When medical treatment is sought as the result of a motor vehicle accident the medical provider is entitled to payment for services rendered to treat your injuries. The medical provider will first look to the health insurance carrier whether it is a private plan such as Anthem Blue Cross Blue Shield or popular government plans, Medicaid and Medicare. When a personal injury case settlement is being negotiated or after a verdict has been rendered it is important to know your rights and responsibilities with respect to any liens.

Private Health Insurance

Chances are if you have private health insurance it is provided by your employer and falls under the Employee Retirement Income Security Act better known as ERISA. An ERISA plan can recover for damages received from third parties. In laymen’s terms, the effect is the plan can seek reimbursement for medical bills they have paid on your behalf which are directly related to injuries sustained as the result of the negligence of a third party.

In the event your health insurance plan does not fall under ERISA the plans contract language will dictate the insurers right to any proceeds arising from a personal injury award.

Medicaid

The Department of Medical Assistance Services administers the Virginia Medicaid program. To be eligible for Medicaid an applicant must assign to the state any rights to payment of medical care from any third party. In the event the injured party fails to pursue the claim, the state has the ability to pursue reimbursement from the third party. Medicaid is required to be reimbursed from the proceeds of a personal injury award for medical expenses related to the injury.

Medicare

Medicare has a federal statutory lien for payments made under the Medicare Secondary Payer Act (“MSP”). The Centers for Medicare and Medicaid Services (“CMS”) and the Medicare Secondary Payer Recovery Contractor (“MSPRC”) enforces the lien against the party receiving a personal injury award. Similar to Medicaid, only medical expenses related to the injury are recoverable by Medicare.

Hospital Liens

Pursuant to Virginia Code § 8.01-66.2 each hospital, nursing home, licensed physician, registered nurse, registered physical therapist, pharmacy, or ambulance service shall have a lien for services rendered on care to any person injured in an accident as a result of the negligence or alleged negligence of any other person. The lien shall be for the amount of a just and reasonable charge for the services rendered, not exceeding $2,500 in the case of a hospital or nursing home, $750 for each physician, nurse, physical therapist, or pharmacy, and $200 for each ambulance service.

How we can help

ERISA, Medicare, Medicaid, and Hospital Liens should be scrutinized and negotiated on the client’s behalf. In some instances the lien holder will agree to reduce their lien in an amount proportional to the amount the client has paid in attorney’s fees and costs. We at Cravens & Noll believe even though the case has settled, our job is not over, and we will continue to advocate on your behalf until the job is done.

The post Medical Bill Liens In Personal Injury Cases appeared first on Cravens & Noll.

The woman underwent carpal tunnel and clavicle surgery in 2011 in Culpepper. During the operation, a surgeon tried to implant a metal plate to stabilize the patient’s clavicle – which had been damaged decades earlier – but was unable to screw in the plate because of the patient’s bone condition. As a result, he used surgical sutures instead to stabilize the plate.

Months later, it was determined that a portion of the woman’s collar bone had been sheared off. The surgeon said this was not due to the sutures, but rather the woman’s osteoporosis. The woman then went to another shoulder surgeon, who removed the metal plate.

To this day, however, she suffers pain due to the permanent injury to her collarbone, and her shoulder remains disfigured. She sued the original orthopedic surgeon for $1 million for the allegedsurgical malpractice.

During the trial, a medical witness for the defense argued that the surgeon’s technique – of suturing the plate into place – was a perfectly suitable option. Another doctor testified for the plaintiff, arguing that the technique was bound to fail, and that the sutures fractured her bones.

The six-member jury deliberated for 11 hours and was unable to reach a verdict.

Medical malpractice is a very complicated area of law in Virginia. Not every negative surgical outcome is caused by medical malpractice, as surgery always involves risks. However, when a surgeon deviates from the accepted standards of care, or when a surgeon shows incompetence or makes errors, this is medical malpractice. Victims of medical malpractice have the right to hold their doctors accountable and obtain compensation for their ongoing medical expenses and pain and suffering.

Victims of surgical or medical malpractice should not be discouraged by this case. It is important to hold negligent medical professionals responsible, and victims should seek legal counsel to learn how to do this.

Source: Star Exponent, “$1M medical malpractice case ends in hung jury,” Rhonda Simmons, Oct. 3, 2013

The post Virginia jury fails to reach verdict in surgical malpractice case appeared first on Cravens & Noll.

The post ONC plan aims to protect patients through EHR data analysis alone appeared first on Cravens & Noll.

Unfortunately, a recent study suggests that too many American women are being subjected to invasive interventions and other procedures during pregnancy without a full understanding of the hazards involved in this kind of care. Certainly most of these women are simply trusting that their doctor knows best. However, an informed patient is more likely to make choices that are best for her. In addition, avoiding invasive intervention whenever possible helps to lower rates of pregnancy complications and birth injuries.

