Last week we posted a blog concerning the NYC Pedestrian Safety Study conducted by the New York City Department of Transportation.  Based on the study’s findings, the DOT has made several action plan recommendations to continue to drive down pedestrian traffic fatalities and ensure New York City truly has world class streets that are safe for everyone. (more…)

The Centers for Medicare and Medicaid Services (CMS) is proposing to add an additional nine categories to its initial list of 8 “conditions that could reasonably have been prevented.” that Medicare will no longer pay the extra costs of treating when acquired in the hospital . In a statement dated April 14, 2008, CMS proposed to add the following to its list of conditions that it will not pay for: Surgical site infections following certain elective procedures: Legionnaire’s disease; Extreme blood sugar derangement; Iatrogenic pneumothorax or collapsed lungs; Delirium; Ventilator-associated pneumonia; Deep vein thrombosis or pulmonary embolism; Staphylococcus aureus septicemia or bloodstream infection; and Clostridium difficile associated disease. (more…)

After coming under attack from doctors, Aetna has withdrawn its intention, announced late last year, that in New Jersey, effective April 1, 2008, it would drop its coverage of propofol, the anesthesia typically used during colonoscopies, calling the same “medically unnecessary.” In reality, it is not the propofol that Aetna minds paying for; what Aetna wants to cut-out is the $300 to $1,000 cost that Aetna pays for an anesthesiologist to be present at a colonoscopy. Propofol, also known by the trade name Diprivan, is more powerful than other sedatives traditionally used to help patients endure the discomfort of a colonoscopy. Because of the powerful effects of the drug, good and accepted medical practice usually necessitates the presence of a qualified anesthesiologist during the procedure. (more…)

Americas Watchdog and its Corporate Whistleblower Center have just released the results of its third annual study focused on Medicare & Medicaid fraud. The report continues to show widespread Medicare/Medicaid billing abuse and fraud involving all aspects of health care. The Corporate Whistle Blower Center has just reported its 2007 year end findings on the state of Medicare/Medicaid over billing/fraud in the United States. The report included three areas where Medicare/Medicaid are being over-billed or defrauded; nursing homes/rehab centers, pharmaceuticals, and boutique hospitals, not for profits hospitals, or hospitals owned by doctors/investor groups. (more…)

Exposure to the chemical known as diacetyl, which adds the buttery flavor to popcorn, has been tied to hundreds of cases of workers whose lungs have been damaged or destroyed. When it is heated diacetyl becomes a vapor and  when it is inhaled over a long period of time, it can cause various problematic symptoms.  Exposure to this chemical can cause one to experience difficulty breathing and exhaling, and one’s lungs can become and scarred.  The severe form of the disease is called “bronchiolitis obliterans,” also known as “popcorn workers’ lung,” which can be lethal.  In fact, in July of 2005, a jury awarded a worker 2.7 million dollars as a result of his development of bronchiolitis obliterans, due to his long term exposure to diacetyl. (more…)

         Both New York City and New York State have joined together and, following the example of various other states, including Louisiana Mississippi and Utah, have filed suit against Merck & Company.  It is alleged that Merck not only defrauded consumers but also defrauded the state Medicaid program and other government insurance programs by purposefully concealing the dangerous side effects of Vioxx.  Vioxx was prescribed to patients for the treatment of migraines and arthritis but caused a high increase in heart attacks and strokes, and was pulled off the market in September of 2004. 

        Medicaid claims that had Merck been forthcoming of the aforesaid risks, doctors would not have prescribed the drug, which Medicaid often paid for.  In fact, between the year 1999, when Vioxx was first placed on the market, and 2004, when it was taken off, Medicaid and the State’s Elderly Pharmaceutical Insurance Coverage program spent over  $100 million on Vioxx prescriptions in  New York. (more…)

            Many patients of health maintenance organizations (”HMO”) are unaware of their legal right to appeal a decision denying their requested treatment.  The desired treatment is normally denied deemed as”medically unnecessary” or “experimental. ” The law also only provides for  a mere 45 day deadline in which one can file this appeal.  The ignorance of various patients of their ability to appeal is particularly problematic in light of the fact that, according to the New York State Insurance Department, approximately 42.6 and 49.4 percent of the cases that are appealed are in fact reversed.  Therefore, it is important that patients are made aware of their ability to appeal their denial of medical treatment and should in fact be encouraged to seek legal counsel to ensure that they are not unreasonably and wrongfully denied  treatment.  This is especially in light of the fact that the aforementioned wrongful denial of treatment has already led to a multitude of unnecessary deaths. (more…)

Medicare, in a significant policy change, will no longer pay the extra costs of treating preventable errors, injuries and infections that occur in hospitals, which the government says could save lives and millions of dollars. Under the new rule, effective October 1, 2007, and applicable to discharges occurring on or after that date, Medicare will not pay hospitals for the costs of treating certain “conditions that could reasonably have been prevented.” Significantly, under the new rules, the hospital cannot bill the beneficiary for any charges associated with the hospital-aquired complication. The Centers for Disease Control and Prevention estimates that patients develop 1.7 million infections in hospitals each year, and it says those infections cause or contribute to the death of 99,000 people a year, or about 270 a day.

The rule identifies eight conditions that Medicare no longer will pay for. (more…)

New York City Mayor Michael Bloomberg reported for jury duty at the New York State Supreme Court, New York County, on August 6th, 2007.  He was called for voir dire along with others into a courtroom where attorneys were set to begin picking a jury for a wrongful death lawsuit brought by a woman whose husband had died after years of operating a printing press that attorneys said contained asbestos in its brakes.  The Mayor was not selected for that case.

Mayor Bloomberg returned to the Manhattan courthouse the following day (more…)

United States District Court Judge Alvin K. Hellerstein (Southern District of New York) has imposed sanctions totalling $1,250,000.00 against Zurich American Insurance Company and two of its law firms for failing to timely produce documents that defeated Zurich’s attempt to avoid lliability insurance obligations regarding lawsuits brought by the legal successors of many of those who died and many of those who suffered personal injuries or suffered property damage in the September 11, 2001 terrorist attacks. Judge Hellerstein imposed the sanctions pursuant to Rule 11 and Rule 37 of the Federal Rules of Civil Procedure based upon a thorough analysis of what Zurich and its lawyers knew and when they knew it. In particular, Judge Hellerstein pointed to Zurich’s “culpable state of mind” (more…)