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(c) 2014 Jon L Gelman, All Rights Reserved.

Tuesday, December 31, 2013

Coordination of Benefits and Non-Group Health Plan Recovery Transition

The Centers for Medicare & Medicaid Services (CMS) is completing its restructuring of the Coordination of Benefits (COB) and Medicare Secondary Payer (MSP) recovery activities.

COB activities for both Group Health Plans and Non-Group Health Plans (that is, liability insurance (including self-insurance), no-fault insurance, and workers' compensation laws or plans) and Recovery activities for Non-Group Health Plans will be transitioned from the COB contractor and the Medicare Secondary Payer Recovery Contractor effective February 1, 2014.  The new Benefits Coordination & Recovery Center (BCRC) will assume these activities.  As previously announced, this action will provide:
  • Improved customer service for stakeholders
  • Consolidated and streamlined data collection and recovery operations
  • Value-added efficiencies and enhanced resource utilization

Clothing Brands Sidestep Blame for Safety Lapses

From a sleek gray distribution center near Barcelona, the global fashion brand Mango ships 60 million garments in a year. Automated conveyor belts whir through the building like subway lines, sorting and organizing blouses, sweaters and other items to be shipped around the world. Human hands barely touch the clothes.

Five thousand miles away in Bangladesh, the Phantom Tac factory in the industrial suburb of Savar was a hive of human hands. Hundreds of men and women hunched over sewing machines to produce garments in an assembly line system unchanged for years. Speed was also essential, but that just meant people had to work faster. 

Last spring, as it pushed forward with global expansion plans, Mango turned to Phantom Tac to produce a sample order of polo shirts and other items. Then, on April 24, the Rana Plaza factory complex collapsed, killing more than 1,100 people in the deadliest disaster in garment industry history, and destroying Phantom Tac and other operations in the building.

Now, eight months later, the question is what responsibility Mango and other brands should bear toward the victims of Rana Plaza, a disaster that exposed the murkiness and lack of accountability in the global supply chain for clothes. Under intense international pressure, four brands agreed last week to help finance a landmark $40 million compensation fund for the victims.

But many other brands, including Mango, have so far refused to contribute to the...

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Asbestos Victims Ask Yale to Revoke an Honorary Degree


An Italian organization representing victims of asbestos exposure has asked Yale University to rescind an honorary degree awarded to the owner of the company they once worked for.

In the mid-1970s, Swiss billionaire Stefan Schmidheiny took over his family’s business. The Eternit company had plants around the world that produced asbestos cement products. The largest was in Casale Monferrato, Italy.

Connecticut lawyer Christopher Meisenkothen represents shipyard workers and boiler makers who worked with asbestos here in the U.S., and later developed diseases like asbestosis, lung cancer, and mesothelioma. He is handling the Italian request to Yale, pro bono.

Meisenkothen described notes from an Eternit company meeting in the 1970s. "Clearly," he said, "they were acknowledging in 1976 that the workers were at risk. The plant continued to use asbestos for many years after that. They could have given the workers respiratory protection, [or] installed exhaust fans. And the worker testimony from workers at the time consistently indicates that there were no serious precautions taken in the plant."

Two years later, Schmidheiny began to dismantle the company's asbestos processing concern. He went on to use his wealth to support eco-friendly sustainable development in other parts of the world.

In 2012, Schmidheiny was tried in absentia in Italy. He was found guilty of causing the deaths of thousands of people in Casale Monferrato, and has been sentenced to 18 years...


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Monday, December 30, 2013

2014 Asbestos Awareness Conference Honorees

Today's post was shared by Linda Reinstein and comes from www.asbestosdiseaseawareness.org

2014 ADAO Asbestos Awareness Conference Keynote Speakers
Saturday: TBA
Sunday: Susan Vento, Widow of the late Congressman Bruce Vento
Heather Von St. James, Mesothelioma Patient

2014 ADAO Asbestos Awareness Conference Honorees
Congressman Henry Waxman will be presented with the Tribute of Hope Award for his steadfast commitment to public health and safety.
Dr. Ken Takahashi will be recognized with the Dr. Irving Selikoff Lifetime Achievement Award in honor of his tireless dedication to increasing awareness about asbestos to eliminate diseases and his unending support of the Asbestos Disease Awareness Organization.
Dr. David Egilman will be recognized with the Dr. Irving Selikoff Lifetime Achievement Award in honor of his tireless dedication to increasing awareness about asbestos to eliminate diseases and his unending support of the Asbestos Disease Awareness Organization.
Congressman Bruce Vento will be honored posthumously with the Warren Zevon “Keep me in Your Heart” Memorial Tribute for his countless years of public service as a legislator and public servant.
Bill Ravanesi will be presented with the Tribute of Inspiration Award for...

