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(c) 2010-2024 Jon L Gelman, All Rights Reserved.

Wednesday, April 16, 2014

Prices Soaring for Specialty Drugs, Researchers Find

Workers' Compensation insurance covers the FULL cost of prescription drugs.Today's post was shared by The New York Times and comes from www.nytimes.com

Even as the cost of prescription drugs has plummeted for many Americans, a small slice of the population is being asked to shoulder more and more of the cost of expensive treatments for diseases like cancer and hepatitis C, according to a report to be released on Tuesday by a major drug research firm.
The findings echo the conclusions of two other reports released last week by major pharmacy benefit managers, which predicted that spending on so-called specialty drugs would continue to rise.
The report, by the IMS Institute for Healthcare Informatics, also found that consumers’ use of health care — visits to the doctor, hospital admissions and prescription drug use — rose in 2013 for the first time in three years, mainly because of the improving economy, it said.
“Following several years of decline, 2013 was striking for the increased use by patients of all parts of the U.S. health care system,” Murray Aitken, executive director of the IMS Institute, said in a statement. He noted that the spike came before the Affordable Care Act, which has helped provide health insurance to millions of new customers, fully went into effect.
But even as consumers became more confident about spending money on health care last year, the report found that a divide is developing between those with medical conditions that can be treated with cheap generic drugs, and those with rare and often more serious diseases that can come with breathtaking price tags.
More than...
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Related Articles:
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A major international pharmaceutical company has made a major change in strategy for the sale of prescription drugs. Part of the change was induced by the economics of litigation and the threat additional lawsuits. Today's ...
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Prescription drugs have become an increasingly important issue in workers' compensation law. Their use in workers' compensation claims has resulted in both a major direct financial cost to the system, and has had .
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Tuesday, April 15, 2014

U.S. Halts Effort to Collect Old Social Security Debts

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


WASHINGTON — The Social Security Administration said Monday that it would stop trying to collect taxpayers’ debts that were more than 10 years old.
 The statement came after a Washington Post article revealed that the Treasury had started intercepting the federal and state tax refunds of debtors’ children — even if the debts were decades old. The debts stem from overpayments by Social Security that the agency had been trying to recoup even if the original recipients had died.
 “I have directed an immediate halt to further referrals under the Treasury Offset Program to recover debts owed to the agency that are 10 years old and older,” Carolyn W. Colvin, the acting commissioner of Social Security, said in a statement.
 Ms. Colvin said the effort would stop until the agency completed a thorough review of its “responsibility and discretion” to collect any debts to the government.
 A revision to the Farm Bill passed in 2008 lifted the statute of limitations “applicable to collection of debt by administrative offset.” That allowed the authorities to withhold the tax refunds of 400,000 people who had relatives with debts to Social Security, The Post reported.
Some of the debts were incurred as long ago as the mid-20th century, The Post said, and the taxpayers whose refunds were being intercepted did not know that their relatives had been overpaid or owed any money.
 The actions by the Social Security...
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Related Articles:
CMS Takes a New Direction in the Proposed MSP Appeal ...
Jan 06, 2014
The Centers for Medicare and Medicaid services (CMS) has proposed rules for the Medicare Secondary Payer (MSP) appeals process that will target the “applicable plan” as the primary responsible party for recovery.
http://workers-compensation.blogspot.com/
Federal Court Enjoins CMS From MSP Recovery Procedures
May 18, 2011
"IT IS FURTHER ORDERED that the Defendant's demand that attorneys withhold liability proceeds from clients pending payment of amounts claimed by the Defendant as MSP reimbursement exceeds her authority under the ...
http://workers-compensation.blogspot.com/
US Supreme Court Asked to Review MSP Preemption Issue
Aug 22, 2013
Medicare is not required to abide by a stipulated order of allocation of benefits in a liability case when seeking reimbursement under the Medicare Secondary Payer Act (MSP). Also, the New Jersey Collateral Source Statute .
http://workers-compensation.blogspot.com/
Workers' Compensation: CMS Publishes Rules to MSP ...
Sep 23, 2013
CMS Publishes Rules to MSP Payments Under the SMART Act. Medicare has published proposed Rules to governor obtaining information concerning the conditional payments as required by the recently implemented ...
http://workers-compensation.blogspot.com/

ND workers' comp agency sues over computer project

Yet another reason for a universal integratable workers' compensation docketing program. Today's post is share from http://www.sacbee.com/.

