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Court tosses $785,000 award over cancer death

  Health Care  -   POSTED: 2008/07/02 07:54
A federal appeals court has thrown out a $785,000 award to a woman who blamed her mother's cancer death on contamination from a wood treatment plant in Mississippi, one of hundreds of such cases against the facility's owner.

The 5th U.S. Circuit Court of Appeals in New Orleans ruled Monday that the state's three-year statute of limitations barred Kenesha Barnes' claim against Koppers Inc. and Beazer East Inc.

After a three-week trial in 2006, a jury found the companies liable for negligently exposing Barnes' mother, Sherrie, to harmful chemicals from the Grenada plant, which treats railroad crossties and utility poles with creosote and other chemicals.

Sherrie Barnes, who lived next to the plant her entire life, died about a year after she was diagnosed with breast cancer in June 1997. More than five years elapsed between her diagnosis and the date in 2003 when Kenesha Barnes filed a wrongful death suit on her mother's behalf.

A three-judge panel from the 5th Circuit said the companies raised "troubling questions" about how the case was handled by U.S. District Judge W. Allen Pepper Jr., including his decisions on the admission of expert testimony.



The Bush administration is urging a federal appeals court to keep meatpackers from testing all their cattle for mad cow disease.

Government lawyers told a three-judge panel Friday they should reverse a lower court ruling that allowed Kansas-based Creekstone Farms Premium Beef to conduct more comprehensive testing to satisfy overseas customers.

The Agriculture Department currently tests less than 1 percent of slaughtered cows for the disease. It argues that more widespread testing does not guarantee food safety and could result in a false positive that scares consumers.

Creekstone claims the Agriculture Department has no authority to prevent companies from using the test to reassure customers.



California universal health care plan in doubt

  Health Care  -   POSTED: 2008/01/27 12:00
California may be losing its chance to set the U.S. agenda for providing health care to millions of uninsured because a bill backed by Gov. Arnold Schwarzenegger aiming to do just that is on its deathbed, state lawmakers said on Friday.

California's Republican governor has made medical insurance legislation a top priority and the bill before the state Senate, which votes on Monday, is a compromise crafted with Assembly Speaker Fabian Nunez, the top lawmaker of the Democrat-led chamber.

But some senators say they have heard enough to vote no on the legislation, which would require all Californians to have health insurance, either through private providers or a subsidized state pool funded by taxes on cigarettes, hospitals and employers.

Millions lack medical insurance in the United States and California's efforts to provide it are being closely watched because it has has the largest state population and major political clout. In addition, the issue is front and center in a presidential election year when voters are anxious about rising health-care costs.

While the state Assembly was eager to advance the bill, the Democrat-led Senate is very much undecided.

"Once fully implemented, over 70 percent of California's 5.1 million uninsured, most of whom are low-income working individuals and their families, including 800,000 children, will no longer be uninsured for health care," according to a statement on the bill from Nunez's office.

Republicans in the Senate's minority fear the bill will require near- and long-term tax increases, while Democrats in the Senate are concerned the bill is too vague to make good on its goals and could cost far more than initial estimates.

Schwarzenegger's administration is hopeful those concerns can be overcome by Monday's vote.

"We're continuing to talk, continuing to work," said Sabrina Lockhart, a spokeswoman for the governor. "This is a comprehensive plan that reflects hundreds of hours of work, if not thousands of hours, lots of compromise and feedback."

If the Senate approves the plan and Schwarzenegger signs it, voters would be asked to vote on it.

With a state budget deficit expected for the remainder of California's current fiscal year and the next year starting in July, California cannot afford an ambitious medical insurance experiment, said Republican state Sen. Tom McClintock.


A city program that provides health care to the uninsured and is partly funded by businesses can continue at least until a lawsuit challenging the program is resolved, a federal appeals court ruled.

A lower court in December struck down key provisions of the program, dubbed Healthy San Francisco, which requires companies with at least 20 workers to provide health coverage or pay the city a fee to help offset the program's estimated $200 million price tag.

The Golden Gate Restaurant Association, a powerful lobby, sued the city, arguing that the mandatory contributions the city sought placed a costly burden on members already struggling to make a profit.

But a three-judge panel for the 9th U.S. Circuit Court of Appeals said Wednesday it appeared the program would ultimately prevail.

"There may be better ways to provide health care than to require private employers to foot the bill," Judge William Fletcher wrote in a unanimous ruling. But he wrote that it wasn't up to the court to "evaluate the wisdom" of the plan, only its legality.

Fletcher wrote that the city and the labor unions that joined San Francisco in defending the lawsuit "have a probability, even a strong likelihood of success."