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Common Knee Surgery Does Very Little for Some, Study Suggests

A popular surgical procedure worked no better than fake operations in helping people with one type of common knee problem, suggesting that thousands of people may be undergoing unnecessary surgery, a new study in The New England Journal of Medicine reports.

The unusual study involved people with a torn meniscus, crescent-shaped cartilage that helps cushion and stabilize knees. Arthroscopic surgery on the meniscus is the most common orthopedic procedure in the United States, performed, the study said, about 700,000 times a year at an estimated cost of $4 billion.

The study, conducted in Finland, involved a small subset of meniscal tears. But experts, including some orthopedic surgeons, said the study added to other recent research suggesting that meniscal surgery should be aimed at a narrower group of patients; that for many, options like physical therapy may be as good.

The surgery, arthroscopic partial meniscectomy, involves small incisions. They are to accommodate the arthroscope, which allows doctors to see inside, and for tools to trim torn meniscus and to smooth ragged edges of what remains.

The Finnish study does not indicate that surgery never helps; there is consensus that it should be performed in some circumstances, especially for younger patients and for tears from acute sports injuries. But about 80 percent of tears develop from wear and aging, and some researchers believe surgery in those cases should be significantly limited.

“Those who do research have...
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Emily Oster’s graph of the year: Why is the U.S. falling behind in life expectancy?

Today's post was shared by RWJF PublicHealth and comes from www.washingtonpost.com

Time has its "Person of the Year." Amazon has its books of the year. Pretty Much Amazing has its mixtapes of the year. Buzzfeed has its insane-stories-from-Florida of the year. And Wonkblog, of course, has its graphs of the year. For 2013, we asked some of the year's most interesting, important and influential thinkers to name their favorite graph of the year — and why they chose it.

Amidst all the focus on health insurance, I think it’s crucial not to lose focus on the fact that -- insurance or not -- the United States is lagging behind in health status. This chart -- from a broader report -- demonstrates not only how low our life expectancy is relative to other developed countries, but also how far we have fallen even in the last 30 years. Why are we not realizing the same gains that countries with comparable incomes are?

Emily Oster is an associate professor of economics at the University of Chicago Booth School. Her book is "Expecting Better: Why the Conventional Pregnancy Wisdom Is Wrong."See all the graphs of 2013 here, including entries from Jonathan Franzen, Bill McKibben, and Ta-Nehisi Coates.

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Global cancer burden rises to 14.1 million new cases in 2012: Marked increase in breast cancers must be addressed

The International Agency for Research on Cancer (IARC), the specialized cancer agency of the World Health Organization, today released the latest data on cancer incidence, mortality, and prevalence worldwide.1 The new version of IARC’s online database, GLOBOCAN 2012, provides the most recent estimates for 28 types of cancer in 184 countries worldwide and offers a comprehensive overview of the global cancer burden. 
GLOBOCAN 2012 reveals striking patterns of cancer in women and highlights that priority should be given to cancer prevention and control measures for breast and cervical cancers globally. 
Global burden rises to 14.1 million new cases and 8.2 million cancer deaths in 2012 
According to GLOBOCAN 2012, an estimated 14.1 million new cancer cases and 8.2 million cancer-related deaths occurred in 2012, compared with 12.7 million and 7.6 million, respectively, in 2008. Prevalence estimates for 2012 show that there were 32.6 million people (over the age of 15 years) alive who had had a cancer diagnosed in the previous five years. 
The most commonly diagnosed cancers worldwide were those of the lung (1.8 million, 13.0% of the total), breast (1.7 million, 11.9%), and colorectum (1.4 million, 9.7%). The most common causes of cancer death were cancers of the lung (1.6 million, 19.4% of the total), liver (0.8 million, 9.1%), and stomach (0.7 million, 8.8%). 
Projections based on the GLOBOCAN 2012 estimates predict a substantive increase to 19.3 million new cancer cases per year by 2025, due to growth and ageing of the global population. More than half of all cancers (56.8%) and cancer deaths (64.9%) in 2012 occurred in less developed regions of the world, and these proportions will increase further by 2025. 
Sharp rise in breast cancer worldwide 
In 2012, 1.7 million women were diagnosed with breast cancer and there were 6.3 million women alive who had been diagnosed with breast cancer in the previous five years. Since the 2008 estimates, breast cancer incidence has increased by more than 20%, while mortality has increased by 14%. Breast cancer is also the most common cause of cancer death among women (522 000 deaths in 2012) and the most frequently diagnosed cancer among women in 140 of 184 countries worldwide. It now represents one in four of all cancers in women. 
“Breast cancer is also a leading cause of cancer death in the less developed countries of the world. This is partly because a shift in lifestyles is causing an increase in incidence, and partly 

