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Wednesday, October 9, 2013

Federal Court Deems CMS Interpretation of the MSP Act Impenetrable

A UD District Court has denied a health provider's challenge to CMS's interpretation of the to the Medicare Secondary Act. CMS's formula for reimbursement was upheld.

"The Court finds this line of argument unpersuasive for several reasons. Most significantly, Allina's heavy reliance on the above-cited cases is unavailing because none of those decisions directly dealt with the precise issue before this Court–i.e., the phrase “entitled to benefits under Part A.” Rather, all of those courts were called upon to interpret the other component of the Medicaid fraction's numerator–the requirement that patients be “eligible” for Medicaid. For this very reason, our Court of Appeals “declined to follow” those same cases, characterizing those courts' discussion of the phrase “entitled to benefits” as dicta. Northeast Hosp., 657 F.3d at 12 n.7. This Court agrees with that assessment and follows the lead of our Circuit. Those decisions do not lend any meaningful support to Allina's arguments here. Moreover, the D.C. Circuit has rejected the substance of this “eligible” versus “entitled” argument as unpersuasive in any event, observing in Northeast Hospital that “the fact that the DSH factions speak of ‘eligibility’ for Medicaid but ‘entitlement’ to Medicare” was not “enlightening.” Id. at 12. Instead, as the Circuit went on to state, “the Secretary's interpretation of ‘entitled’ as ‘meeting the statutory criteria for entitlement’ ... does not actually collapse the terms.” Id. (explaining that an individual could be “ ‘eligible’ for, but not ‘entitled’ to, Part A benefits because one has not yet ‘enrolled’ in the program”). This Court concurs. The Secretary's reading of the statute at issue here does not equate these two terms, and Allina's insistence otherwise lacks merit."

Allina Health System v. Sebelius,
--- F.Supp.2d ----, 2013 WL 5530609, D.D.C., October 08, 2013 (NO. 09-CV-1889 (RLW))

Case Remanded to Compensation Court to Determine Employment Status

A NJ Appellate Court has remanded a negligence case from Superior Court to the Division of Workers' Compensation to determine when an employee held joint employment and subject to the Exclusivity Bar.

" It is well settled in this jurisdiction that for workers ' compensation  purposes
an employee may be simultaneously employed by more than one employer, either because
of the employee's separate contracting with multiple employers or because
his general employer has “lent” him to a special employer. The question to be
determined in the dual employment situation is whether, at the time of the injury,
the petitioner was, as a factual matter, the employee of one or the other
or both of the employers.
In determining which among multiple employers are liable for workers ' compensation ,
this court has noted the indicia of employment that ordinarily require
evaluation, including the existence of a separate agreement between the employee
and each employer, the determination of whose work is being done at the time of
the compensable injury, which has the right to control the details of the work,
which pays, and which has the power to hire, discharge or recall the employee.
The relative weight to be accorded these factors and the manner in which they
are to be balanced are not, however, ... subject to mechanical or automatic application.
Rather, the criteria determinative of the employment relationship
must be “rationalized and applied so that each case may be considered and determined
upon its own particular facts.” And, ...in the dual employment situation,
the most significant inquiry is the determination of “whose interest the
employee was furthering at the time of the accident. ”

CHALMERS and FRED CHALMERS, Plaintiffs–Appellants,
v.
STEPHEN J. SWARTZ
--- A.3d ----, 2013 WL 5525694 (N.J.Super.A.D.) October 9, 2013

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Tuesday, October 8, 2013

When It Comes To Brain Injury, Authors Say NFL Is In A 'League Of Denial'


Today's post was shared by The Health Care Blog and comes from www.npr.org

The casket bearing the body of former Pittsburgh Steelers center Mike Webster is surrounded by flowers, after funeral services in Pittsburgh in September 2002. Mark Fainaru-Wada and Steve Fainaru, authors of League of Denial, point to Webster's autopsy as one of the most significant moments in the history of sports.

When the Pittsburgh Steelers won four Super Bowls in the 1970s, you could argue that no one played a bigger role than Mike Webster. Webster was the Steelers' center, snapping the ball to the quarterback, then waging war in the trenches, slamming his body and helmet into defensive players to halt their rush.