The recent study was released by the nonprofit maternity care organization Childbirth Connection. The executive director of that organization explained that “Our survey suggests that pregnant women need to take a more active role to make sure they get the care that is best for themselves and their babies. They need access to trustworthy information about the benefits and harms of interventions, to educate themselves, and be their own advocate.”

Why is an active approach to patient care so critical for pregnant women? Because informed patients are less likely to cave to physician pressure in situations that do not warrant invasive and potentially hazardous interventions. In addition, interventions tend to breed additional interventions, so informed patients can often avoid multiple challenging procedures if they are educated about risks and alternatives.

Legal recourse is generally available for patients who are harmed by invasive procedures. But ideally, patients may avoid many of these potentially dangerous procedures in the first place by advocating for themselves in an informed way.

Source: Consumer Reports, “Pregnant? Watch out for unnecessary c-sections and other questionable medical procedures,” Joel Keehn, May 8, 2013

The post Beware unnecessary medical intervention during pregnancy appeared first on Cravens & Noll.

However, the inevitability of mistakes on the part of providers should be informing the functionality of the medical malpractice system more than it currently does now. Based on a physician’s area of expertise, he or she will face a medical malpractice claim every seven years or so. These claims should be processed with appropriate urgency and then if the physician has not behaved so negligently that his or her license is suspended, he or she should then be allowed to return to work informed by the knowledge that his or her mistakes have real consequences.

Unfortunately, the medical malpractice system functions largely without the expectation that nearly all physicians will face malpractice claims over the course of their careers. The legal battles over these claims drag on so long that a recent study published in the journal Health Affairs indicate that 10 percent of any given physician’s medical career will be spent dealing with these claims.

The current structure and procedures governing the medical malpractice system are contributing to patient harm and physician resentment. If the system was more prepared for the fact that physicians will make mistakes and should be held accountable for them, perhaps doctors could practice more medicine and patients could receive their due more quickly and efficiently than they can currently.

Source: Forbes, “Medical Malpractice: Broken Beyond Repair?” Robert Glatter, Feb. 6, 2013

The post Grappling with a misguided medical malpractice system appeared first on Cravens & Noll.

The financial cost of mistakes and preventative measures that try to avoid making medical errors runs into the billions of dollars. A large percentage of medications, tests and procedures are unnecessary; they are run in an attempt to avoid lawsuits for medical malpractice.

The pressure among colleagues to not call out another practitioner’s errors is intense. A doctor or intern could be shunned, given the lowest possible duties or forced out of a job if they complain about another medical professional’s practice or mistakes. Hospitals are also reluctant to publish statistics about their performance, making it harder for patients to make an informed choice.

Some possible solutions to this problem are obvious and actually have helped reduce errors in some cities. Suggestions include:

• Provide an online dashboard that could show potential patients which hospitals and surgeons have the best ratings for successful medical operations and results.

• Cultivating an internal atmosphere that allows any medical professional freedom to speak up when they notice a potential error.

• The use of cameras and video recordings of procedures is another good way to get compliance with best medical practices and to help avoid mistakes.

• Allow patients to review doctor’s notes immediately to catch errors of information.

• No gagging of patient reviews of their doctors.

When mistakes are preventable, it is unconscionable for the medical community to resist any improvement that could benefit their patient population.

Source: Wall Street Journal, “How to Stop Hospitals From Killing Us,” Marty Makary, September 21, 2012

Our law firm represents individual harmed by medical mistakes. For more information, please visit our medical malpractice page.

The post Prevention of Medical Errors is Possible appeared first on Cravens & Noll.

Doctors, nurses, hospitals and emergency room staff make errors and those errors can have a catastrophic effect on their patients. Medical mistakes include prescribing the wrong medication or treatment, prescribing a medication that adversely reacts to another medication, providing the wrong dosage of medication and misdiagnosing illnesses.

When medical mistakes happen patient safety is at risk.

Causes of Medical Mistakes

The Wolters Klewyer Health survey asked 1,000 participants about their experiences with medical mistakes, why they think medical mistakes occur and what patients can do to help prevent medical errors. The participants identified many of the common causes of medical errors such as:

• Miscommunication between hospital staff
• Hospital understaffing
• Work overload
• Hospital staff fatigue
• Lack of proper sanitation

The survey also revealed that the majority of Americans have attempted to prevent medical errors by taking action. Those actions include validating a doctor’s diagnosis and treatment plan by doing independent research or getting a second opinion.

While taking steps to validate a course of treatment or diagnosis may prevent some medical errors, it will not stop them all. If a medical error or misdiagnosis has caused you to suffer serious injuries or caused the wrongful death of someone you love, an attorney can help you protect your rights.

Source: equities.com, “Survey: Nearly One in Three Americans Report Experiencing Medical Mistakes, Either Themselves or Among Family and Friends,” August 15, 2012

Our firm handles cases like the one mentioned in this article. For more information, please visit our hospital negligence page.

The post Medical Mistakes are On the Rise appeared first on Cravens & Noll.