The couple alleged that inadequate care at a Naval Medical Center caused their child to be born with developmental disabilities. The government denied any malpractice and admited no wrongdoing in the settlement.

In 2006,the plaintiff checked into the hospital with severe cramping in her lower abdomen. She was 35 weeks pregnant, according to the lawsuit. She was moved to a triage room and connected to a fetal heart monitor, which showed abnormalities indicating the fetus was under stress, the suit says. Instead of notifying a doctor, the papers say, the staff left the patient for more than an hour without any intervention.

About 2-1/2 hours after she was admitted, doctors performed an emergency cesarean section. The doctors determined that the placenta had detached from the uterine wall, causing a loss of oxygen to the fetus, the suit says. The baby girl was born pale and limp, with respiratory failure and a slow heart rate, the suit says. She was intubated and later transferred to Children’s Hospital. The girl’s “neurological injuries are extensive, severe and permanent,” the suit says. “She is severely delayed in all areas of development.” The damage, including cerebral palsy, will be lifelong.

In what state officials describe as a record-setting verdict, a jury found that a global drug manufacturer misrepresented prices to the state’s Medicaid program and said the company should pay the state and federal government $170.3 million. The verdict concluded a nearly three-week trial in state district court, where lawyers for the attorney general’s office argued that the drug company artificially inflated the costs of medications to obtain more money. Medicaid reimbursed pharmacies at higher rates because of the falsely reported prices, officials said.

The trial reportedly was the first of its kind in the state; similar cases in recent years have settled out of court. The attorney said in a statement that the case makes clear his office will hold accountable those who defraud the Medicaid program, a joint federal and state effort to provide health coverage to needy Americans. “Considering the hundreds of millions of dollars that are at stake, we will continue to vigilantly pursue providers that falsely report prices to defraud the taxpayers,” he said.

Drug company officials said in a statement that they are disappointed by the verdict and are exploring legal and appeal options. “We remain, as always, committed to offering high-quality, lower-cost alternatives for health consumers, including the millions of Americans who participate in the Medicaid program,” said the company’s vice president and chief legal officer.

Two doctors and a medical assistant have filed a workplace discrimination lawsuit against a Medical Center, claiming that more than one patient has died there as a result of “substandard care” and that they were ignored or embarrassed, and in one case, terminated, for speaking out. The County Executive said several outside and internal inspectors found “absolutely no evidence” that the patients in question died because of negligence. But he acknowledged that the hospital’s cardiology department is “dysfunctional” because of the many “personality conflicts” and “plethora of he-said, she-said arguments.”

Lawsuit filed Friday in U.S. District Court offers a rare glimpse into the mostly private goings-on in the county-run hospital hallways. Seventy-four pages of allegations paint a one-sided picture of death, backbiting and sexism. The suit was brought by a medical administrative assistant in the cardiology department; a cardiologist; and a chief of cardiothoracic surgery. “This was a last resort,” said the attorney “But the plaintiffs felt this was a moral imperative that they come forward. We have to tell the community what is going on here, that people are dying, and the administration will not change.”

Named as defendants are a chief of cardiology; a chief medical officer; a medical director; and a cardiologist. Among other things, the suit alleges retaliation, discrimination, a hostile work environment, invasion of privacy, slander and intentional infliction of emotional distress.

In 2007, a 17-year-old girl, was refused a liver transplant by her health insurance company. The transplant was denied because the health insurance company said that it was experimental and was not covered. After a storm of publicity, the health insurance company agreed to the transplant nine days later but it was too late and the 17-year-old girl died a few hours later. Ten months later, the deceased’ mother went to the insurance company’s headquarters and announced at the security desk in the lobby that “You guys killed my daughter. I want an apology.” Instead of an apology, she got heckeled by insurance employees looking down into the atrium lobby from a balcony above and one of them gave her the “finger.”

The child’s parents parents filed a wrongful-death lawsuit against the insurance company’s for their child’s death due to insurance company’s refusal to pay for the transplant. A Los Angeles judge threw out the complaint, saying that it was barred by a 1987 U.S. Supreme Court ruling that shields employer-paid healthcare plans from damages over their coverage decisions. Under the 1974 Employee Retirement Income Security Act, or ERISA, the only monetary damages that beneficiaries of workplace health plans can sue for is the cost of the treatment of service in dispute, not damages arising out of refusal of the treatment.

Recently, a U.S. District Court Judge ruled that the parents could pursue damages for any emotional distress caused by the incident at the insurance company’s headquarters. The parent’s of the child are hoping that by bringing the wrongful-death suit the legislature will see that ERISA needs to be revised and that insurance companies need to be liable for their treatment decisions.