He was a local hero, which is why the city was stunned when his life fell apart. He lost all his money, and his marriage, and ended up spending nights in the bus terminal in Pittsburgh. Webster died of a heart attack, and on Sept. 28, 2002, came the autopsy.

"His body ends up in the Allegheny County coroner's office," ESPN investigative reporter Mark Fainaru-Wada tells NPR's David Greene. "And there's a young junior pathologist there named Bennet Omalu. He makes this decision sort of on the spur of the moment to study Mike Webster's brain."

Fainaru-Wada and his brother, Steve Fainaru, have written a new book called League of Denial, which was also turned into a Frontline documentary on PBS. They take an exhaustive look at how the NFL has dealt with allegations that playing football can lead to brain damage. They interviewed...

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Judge denies jury trial in Chevron RICO case

The federal judge overseeing a fraud lawsuit filed by Chevron Corp. has decided to deny the defendants in the case a jury trial.

Monday, October 7, 2013

Is Workers' Compensation Just a Promise That Can't Be Kept?

Over a century ago, Labor and Industry made a promise to each other called Workers' Compensation. It was summary, remedial, inexpensive administrative process that provided benefits to injured workers through a social insurance program for work-related accidents and diseases. The shifting of wealth in the US has now made the workers' compensation program a target for reform and elmination. Today's post is shared from the opinion pages of the NYTimes.com.

As bad as things in Washington are — the federal government shutdown since Tuesday, the slim but real potential for a debt default, a political system that seems increasingly ungovernable — they are going to get much worse, for the United States and other advanced economies, in the years ahead.

From the end of World War II to the brief interlude of prosperity after the cold war, politicians could console themselves with the thought that rapid economic growth would eventually rescue them from short-term fiscal transgressions.

The miracle of rising living standards encouraged rich countries increasingly to live beyond their means, happy in the belief that healthy returns on their real estate and investment portfolios would let them pay off debts, educate their children and pay for their medical care and retirement. This was, it seemed, the postwar generations’ collective destiny.

But the numbers no longer add up. Even before the Great Recession, rich countries were seeing their tax revenues weaken,...
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Sunday, October 6, 2013

Berkshire Hathaway subsidiaries deny, delay asbestos, hazard claims, suits, insiders allege

Asbestos related disease continues to be epidemic. The victims and their families continue to be meet with delay and denial of benefits. Today's post is shared from turnto23.com

For months, mysterious white flakes and construction dust fell on Nancy Lopez’s desk in the Jackson County Courthouse in Kansas City, Mo.
No question the debris was worse after renovation crews worked the weekend. But really, the mess was getting out of hand. On that Monday in 1983, Lopez grabbed a rag and started dusting.
Berkshire_Hathaway_subsidiaries_deny__de_970160000_20131003001057-10946The impeccably dressed young administrative assistant finished tidying her office and set to work. Unknowingly, she had brushed off her desk, into the air and into her lungs deadly asbestos fibers.
Those tiny fibers stayed with Lopez for decades, and, in 2009, at age 54, she learned she was dying from mesothelioma, an asbestos-caused cancer. She sued the construction company and the county for negligence and punitive damages.
Lopez didn’t realize her suit would eventually pit her against the empire built by acclaimed investor and philanthropist Warren Buffett. Buffett’s Berkshire Hathaway Inc. of Omaha, Neb., has become one of the most powerful forces in asbestos and pollution litigation in the world.
Berkshire’s reach has grown so vast that if you or a loved one files an asbestos- or pollution-related lawsuit in America, like Lopez, you’re likely to encounter a Berkshire subsidiary.
Scripps interviewed more than 20 sources -- some confidential -- reviewed dozens of lawsuits and spoke with former insiders, who all allege the Berkshire-owned companies that...
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2012 ADAO AAC: Joel Shufro, "Left in the Dust Ten Years After the Attack...

The need for better safety and health care and planning is the subject of a talk of Joel Shufro. This post is shared from ADAO.


