Illinois Medical Malpractice Blog

The Medicare program may soon stop paying for more medical care that comes as a result of hospital error. In an effort to encourage hospitals to improve their patient care and avoid medical malpractice lawsuits, hospital infections, and hospital patient injury, Medicare announced last year that it would stop funding certain procedures and treatments. Now Medicare has added more potential preventable errors to the list.

Medicare may stop funding for these common hospital errors and preventable injuries:
-Surgical site infections following certain elective procedures
-Deep vein thrombosis/Pulmonary Embolism
-Legionnaires’ disease
-Extreme blood sugar derangement
-Lung Collapse resulting from medical treatment
-Ventilator-associated pneumonia
-Delirium
-Staph infection in the bloodstream
-Disease associated with Clostridium difficile infection

Medicare’s logic is that hospitals will stop making preventable errors and preventable patient injuries if the hospital won’t get paid for the error. Hospitals used to be paid for every consult and procedure but Medicare believes that not funding for preventable error will encourage hospitals to improve patient care to protect their bottom line.

Read more on these proposed changes here.

The Department of Health and Human Services recently released its patient survey where hospital patients rate their experiences and patient care in a format much like a restaurant guide.

The survey showed some troubling results for Chicago area hospitals including some reports of patient dissatisfaction and hospital care statistics that need serious attention. For instance, four out of ten Illinois hospital patients responding to the survey indicated that they had to wait longer than expected when they needed help or called for assistance. Nearly one third of Illinois hospital patients felt that the hospital did not manage their pain properly. Additionally, only 57% of hospital patients thought that the hospital’s staff properly explained the benefits and risks of medication before administering it.

The Department of Health and Human Services plans to make this survey mandatory for every US hospital; though the survey was voluntary in 2007, the Department will reduce Medicare funding for hospitals that do not participate in the survey.

Read the full news story here, and access the survey here.

According to a recent HealthGrades study of patient care in hospitals, the past three years of medical errors have cost the Medicare system more than $8.8 billion dollars. Additionally, the study found that hospital safety problems caused 238,337 preventable deaths to patients. Bed sores, failure to rescue, and respiratory failure were the most common cause of preventable death, affecting nearly 2 out of 3 patients. Other preventable malpractice errors included foreign bodies left in the patient during a procedure, anesthesia errors, hospital infections, and accidental lacerations.

For the full story, click here.

There are many factors that contribute to why Medicare & Medicaid fraud is becoming out of control in America. Two serious contributors are overpriced prescriptions for medications, devices and treatments in addition to overspending by largely unregulated hospitals. Billions of Americans' tax dollars are not going to where they are intended.

Doctors have many incentives for prescribing the most expensive drugs and medical devices mainly including rewards from drug companies. This type of fraud is estimated to account for about 15% of Medicare & Medicaid over-billings. It is difficult to restrict the ability of the drug companies to manipulate doctors because according to the study, the corporations have too much influence in the US Government.

Additionally, "boutique hospitals," those owned by investor groups and not-for-profit hospitals are also cited as a large source of Medicare & Medicaid fraud. According to the study, these hospitals are less regulated by the government and can, as a result, over-bill the federal government.

Medicare & Medicaid fraud was also shown to be extensive in nursing homes, rehab centers, and long term care facilities. Click here to learn more.

Click here for the full article

Another case of illegal kickbacks where doctors receive illegal payments for steering their patients in a certain direction has struck close to home. Illinois Attorney General recently intervened in a lawsuit against multiple Chicago radiology centers alleging illegal kickbacks to referring doctors. The complaint states that the radiology centers entered into sham agreements with Chicago doctors where the doctors would pay less for radiological services but charge the patient’s insurance a higher rate. The Chicago doctors would then keep the difference. The lawsuit asks the court to order the defendants to stop paying the illegal kickbacks and seeks monetary damages, restitution, and penalties.

For the full article.

A company that manages government health plans for the poor must pay at least $144 million in damages for wrongfully denying coverage to pregnant women eligible for Medicaid. The plaintiffs, which included the federal and Illinois governments, were awarded a total of $48 million by the jury. The company may also be liable for a total of as much as $199 million in penalties for more than 18,000 instances of fraud found by the Chicago jury.

For the full article.

$15.4 million was recently paid by a city hospital to resolve both state and federal claims against it. The lawsuit, brought by the government, alleged violations of the False Claims Act, stating that the hospital conspired to increase Medicare bills by paying physicians kickbacks to steer patients to the facility, where they frequency received unnecessary treatment. One of the defendants was a party to a $14 million settlement for a similar scheme he ran at a Chicago facility involving Chicago medical malpractice and Medicare fraud.

To read the full article.

A company called Neurometrix recently introduced a system that checks patients for nerve disease and has targeted the system for use by general practitioners. Its introduction to the market has not been painless.

Continue reading "Expensive new nerve test stirs controversy " »

An article reported that Our Lady of Lourdes Regional Medical Center had allowed one of its doctors to perform unnecessary heart procedures, such as angiograms, angioplasty, and stent replacements on their patients. The lawsuit against the Medical Center for defrauding public health care providers was filed by a whistleblower who had formerly worked with the doctor. The Federal Government has settled the lawsuit for $3.8 million and the whistleblower will receive $760,000 of the award. The doctor is also individually facing several criminal charges and hundreds of medical malpractice lawsuits for the unnecessary heart procedures.

For the full article.