Recently in Diagnostic Inaccuracies Category

February 7, 2013

DePuy ASR Hip Implant Recall

DePuy Hip Implant.jpg
Over 10,000 lawsuits have been filed against the company Johnson & Johnson for their distribution of the DePuy ASR hip implant, since a recall was issued in August 2010. The DePuy ASR hip implant has a metal on metal design, which means that a metal head rotates within a metal cup. This design causes metal debris, caused from the metal parts rubbing against each other, to be released into the surrounding tissue and cause medical problems. The failure occurs within five years of replacement.

When the recall was first issued, Johnson & Johnson stated that the failure rate was only about 13%, but after documents were released as part of the litigation, it was estimated that the failure rate of the DePuy ASR hip implant is as high as 37%. This means that one out of every eight DePuy ASR hip implants were failing within five years of replacement surgery.

There is currently a case going on in California against Johnson & Johnson for the marketing, manufacturing and sale of the defective DePuy ASR hip implants. It is being said that the company failed to properly warn the public, as well as healthcare professionals, about the risk of loosening and other complications that may develop shortly after hip replacement surgery.

In testimony in the current case being heard in California, a DePuy engineer testified that Johnson & Johnson only tested one angle of implantation and that the company failed to use the right engineering controls when trying to assess potential problems. The engineer further stated that the testing conducted failed to predict how much wear the hip implants would experience and how much they could loosen.

The FDA released a new guidance for metal on metal hip replacements in January of this year. Doctors were advised that metal on metal hip replacement systems should only be used if other artificial hip implants were not appropriate for the patient, and called on all manufacturers to prove that their implants are safe enough to stay on the market. Also, future metal on metal hip designs will have to undergo extensive human clinical trials before being made available for sale to the public.

March 14, 2011

What is the Real Cost of Health Care Fraud?

Medical Doctor - Fraud.jpg

The National Health Care Anti-Fraud Association (NHCAA) defines health care fraud as an intentional deception or misrepresentation that the individual or entity makes knowing that the misrepresentation could result in some unauthorized benefit to the individual, or the entity or to some other party.

In the United States, it is estimated that almost $226 billion a year are spent on health care fraud. That is 10% of the nation's health care expenditure. Therefore; consumers have higher premiums and out-of-pocket expenses, also reduced benefits and coverage. As for employers, they have increases in the cost of providing insurance benefits to their employees, as well as increasing the overall cost of doing business.

The Coalition Against Insurance Fraud claims that two out of five Americans want little or no punishment for insurance cheats. Consumers blame the insurance industry for its fraud problems because they believe insurers are unfair.
Fraud.jpg
The Journal of the American Medical Association, claims that almost one-third of doctors exaggerate the severity of a patient's illness to help the patient avoid early discharges from a hospital.

Categories of Fraud:
- Hard Fraud - this occurs when someone purposely plans or invents a loss. For example: staged automobile accidents. The "victim" obtains an attorney, who in turn refers the victim to a physician. The physician then submits charges to the insurance carrier and refers the victim for additional physical therapy. The physical therapy physician then also submits charges to the insurance carrier.
- Soft Fraud - this occurs when policy holders exaggerate a legitimate claim. For example: receiving treatment for a slip and fall accident on 2/1 and submitting that claim to insurance carrier and then changing that same service charge to 2/4 and resubmitting the claim.

The most common fraudulent acts are:
- The billing of late charges by a hospital
- False durable medical equipment claims (DME)
- Behavioral health fraud
- Medical identity theft
- Billing for services, procedures and/or supplies that were never provided or performed
- The condition treated or the diagnosis made
- The charges for services, procedures and/or supplies provided or performed
- The deliberate performance of medically unnecessary services for the purpose of financial gain

The cost of insurance fraud is factored in to the premiums we all pay. In order to lower these premiums, the laws against health care fraud must be tougher. Penalties must be instituted by both federal and state governments. As of the year 2010, only 40 state fraud bureaus exist. In order for health care fraud to be less common and less costly for each citizen in general, each state should have a fraud bureau. It is easier to prevent fraud than to recover payments once they have been made.

We, as consumers, can also do our part to lower health care fraud. We must never sign a blank insurance form. We must comprehend all claim forms we complete. We must request detail bills, or HICFA/UB 92 billing statements and we must always keep our insurance information confidential.

If you need to report health care fraud, please call your insurance company immediately. Also, contact your state insurance fraud bureau and file a complaint with the State Medical board.