Oklahoma Chamber of Commerce Seeks to Intervene in Opt-Out Case

In Oklahoma it is now off to the Courts to determine if the Workers' Compensation legislation is really Constitutional. The radical program eliminates the the century old promise between Labor and Industry by transferring the benefit program out of the administrative/judicial adversary system for an employer based insurance scheme. This post is shared from the Oklahoma Chamber of Commerce.
State Chamber President & CEO Fred Morgan comments on the joint chamber Motion to Intervene filed to protect Senate Bill 1062:

“The reforms and restructuring of Oklahoma’s workers’ compensation system that were passed this past legislative session need to be defended,” said Fred Morgan, president and CEO of the State Chamber of Oklahoma. “For the past twenty years, workers’ compensation reform has been the number one economic development issue for Oklahoma. The change to an administrative system, and bringing our benefits back into line with surrounding states, has already seen positive results.”

“We are pleased to join with the Attorney General’s office, Oklahoma City and Tulsa chambers in our fervent defense of these long-needed reforms. Oklahoma businesses need the recently passed reforms to be upheld so we can focus on creating strong, well-paying jobs and developing our growing economy.”

Mike Neal, president and CEO of the Tulsa Regional Chamber also commented on the motion.

“Along with our regional partners, through the OneVoice agenda, we have advocated for appropriate changes to the state's workers' compensation system for many years," said Neal. "We are hopeful the legal challenges can be addressed swiftly so businesses can begin seeing decreased costs and our state will finally realize competitive advantage with a system that works for both employers and employees.”

The Motion to Intervene was filed on behalf of the State Chamber of Oklahoma, Tulsa Regional Chamber, and the Greater Oklahoma City Chamber.

Claims administrator ordered to halt oil spill claims payments

Today's post was shared by Legal Newsline and comes from legalnewsline.com


U.S. District Judge Carl Barbier has ordered claims administrator Patrick Juneau to immediately stop business-related loss payments connected to the 2010 BP oil spill.
Barbier
Barbier

Barbier, who is overseeing the case at the Eastern District of Louisiana, made the ruling Friday — a day after the U.S. Court of Appeals for the Fifth Circuit sided with BP concerning the way funds were being paid out under the Court Supervised Settlement Program under the leadership of Juneau.

BP claims Juneau misinterpreted the settlement agreement and allowed businesses that could show little or no economic damages to receive payments. While business claims will be suspended for the time being, all other claims will be allowed to be processed.

“This order is issued only as an immediate and interim measure until the Court is able to confer with and receive input from the parties in order to confect an appropriate ‘narrowly tailored’ preliminary injunction order as instructed by the Fifth Circuit,” Barbier wrote.

Both BP and the plaintiffs’ steering committee also have been ordered to submit a proposal on how damages for businesses should be handled to eliminate the potential for false claims.
The ruling comes after multiple denials by Barbier to revisit the settlement program at BP’s request.
BP, the plaintiffs’ steering committee and Juneau will meet in a status conference on Oct. 11 to go over potential new...
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Company Is Scolded for Mistakes at Fukushima

Companies need to be honest with both their and employees and the public about safety issues. The age of conspiracy one would think is long passed. This post is shared from the NY Times and highlights the failings of corporate transparency.

In an unusually public scolding, Japan’s nuclear watchdog agency criticized the operator of the crippled Fukushima nuclear plant on Friday for making mistakes that allowed radioactive water to leak into the Pacific Ocean, and ordered it to fix the problems quickly.

The agency, the Nuclear Regulation Authority, summoned the president of the operator, the Tokyo Electric Power Company, to explain the accidents and spills that have plagued the cleanup of the Fukushima Daiichi plant since it suffered a triple meltdown two years ago. In the most recent mishap, workers spilled 114 gallons of contaminated water this week while trying to fill an already overflowing tank, said the company, known as Tepco. It said some of the water might have run into the ocean.

In a public hearing, an official at the regulatory agency, Katsuhiko Ikeda, dressed down Tepco’s president, saying the problems raised serious questions about the company’s ability to operate its other nuclear plants, like the huge Kashiwazaki-Kariwa facility, which Tepco wants to restart.
“That these leaks occurred due to human error is very regrettable,” Mr. Ikeda told the president, Naomi Hirose. “The failure to make rudimentary checks reflects a clear deterioration in the ability to manage the site.”