North Dakota's workers' compensation agency has sued a Chicago company over a failed $17 million computer system overhaul.
The Workforce Safety and Insurance agency filed its lawsuit last month in state court against Aon eSolutions Inc. to recoup costs associated with the system that was never delivered.
WSI hired Aon eSolutions in 2007 for a software system upgrade. The work was to cost $14 million, but it was plagued by delays and cost overruns and was never finished.
The contract with the company expired in 2012, and WSI did not renew it. The state Legislature last year gave WSI $750,000 for potential litigation.
WSI, which provides coverage for businesses when employees are hurt or killed on the job, alleges, among other things, negligence, fraud and deceit against the company in court papers. The agency has requested a jury trial.
"Aon promised to deliver a state-of-the-art integrated software package that would replace WSI's existing software system and meet all of the agency's business needs," said WSI Director Bryan Klipfel said in a statement. "WSI intends to prove that Aon did not follow through on its promise. We are acting in the best interest of our stakeholders as we try to recover the money that was spent on this desired product."
Aon said in a statement that it is "disappointed that WSI chose this course. We delivered substantial value to WSI and we did nothing wrong. We look forward to telling our side of...
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Related articles:
Feb 08, 2009
While the regulations cover health plans, health care clearinghouses and certain other providers who use computers to transmit claims information, workers' compensation insurance carriers are exempted. The Institute of ...
Oct 28, 2010
"Nanotechnology has the potential to revolutionize countless products, create computers smaller and faster than once could be imagined, and fight diseases such as cancer. According to the Project on Emerging ...
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In one implementation, the system may comprise a computer system, and the computer system may further host, interface with, or otherwise enable access to a billing management application for tracking information/contracts ...