September 20, 2010

$55.6 Billion Spent on Medical Malpractice Lawsuits in the U.S. in 2008

Medical Malpractice.jpgIn 2008, the cost of health care was $2.3 trillion, according to the U.S. Department of Health and Human Services. That averages out to about $7,681.00 per person. The U.S. spent nearly $55.6 billion on medical malpractice lawsuits and defensive medicine, which represents about 2.4% of the entire budget. Defensive medicine however, made up about $45.6 billion of that, meaning that only $10 billion was spent on medical malpractice lawsuits in 2008.

Defensive medicine is defined as medical tests and procedures performed to avoid medical malpractice liability and not to improve the patient's health.

Researchers for the journal Health Affairs, published by the Harvard School of Public Health in September 2010, found that attempting to reduce the number of medical malpractice lawsuits would result in only a negligible effect on the cost of health care, and reducing the cost of defensive medicine would do little more.

If we could improve the quality of health care in the United States, we would be saving a lot of money a year. By improving the quality of health care, we would reduce the need for medical malpractice lawsuits and costs, such as longer hospitalizations due to hospital acquired infections and pneumonia, bedsores, and wrong site surgeries, all of which are avoidable medical problems.

May 27, 2010

Medical Malpractice Reform

medical malpractice 2.jpgThe medical malpractice system exists so that patients injured by the negligence of medical personnel can sue for their injuries. To date, it is the only opportunity for victims of medical malpractice to address their injuries in a legal and meaningful matter.

Medical malpractice lawsuits do not drive up healthcare costs. In fact, the present system saves thousands of additional patients from avoidable deaths and it provides fair compensation to those affected.

About 44,000 to 98,000 people die as a result of medical malpractice each year, according to the Institute of Medicine. These deaths can be avoided. Medical errors by health care personnel need to be prevented in order to lower this alarming number of deaths.

Tort reform may actually harm patients by focusing on costs over patient safety. In addition, the award caps that want to be implemented can also put a maximum price on a person's potential for injury compensation. This would pull some attorneys toward certain cases with higher damage caps and away from other malpractice lawsuits with less monetary value, ultimately harming many of those who truly need legal representation and financial help with continuing medical costs. This in turn does not provide a solution to the health care crisis in the United States. These limits to medical malpractice litigation instead, try to curb legal rights and costly verdicts, but do not address the prevention of medical errors.

Patients have a duty to keep better track of their own medical histories and review their medical records. Doctors also need to be questioned about anything unfamiliar or that seems unnecessary.

Victims of medical negligence deserve their day in court. They need financial compensation for their injuries and future healthcare costs and needs. If you or someone you know has been a victim of medical negligence, contact a medical malpractice attorney to discuss your legal rights and options.

April 29, 2010

Medical Errors Are Costly and On the Rise

Research has shown that medical errors may result most frequently from system errors. One out of 25 patients in hospitals are injured due to medical errors, and an estimated 48,000 to 98,000 patients die from these errors a year. Even if you consider the lower estimate of 48,000 errors a year, it is still higher than the annual mortality from motor vehicle accidents (43,458), breast cancer (42,297), or even AIDS (16,516), thus making medical errors the eighth leading cause of death in the United States. These errors, besides causing death, have also cost the economy from $17 to $29 billion each year and cost more that $5 million a year in large teaching hospitals, according to the Agency for Healthcare Research and Quality (AHRQ).

For Patients at Risk, Medical errors may result in the following:

- A patient being given the wrong medicine
- A clinician misreading the results of a test
- An elderly person that shows up to an emergency room with ambiguous systems, such as: shortness of breath, abdominal pain and dizziness, whose heat attack is not diagnosed by the medical staff

How Errors Occur:
- Medication Errors:
These are preventable mistakes in the prescribing and delivering of medications to a patient, these errors include: prescribing two or more drugs whose interaction is known to produce side effects or prescribing a drug to which the patient is allergic to.
- Surgical Errors
- Diagnostic Inaccuracies:
This leads to ineffective treatment and/or unnecessary testing, which is costly and can be invasive to the patient.
- System Failures:
This is the way health care is delivered and the way that resources are provided to the delivery system.

Medical Mistakes are also made by distracted nurses. It is believed that if medical facilities had more nursing staff that could focus their attention on fewer tasks at a time that medical mistakes would decrease, patient safety increase and it would reduce the risk of medical malpractice. When nurses are interrupted, it increases the chance of a procedural failure by 12.1%, and the chances of a clinical error by 12.7%, as indicated by the Archives of Internal Medicine study published in Australia in 2008.