Sunday, December 29, 2013

Police Salaries and Pensions Push California City to Brink

How much can be expended in public entity benefits to employees remains be challenging question. In California, a municipality is moving even closer to bankruptcy the cost of those issues.Today's post was shared by Steven Greenhouse and comes from www.nytimes.com

DESERT HOT SPRINGS, Calif. — Emerging from Los Angeles’s vast eastern sprawl, the freeway glides over a narrow pass and slips gently into the scrubby, palm-flecked Coachella Valley.
Turn south, and you head into Palm Springs with its megaresorts, golf courses and bustling shops. Turn north, and you make your way up an arid stretch of road to a battered city where empty storefronts outnumber shops, the Fire Department has been closed, City Hall is on a four-day week and the dwindling coffers may be empty by spring.
The city, Desert Hot Springs, population 27,000, is slowly edging toward bankruptcy, largely because of police salaries and skyrocketing pension costs, but also because of years of spending and unrealistic revenue estimates. It is mostly the police, though, who have found themselves in the cross hairs recently.
“I would not venture to say they are overpaid,” said Robert Adams, the acting city manager since August. “What I would say is that we can’t pay them.”
Though few elected officials in America want to say it, police officers and other public-safety workers keep turning up at the center of the municipal bankruptcies and budget dramas plaguing many American cities — largely because their pensions tend to be significantly more costly than those of other city workers.
Central Falls, R.I., went bankrupt in 2011 because its police and firefighters’ pension fund ran out of money. Vallejo, Calif., went bankrupt...
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Where the 1.3 million people losing unemployment aid this week live

NJ is going to suffer the most by the termination of the unemployment benefit extension. Today's post was shared by Steven Greenhouse and comes from www.washingtonpost.com

Darker shading means a larger share of a state's population will lose emergency jobless benefits on Saturday. Scroll down for an interactive map.
Darker shading means a larger share of a state's population will lose emergency jobless benefits on Saturday. Scroll down for an interactive map.
Darker shading means a larger share of a state’s population will lose emergency jobless benefits Saturday. Scroll down for an interactive map. (Committee on Ways and Means Democrats/Labor Department)
A projected 1.3 million people will lose emergency unemployment benefits when they expire Saturday.
Congress offered the extended benefits as unemployment ballooned during the Great Recession and has put off their expiration 11 times since. Renewing the long-term insurance is a top agenda item for the Senate when it convenes  Jan. 6, Sen. Majority Leader Harry Reid (D-Nev.) has said. The body is expected to vote quickly on a three-month extension of the benefits.
Recipients still face, at best, a delay in their checks and, at worst, a permanent end to them. When the aid expires Saturday, the unemployed will only be able to collect a maximum 26 weeks of benefits in most parts of the U.S., down from about twice as much in many states.
The recession may technically be over, but for many the recovery has yet to begin. The plight of the long-term unemployed — a group the benefits are aimed at helping and whose ranks have swelled — has also proven particularly difficult to solve. Studies have shown that they are more likely to suffer mental-health setbacks and are less likely to be...
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US flu activity keeps climbing

