A California attorney who won a landmark denial-of-care lawsuit against Health Net four years ago is suing PacifiCare Health Systems, claiming its alleged denial of home healthcare for a newborn with congenital heart defects constituted "torture."
The suit was filed in state Superior Court late last month by Oxnard attorney Mark Hiepler. He alleges PacifiCare, Santa Barbara, Calif.-based Monarch Medical Alliance and two of its directors violated the state law against torture when it would not pay for home care for Daniel Wallock, causing him and his family pain and suffering in order to enjoy a monetary gain.
In a statement, PacifiCare said the issues could have been addressed swiftly if the Wallocks "had called our member service department before taking matters into their own hands." The plan had begun paying for home care after the Wallocks filed a complaint with state regulators, according to the Los Angeles Times.
Hiepler won an $89.1 million judgment against Health Net in 1993 when a jury determined that it deliberately stalled paying for an experimental bone marrow transplant to cure his sister's breast cancer. Although Nelene Fox was able to pay for a transplant with contributions from family, friends and neighbors, she died before the case reached trial.
Audited. When MODERN HEALTHCARE spoke recently with several auditors for a story on consolidation and competition in the vendor payment recovery business, we weren't sure at first how this business really works. Now we know.
For a 50% finder's fee, firms that specialize in vendor payment audits will plow through a hospital's purchase orders and invoices to uncover billing errors, shipping overcharges and neglected discounts on volume purchases. Auditors say it's a tough business, but it can be a lucrative one.
So it was with some amusement that we opened mail from one of the audit firms. The envelope, which contained a note pad and business card, arrived in our New York bureau with 25 cents postage due.
Music bridges the gap.In one of the most unusual political-musical alliances in history, dozens of doctors, nurses and other healthcare professionals from the Department of Veterans Affairs teamed up on Capitol Hill with arch-conservative Sen. Orrin Hatch (R-Utah) and the family of arch-liberal Jesse Jackson. The purpose? A performance of one of Hatch's musical compositions.
The setting was the Second Congressional Flag Day Prayer Concert. Backed by the VA-National Medical Musical Group and a chorus and orchestra of VA physicians and other health professionals, Santita Jackson, Jesse Jackson's daughter, premiered "Heal Our Land," a Hatch composition. Hatch recently broke into musical composition with an album of inspirational and religious songs.
"It was the lion laying down with the lamb," said Victor Wahby, M.D., musical director of the VA medical musical group.
The name game.Acknowledging "a few inherent problems with the PHO concept," the American Association of Physician Hospital Organizations/IDS has dropped the reference to PHOs from its name. The new moniker is the American Association of Integrated Healthcare Delivery Systems.
It's the second name change for the 4-year-old group, which started out as the American Association of Physician Hospital Organizations.
The Glen Allen, Va.-based group wants to expand its membership ranks of about 2,000 to include leaders of independent practice associations, management service organizations and other structures.
Some members left because their PHOs had evolved into something else, says spokeswoman Jeanette Godfrey.
Hot air.The past several weeks have not been good for suppliers of home oxygen therapy equipment.
First, they were targeted for about $1.3 billion in Medicare spending cuts over five years in the White House budget, a whopping 40% reduction in spending.
Things got worse. The House Ways and Means Committee refigured how it would reduce oxygen spending and settled on a reduction of about $1.8 billion.
Then came the coup de grace. The Senate Finance Committee called for $2.2 billion in reductions and a competitive-bidding demonstration project for home oxygen that the suppliers say will lead to even further cuts.
What went wrong?
One factor was a lobbying campaign by the industry that was less than successful. It seems lobbyists thought it would be a good idea to have hundreds of home oxygen users flood the switchboards of Congress with complaints about the budget package.
According to one staffer, the calls, which were described as coming from "people who sounded like they were half dead," were the "most annoying thing I have ever dealt with. It really aggravated a lot of people."
Another staffer called it "the single worst lobbying campaign I have ever seen."
But who's counting.Did you remember Columnist's Day? All but one of you forgot.
Heck, Outliers didn't even know it existed until we received a note from John Evers, the community relations coordinator at Rest Haven Central, a nursing home in Palos Heights, Ill. The card, which looked like it had been computer-generated, read, "Your help and efforts are very much appreciated. Have a fantastic day!" Whoever said reporting is a thankless job? Look for Hallmark to cash in on this one.