Mr. Ikeda said Tepco should consider emergency measures like bringing in workers from its other nuclear plants to help improve the cleanup.
Such blunt and direct...
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Saturday, October 5, 2013

Jobs Report Becomes a Casualty of Shutdown

Today's post was shared by The New York Times and comes from www.nytimes.com

On the first Friday morning of almost any other month, from the trading floors of Wall Street to the hushed hallways of the Federal Reserve, all the attention would be focused on two numbers: the latest government estimates for unemployment and job creation.
This Friday, much of the government will be closed. As a result, the economists and statisticians at the Bureau of Labor Statistics will be at home, and everyone from Ben S. Bernanke, the Fed’s chairman, to thousands of traders glued to their Bloomberg screens, will be left without one of the most important clues to the state of the economy.
The mystery is heightened by the question of just how much of an impact the shutdown itself will have. And while the job numbers from last month cannot answer that question, economists almost universally agree that the cost to the economy depends on how long the standoff lasts, and whether the much larger danger of a debt default can be averted.
“If it’s short, it’s barely a blip on the radar,” said Ellen Zentner, senior United States economist at Morgan Stanley. “If a shutdown is prolonged, it’s a whole different story.”
Like many Wall Street economists, Ms. Zentner estimates that each week of the shutdown will shave one-tenth to two-tenths of a percentage point off economic growth in the final quarter of 2013.
That may not sound like much, especially in a $16 trillion economy. And during the last extended shutdown in the mid-1990s...
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Now the Government Shutdown Is Stopping Blood Drives

Today's post was shared by Mother Jones and comes from www.motherjones.com

blood donation

Here's how the government shutdown may literally be killing people: by causing blood shortages.

For all the scorn heaped on government employees, some people forget that the faceless bureaucrats who populate Washington are often, in fact, a bunch of do-gooders—people who genuinely believe in the notion of public service. As such, they contribute to the public good in a lot of ways that are taken for granted, like their immense contribution to local blood banks. Thirty-eight percent of the population is eligible to give blood, but only 5 percent actually does so. A lot of that 5 percent apparently works for the federal government. Thanks to the shutdown, in just two days, four federal agency blood drives scheduled by one DC-area health care system have been canceled. The regional Red Cross has had to cancel six others in the Washington region.

Inova Blood Donor Services projects that the cancelations will result in its projected loss of 300 donations that would have helped 900 patients in DC, Maryland, and Virginia. Inova's donated blood collections supply 24 hospitals, which bank much of the blood for inevitable disasters or, say, terrorist attacks. The Red Cross is suffering from similar disruptions, projecting the loss of 229 donations, each of which could potentially save up to three lives. A single major trauma event can easily deplete a hospital's entire blood store. The longer the shutdown goes on, the...
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Intervening Superseding Event: Turning in Bed Held Not a Bar to Workers' Compensation

A NJ Workers' Compensation Judge has held that turning over in bed did not constitute an intervening superseding event and therefore the claim was held to be compensable.

"....the act of turning in bed to shut off an alarm clock did not constitute an intervening, superseding
event which would free respondent of the liability for petitioner's second back
surgery of September 27, 2007 and I further find that the need for that surgery is
causally related to the work accident of July 12, 2005." 
Philip A. Tornetta, Judge of Compensation

IPPOLITO v. COUNTY OF BERGEN ROAD DEPT
2011 WL 11004007 (N.J. Adm.)
CLAIM PETITION NOS. 2007 - 25283, 2010 - 17376 August 1, 2011
(Reported Oct. 5, 2013)

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New York Second in Nation for Questionable Workers’ Compensation Claims

New York State is second in the nation, only behind California, for questionable workers’ compensation insurance claims. The Empire State jumped to the second place in 2012 from fifth in 2011, the New York Insurance Association noted.

Workers compensation insurance fraud is a serious problem in New York,” Ellen Melchionni, president of the New York Insurance Association, said. “Fraud drives up workers compensation rates. The state and insurance industry need to remain vigilant in cracking down on those looking to cheat the system.”

The National Insurance Crime Bureau (NICB) analysis shows that the number of New York’s questionable claims reported in 2012 was more than double the questionable claims reported in 2011. There were 344 reported in 2012 versus 161 in 2011.