Monday, April 14, 2014

Distracted Driving - Time To Revisit Compensability Issues


Hang Up! Just Drive.
The Attorney General of the State of New Jersey reported today that there has been a surge of 26% in reported accidents attributed to "distracted driving." While the enforcement effort has been made some headway in leveling off the statistics, a question remains whether it is time to change the compensability rules in workers' compensation to prohibit claims if the employee was texting while driving.
Acting Attorney General John Hoffman today announced the staggering toll driver inattention has taken on New Jersey’s roadways in the past 10 years, declaring that the State experienced a “distracted driving decade” and that an ongoing law enforcement initiative is working to help end the crisis.
From 2004 to 2013, driver inattention was a major contributing circumstance in 1.4 million crashes in New Jersey – that is about half of the total crashes in the state in that period. Distraction was the number one contributing circumstance in total crashes. And in one decade (2003-2012), more than 1,600 people have been killed in crashes where driver inattention was a major contributing factor.
“The numbers tell the sad truth: we are in the midst of a surge in driver inattention, and crash statistics bear out that we can characterize the last 10 years simply as ‘New Jersey’s Distracted Driving Decade,’” said Hoffman. “What is perhaps most troubling about these numbers is that the issue of distracted driving seems to be getting progressively worse. Our research indicates that while crashes and fatalities are trending downward as a whole, the number and proportion of distracted crashes are rising.”
At the beginning of the “Distracted Driving Decade” in 2004, driver inattention was cited as a major contributing circumstance in 42 percent of crashes. But that number has risen in those 10 years and last year it peaked at 53 percent. And the proportion of distracted crashes has surged 26 percent in that time span.
“In recent years smartphones and other devices have become more sophisticated and it’s clear to most of us that they’re being used more by drivers,” said Acting Director of the Division of Highway Traffic Safety Gary Poedubicky. “Though the overall picture of road safety is brightening, one cannot help but conclude that there is an increasing addiction to distraction for drivers. We need to put an end to the epidemic of driver inattention and close the book on the ‘Distracted Driving Decade.’”
In an effort to stop distracted driving, the Division of Highway Traffic Safety has for the first time made funds available to law enforcement agencies for a statewide crackdown on motorists who are using a handheld device while driving, which is illegal in New Jersey. Sixty police departments received $5,000 each for the campaign called U Drive. U Text. U Pay. and the funds will be used to pay for checkpoints and increased patrols. Many more enforcement agencies are also expected to participate unfunded in the initiative, which was funded and developed by the National Highway Traffic Safety Administration (NHTSA).
About halfway through the three-week campaign, which runs from April 1 to 21, the funded departments have issued an estimated 3,000 summonses for cell phone and electronic device violations.
“People need to know that we are serious about stopping this deadly behavior,” said NHTSA Region 2 Administrator Thomas M. Louizou. “Using a handheld phone and texting has reached epidemic levels. When you text or talk on the phone while driving, you take your focus off the road. That puts everyone else’s lives in danger, and no one has the right to do that.”
The crackdowns are similar in scope to the Drive Sober, or Get Pulled Over and Click It or Ticket mobilizations, which have targeted impaired driving and seat belt usage, respectively. Louizou said the successes of those programs have proven that the combination of tough laws, targeted advertising, and high-visibility enforcement can change people’s risky traffic safety behaviors.
To see a list of agencies receiving funding for this initiative please visit:www.nj.gov/oag/hts/downloads/UDUTUP_2014_Grant_Recipients.pdf
This increased police presence on the roads will soon be paired with stepped up penalties for breaking the State’s primary cell phone law. Currently, motorists violating New Jersey’s primary cell phone law face a $100 fine plus court costs and fees. Because of a new law signed by Governor Chris Christie last year, penalties for that transgression will get stiffer. On July 1, those penalties will rise to a range of $200 to $400 for a first offense, $400 to $600 for a second, and up to $800 and three insurance points for subsequent violations. These changes follow the adoption in 2012 of the “Kulesh, Kubert and Bolis Law.” Under that law, proof that a defendant was operating a hand-held wireless telephone while driving a motor vehicle may give rise to the presumption that the defendant was engaged in reckless driving. Prosecutors are empowered to charge the offender with committing vehicular homicide or assault when an accident occurs from reckless driving.
Joining Acting Attorney General Hoffman’s call to end distracted driving was Gabriel Hurley. Hurley, 29, was severely injured in a 2009 crash that left him blind and with extensive damage to his face and skull. Hurley sustained his injuries when an oncoming car collided into an underpass while he was entering it. The impact caused the other car’s air-conditioning compressor to come flying into his windshield. Hurley, of Middlesex, said he believed the 17-year-old driver had been inattentive behind the wheel at the time of the crash.
After an extensive recovery period, which included more than a dozen facial reconstructive surgeries, he began a career as a safe driving advocate and has spoken to thousands of drivers, most of them in high school, about the consequences of reckless and inattentive driving.
“The course of my life was altered in that crash,” Hurley said. “I have lost my sense of sight and smell and suffered other physical and emotional damage. However, I believe what happened gave me a purpose to tell everyone that crashes like mine are preventable and we can stop them by simply focusing on the task at hand when we’re behind the wheel.”

Read more about distracted driving:
Apr 10, 2014
Stay Alert and Avoid Distracted Driving – Work zones present extra challenges and obstacles. Motorists need to pay attention to the road and their surroundings. – Schedule your trip with plenty of extra time. Expect delays and ...
Apr 18, 2011
OSHA has announced an aggressive program to combat "The Number 1 Killer of Workers," Distracted Driving. The announcement was made today by Dr. David Michaels, Assistant Secretary of Labor of the Occupational ...
May 29, 2013
Transportation accidents rank on the top of the list for worker fatalities. Now the federal government is attempting to reduce that number by restricting distractions while driving.driving. Voluntary guidelines reduce ...
Jun 13, 2013
Transportation (DOT) have made major efforts over the last few years to target distracted driving as a major safety issue to avoid serious accidents and ultimately save lives and reduce insurance costs. The DOT reports ...