Today's post was shared by CIDRAP and comes from www.cidrap.umn.edu

Highly magnified, digitally colorized electromicrograph of 2009 H1N1 influenza virus, the predominant strain this season.
Highly magnified, digitally colorized
 electromicrograph of 
2009 H1N1 influenza virus,
 the predominant strain this season.
US influenza activity kept climbing last week, as several states outside the South reported widespread cases, and the 2009 H1N1 virus continued to be the predominant strain, according to the US Centers for Disease Control and Prevention (CDC).
Ten states reported geographically widespread flu activity, up from just four southern states the week before. The ten are Alabama, Alaska, Kansas, Louisiana, Massachusetts, New York, Pennsylvania, Texas, Virginia, and Wyoming.
Also, six states reported high influenza-like illness (ILI) activity as measured by visits to sentinel clinics, up from four states the previous week, the CDC reported. Nationally, 3.0% of medical visits were due to ILI, compared with the national baseline of 2.0%.
States with high ILI activity were Alabama, Louisiana, Mississippi, Missouri, Oklahoma, and Texas. Another eight states cited moderate ILI activity, and the rest had low or minimal numbers.
The CDC also reported a big jump in the percentage of respiratory samples that tested positive for flu: 24.1% (of 6,813 specimens), versus 17.8% a week earlier.

An H1N1 season so far

Of the positive specimens, more than 98% were influenza A viruses, and 2009 H1N1—the former pandemic virus, now a seasonal strain—accounted for nearly all of those that were subtyped. Only 1.8% of the positive specimens were influenza B isolates.
Last week the...
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Saturday, December 28, 2013

Experts Speak Out About The Asbestos Industry

Today's blog post is shared from Laurie Kazan-Allen and the http://ibasecretariat.org

Part I - About the Asbestos Industry
video

Part II - Asbestos Causes Cancer and Why Asbestos Should Be Banned
video

N.Y. Workers’ Comp Board to Transition Established UEF Claims Management to Triad Group

The New York State Workers’ Compensation Board recently announced it will transition the management of established Uninsured Employers’ Fund (UEF) claims to the Triad Group, LLC effective Jan. 13, 2014.
Triad Group, based in Troy, N.Y., is a professional service organization providing comprehensive claims management.
These claims consist of established claims where liability has been determined, and medical, and/or indemnity payments must be made. Triad will perform all claim-related functions and legal representation. Claimants who have such UEF claims, and all parties of interest, including health care providers and legal representatives, will receive individual written notice of the change in claim administrator.
The Workers’ Compensation Board said the transition of claim management should have no impact on claimants receiving workers’ comp benefits. Claimants who are receiving biweekly indemnity benefits will continue receiving benefits on the same schedule currently in place.
For medical and transportation reimbursement requests after Jan. 13, 2014, Form C-257, Claimant’s Record of Medical and Travel Expenses and Request for Reimbursement, must be sent to Triad for processing with a copy to the Workers’ Compensation Board. For medical services provided on or after Jan. 13, 2014, in established cases only, health care providers should send new medical reports, bills and authorization requests to Triad, and a copy to the...

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Senators Press Medicare for Answers on Drug Program

A Senate committee chairman said he is concerned about the “serious vulnerabilities” detailed in a ProPublica report about scams that target Medicare’s popular prescription drug program.

Sen. Tom Carper, D-Del., who chairs the Homeland Security and Governmental Affairs Committee, said in a statement that he plans to ask Medicare officials and the inspector general of the U.S. Department of Health and Human Services “to look into the specifics of these cases, as well as determine the extent of any program-wide vulnerabilities that may have allowed them to occur.” The committee monitors fraud in government programs.

ProPublica reporters, using Medicare’s own data, identified scores of doctors whose prescription patterns within the program bore the hallmarks of fraud. The cost of their prescribing spiked dramatically from one year to the next — in some cases by millions of dollars — as they chose brand-name drugs that scammers can easily resell.

The cost of medications prescribed by one Miami doctor jumped from $282,000 to $4 million in one year, but her lawyer said Medicare never questioned it. A Los Angeles psychiatrist said Medicare didn’t shut off his provider identification number, used to fill prescriptions, even though he claimed someone had forged his name on more than $7 million worth of them.

All told, just the schemes identified by ProPublica totaled tens of millions of dollars.

While credit card...

Nebraska Appeal Dismissed - Failure to Exhaust Remedies

The failure to exhaust administrative remedies terminated an appeal to Nebraska Spring court. Today's post is shared from starherald.com

The Nebraska Supreme Court dismissed an appeal Friday in a case involving a co-op employee who suffered a traumatic brain injury when he fell off a truck's flatbed.