The NICB analysis also shows that in New York State, questionable claims in 2013 are on pace to exceed the 2012 figure. According to data available for the first half of 2013, 183 questionable claims were reported in the state between January and June.

“The growing rate of questionable workers compensation claims is alarming,” Melchionni said. “Fraud takes away from workers compensation serving its intended purpose of protecting injured workers.”
Source: The New York Insurance Association
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US data show higher flu vaccine uptake in health workers

The US Centers for Disease Control and Prevention's (CDC's) final flu vaccine coverage estimates for the 2012-13 season, released today, showed a healthy bump in children and a small gain in adults.
The CDC also found improved flu vaccine coverage in healthcare workers, one of the groups the agency has targeted with more intensive efforts to raise immunization levels.

Federal officials unveiled the findings today at a press conference sponsored by the National Foundation for Infectious Diseases (NFID) at the National Press Club in Washington, DC. The event was part of a broader effort to rally health groups and the public behind this season's flu vaccination efforts.

Vaccine makers expect to produce about 135 million doses for the US market, and so far 73 million doses have been distributed, according to the latest estimate from the CDC. Two new types of vaccine will debut this flu season, a quadrivalent (four-strain) version containing two influenza B strains offered by three different companies and a cell-based version, made by two companies, including Protein Sciences' FluBlok, which has been recommended for adults up to age 49 who have egg allergies.

Health officials said today that limited quantities of quadrivalent flu vaccine will be available in its first season, and that some people may not be able to find it in their area. According to an earlier report, roughly 25 million doses of the 135 million to 139 million doses manufacturers expect to produce will be the...
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Friday, October 4, 2013

To cut costs, New York will close workers' comp hearing sites

The state is shutting down eight offices used for workers' compensation hearings, Capital has learned, a move that will save money but could inconvenience sick or injured working people.
Last month, the Workers Compensation Board informed a state employees union of its intention to close “customer service centers” in Lockport, Riverhead, Canton, Geneva, Oneonta, Monticello, Queensbury and Hornell. The centers are hearing sites for injured workers contesting the denial of their compensation claims. Their closure would force injured workers on those areas to travel longer distances or make phone appearances in support of their case.

"Since 2008, the Workers Compensation Board has been engaged on comprehensive review of its facilities to achieve savings and efficiencies, while at the same time ensuring the quality of services for stakeholders.

As part of this year’s enacted budget, the Workers Compensation Board agreed with the legislature to consolidate the functions of eight customer service centers that were largely unused or underutilized and in some instances housing no employees,” said board spokeswoman Rachel McEneny. “There are no layoffs associated with the consolidations and the Board is allowing any affected claimant to appear telephonically where possible.

The consolidation will result in $3,000,000 in savings to employers throughout the state over the next 10 years.”
A spokesman for the Civil Service Employees...
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Jury weighs talcum powder-cancer link

Talc has been considered a potentially carcinogenic substance.Tody's post is shared from argusleader.com

A jury has been asked to decide whether a Sioux Falls womans ovarian cancer was caused by her use of talcum-based body powder.

Deane Berg, 56, sued Johnson & Johnson in 2009, saying her 30-year use of the companys products for feminine hygiene caused her illness and that the products should have carried warning labels.

Bergs trial began almost two weeks ago in U.S. District Court in South Dakota. Jurors heard testimony from eight expert witnesses who sparred over decades of medical research on the topic and over the meaning of the talc found in Bergs cancer tissue.

Berg, whose cancer is in remission, wants jurors to award damages for medical expenses and punitive damages for failing to warn the public. The company wants jurors to reject the notion that the mineral, which is used in toothpaste, chewing gum and aspirin, carries any real danger for consumers.

During closing arguments Thursday morning, Bergs lawyers said talcum-based powders should carry a warning that notes the association between their use and increased risk of ovarian cancer.

Berg learned of the possible link after her diagnosis in 2006, from a brochure she was offered at Sanford USD Medical Center.

Studies dating as far back as 1971 have found an association. The International Agency For Research on Cancer lists talc as a 2B substance, meaning possibly carcinogenic to humans. Condom manufacturers stopped using the mineral in 1996, and a Johnson & Johnson subsidiary ceased using it in diaphragms that same...
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