Add Texting to the List of Things That Are Killing Us Faster


Today, in news that will make you feel bad about your existence: Texting and tinkering with mobile devices for extended periods of time could make you die sooner, the doctors of the world say.
As The Telegraph reports, the hunchback pose that people adopt while staring down at their devices is known to increase the risk of an early death in the elderly. Chiropractors are concerned that younger people—who spend between one and two hours on their phones a day—could be shaving years off their lives.
The United Chiropractic Association (and probably your mom) say that Gollum-like posture can be just as threatening a health risk as obesity, citing studies that bad posture in older people is linked with a disease called hyperkyphosis. Colloquially known as “dowager’s hump,” this condition is often associated with heart problems. Apparently older folk with even the slightest hump are 1.4 times more likely to die than those without.
In other words, we’ve all been killing ourselves slowly while we sit, smoke, and apply sunscreen. Now texting is helping speed up the process. 
“This isn’t alarmist or scaremongering; it’s what more and more research is telling us,” UCA chiropractor Edwina Waddell told The Telegraph. “And the good news is that it doesn’t have to happen because it’s something we all have a degree of control over.”
Control? Sounds like someone’s never...
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Related articles:
Nov 03, 2013
Lost in the clamor for stricter distracted-driving laws, a study from April 2013 found discouraging patterns in the relationship between texting bans and traffic fatalities. As one might expect, single occupant vehicle crashes dip ...
Oct 01, 2013
Andrew M. Cuomo revealed a plan to put "texting zones" on the New York State Thruway and state highways, where drivers can pull over and respond to text messages. This is, in part, a response to the fact that New York has ...
Oct 23, 2013
... drive on the roads. While the Federal government has strictly enforced the no texting while driving rule, the states maintain a patchwork of confusing regulations and statutory prohibitions. Today's post is shared from nj.com.

CMS Posts WCMSA Self-Administration Guidance

A new WCMSA Self-Administration page has been added to the Workers Compensation Medicare Set-Aside Arrangement section of CMS.gov. The new page contains information for individuals who choose to self-administer their WCMSA accounts. Materials available on the new page include:
  • New Self-Administration Toolkit for WCMSAs 
  • Account Expenditure for Lump Sum Account (Attestation Letter)
  • Account Expenditure for Structured Annuity (Attestation Letter)
  • Transaction Record Sample
  • WCMSA Reference Guide
The following link may be used to access the page http://go.cms.gov/WCMSASelfAdm.

Related Articles:
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An updated Workers' Compensation Medicare Set-Aside Arrangement (WCMSA) Reference Guide is now available in the Downloads section found at the bottom of this page. This version documents the current WCMSA ...
Feb 21, 2013
Effective immediately, if a WCMSA proposal amount was originally submitted via the web-portal, a re-evaluation of an approved WCMSA amount can be requested through the WCMSA web portal, if the claimant or submitter ...
Apr 02, 2013
The CMS will be hosting a WCMSA teleconference on April 11, 2013. This event will provide stakeholders an opportunity to learn more about the Workers' Compensation Review Contractor (WCRC), and discuss procedural ...
Jan 03, 2012
Please send your completed annual Workers' Compensation Medicare Set-aside Arrangement (WCMSA) Account Expenditure accounting documentation to the CMS lead Medicare Contractor at the address below: MSPRC ...

Executive Pay: Invasion of the Supersalaries

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

Browse the proxy statements of the nation’s largest corporations and you’ll find the instruction manuals for this apparatus explaining how to finely calibrate the pay of top executives with company performance.
The Coca-Cola board, for example, lays out the formula that set the 2013 cash bonus for Muhtar Kent, its chief executive (base salary x base salary factor x business performance factor). It explains how a failure to achieve certain goals helped limit the bonus to $2 million, but also describes how Mr. Kent got millions more in stock and options. It notes that under his leadership, Coke had “continued to gain value share globally in nonalcoholic ready-to-drink beverages,” and tells shareholders why the board might require him to fly on the company jet (“to allow travel time to be used productively for the Company”). What was all that worth? A tidy $18 million.
But putting aside whether those particular metrics for aligning pay with performance make sense (or, rather, turning over that discussion to Gretchen Morgenson in her Fair Game column), the elegant machine itself would seem to have a dark side. Some say, in fact, that it is the main engine of inequality in America today.
The current system of executive compensation, with its emphasis on performance, can theoretically constrain pay, but in practice it has not stopped companies...
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Related Articles:
Apr 09, 2014
Today, he took two executive actions aimed at federal contractors. One bars companies from retaliating against workers who discuss their pay with each other. The other requires compensation data broken down by race and ...
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Before that, he served as the Obama administration's “pay-czar”, a job created by the 2009 stimulus law to oversee executive compensation practices at financial firms bailed out during the financial crisis. He's administered or.
Apr 06, 2014
At the White House Tuesday, President Barack Obama will sign two new executive actions on equal pay as Senate Democrats move for a show-vote on the Paycheck Fairness Act — launching Democrats' first large-scale ...