The high court ruled that the Aurora Cooperative had filed its appeal too early, and sent the case back to a workers' compensation court for more deliberations.

John Jacobitz, of Milligan, was injured in August 2010 while cleaning up after a customer appreciation supper. Jacobitz and two other managers dropped off a grill in a company shed, and Jacobitz hopped onto the back of the flatbed truck for a ride back to the community center where the event was held, according to court records. He fell off in Ong after riding about half a block.

The dispute at trial focused on whether Jacobitz was acting within the scope of his job duties when the accident occurred. Jacobitz and the co-op disputed whether he was asked to help host the event, or whether he was told he could come if he wished. They also disputed whether the co-op or one of its vendors had sponsored the event.

A Nebraska workers' compensation judge ruled in Jacobitz's favor on Jan. 28, saying that he believed he had to attend the event for his job or that it was within his best interests to attend. The judge had not yet decided how much to award in benefits, but the co-op appealed the case.

"We conclude that the co-op has not appealed from a final order because the trial court has determined only...

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Related articles

Court Holds OSHA HazCom Standard Not A Bar To State Failure to Warn Claims

The US Court of Appeals for the District of Columbia has held that The Occupational Safety and Health Administration’s (OSHA) HazCom Standard does not preempt state law, therefore allowing state lawsuits to go forward based on “failure to warn” claims.

The Court dismissed the Petition filed by the American Tort Reform Association for a definitive determination concerning Federal preemption of state court based actions. The case overrules an unpublished NJ Appellate Court decision dismissing a state based claim for “failure to warn.”  Bass v. AirProducts & Chemicals Inc., et al., Docket No. A-4542-03T3, 2006 WL 1419375, May 25, 2006 (N.J. Superior A.D.), NJ Supreme Court denied certification, 907 A.2d 1014, Sept. 8, 2006.

The Court reasoned that the petition for review was, “….much to do about nothing.” The Court held, that while OSHA had no authority to issue an authoritative statement, OSHA could issue an interpretative statement that is not subject to notice and comment rulemaking  under the Administrative Procedures Act (APA) 5 U.S.C. § 553(b).

The HazCom Standard establishes labeling requirements for chemicals used in the workplace. 29 C.F.R. § 1910.1200(a)(2).

American Tort Reform Association v. OSHA, et al., Docket No. 12-1229 (2013 D.C. Cir.)  Decided: December 27, 2013.

Social Security - Administrative Law Judge Rulings

ALJ Disposition Data
FY 2014 (For Reporting Purposes: 09/28/2013 Through 11/29/2013)
A listing of hearings completion data by name of individual administrative law judges (ALJ) for all ALJs in ODAR. The data includes hearing office name, total dispositions, decisions, allowances, denials and fully favorable or partially favorable decisions.
Click here to down oad the data in PDF format.
Found on
Tembow….

Friday, December 27, 2013

McDonalds Kills Site That Advised Employees to Eat Healthy Meals

Today's post was shared by Steven Greenhouse and comes from mashable.com

Mcdonalds-burger-and-fries

McDonald's had a thoughtful piece of advice for its own employees: If you want to be healthy, avoid fast food.
That's what the fast-food outlet posted on its employee resource website McResource Line. The company pulled the site on Wednesday, saying the advice, which a third-party vendor provided, was taken out of context.
"Fast foods are quick, reasonably priced and readily available alternatives to home cooking. While convenient and economical for a busy lifestyle, fast foods are typically high in calories, fat, saturated fat, sugar and salt and may put people at risk for becoming overweight," read one posting on the site's diet section, according to CNBC.
Another page displayed a large soda, french fries and a hamburger — a meal labeled as an "unhealthy choice." Next to it, the "healthier choice" of a cup of water, a salad and a sandwich.
These postings disappeared Wednesday when McDonald's took down the entire website, saying its content was unfairly misrepresented.
"A combination of factors has led us to re-evaluate and we've directed the vendor to take down the website," McDonald's wrote in a statement posted on its main website. "Between links to irrelevant or outdated information, along with outside groups taking elements out of context, this created unwarranted scrutiny and inappropriate commentary. None of this helps our McDonald's team members."
This is not the first...
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