City officials hope the program, the first of its kind in the nation, will eventually cover about 80,000 people. Mayor Gavin Newsom said that nearly 8,000 people have already signed up and that the city hopes to enlist about 40,000 more people by the end of the year.

The "ruling is an important victory for uninsured San Franciscans," Newsom said Wednesday.

U.S. District Court Judge Jeffrey White in December knocked out the business fee when he agreed with the restaurant owners and ruled that the program violated federal law.

A telephone message left Wednesday for an attorney representing the restaurant owners was not immediately returned.



Health Care Co. Owner Sentenced to 66 Months

  Health Care  -   POSTED: 2007/11/19 10:59
The owner and operator of a Florida health care company has been sentenced to 66 months incarceration for Medicare fraud, Assistant Attorney General Alice S. Fisher of the Criminal Division and U.S. Attorney R. Alexander Acosta of the Southern District of Florida announced today.

Marianela Smith was sentenced on Friday, Nov. 9, 2007, by U.S. District Court Judge Joan A. Lenard at the federal court in Miami. Judge Lenard also ordered Smith to pay approximately $363,000 in restitution for submitting approximately $800,000 worth of fraudulent claims to the Medicare program.

Smith owned and operated Smith Medical Equipment, a Miami medical equipment company, from approximately 2000-2003. She was convicted on five charges following a seven-day trial in August 2007. At trial, the government established that Smith had been paying kickbacks to Medicare beneficiaries throughout Miami-Dade County to gain access to their Medicare information. After gaining access to their Medicare cards, Smith billed Medicare for unnecessary services on behalf of these patients, including oxygen concentrators and nebulizers. One of these patients testified that Smith paid him in cash and that he did not need the treatments or medication that Smith was billing to Medicare. Further, he testified that he threw away the medication that was paid for by Medicare. According to trial testimony, Smith paid $150 per month if the patients agreed to accept unneeded aerosol medications, such as Albuterol, and related respiratory equipment such as oxygen concentrators.

Smith obtained the compounded aerosol medications from previously convicted pharmacy owners in Miami. From 2000 to 2003, these pharmacies billed the Medicare program for over $17 million.

The case was prosecuted by Assistant Chief John Kelly and Trial Attorney Hank Bond Walther from the Fraud Section of the U.S. Department of Justice in Washington, D.C., with the investigative assistance of the U.S. Department of Health and Human Services, Office of the Inspector General; the FBI; and the Medicaid Fraud Control Unit from the State of Florida. This case was brought as part of the Medicare Fraud Strike Force initiative created in March 2007, led by the Fraud Section in Washington, D.C., and the U.S. Attorney’s Office in the Southern District of Florida. The Strike Force operates out of the federal Health Care Fraud Facility in Miramar, Florida, and has brought over 74 cases involving 120 defendants since March 1, 2007.

A copy of this press release may be found on the website of the United States Attorney's Office for the Southern District of Florida at www.usdoj.gov/usao/fls . Related court documents and information may be found on the website of the District Court for the Southern District of Florida at www.flsd.uscourts.gov or on .


Dianon Systems Agrees to Pay U.S. $1.5 Million

  Health Care  -   POSTED: 2007/10/30 11:50
Dianon Systems Inc. has agreed to pay the United States $1.5 million to resolve claims under the False Claims Act that the company mischarged Medicare and TRICARE for certain tests it performed, the Justice Department announced today.

Dianon, a reference lab located in Stratford, Conn., specializes in conducting tests to detect and stage various types of cancer. Doctors obtain tissue or liquid specimens from patients and refer the specimens to Dianon to determine whether they contain cancer cells, and if so, the stage of the disease.

The original suit against Dianon was filed by Dr. James Tiesinga, a pathologist formerly employed by the company. He filed the complaint against the company on behalf of the United States under the qui tam or whistleblower provisions of the False Claims Act. Dr. Tiesinga will receive $300,000 as his share of the proceeds of the settlement.

The complaint alleged that Dianon billed for medically unnecessary tests in that it performed 26 flow cytometry tests on every sample sent to the company for diagnosis regardless of whether all 26 were medically necessary for a particular patient. Flow cytometry tests can be used to measure the amount of DNA in cells.

The investigation and settlement were jointly handled by the Office of the United States Attorney for the District of Connecticut and the Justice Department’s Civil Division, with the assistance of the Office of Inspector General for the Department of Health and Human Services, the U.S. Defense Criminal Investigative Service, and the Federal Bureau of Investigation.


GM Details Funding Plans For UAW Health Trust

  Health Care  -   POSTED: 2007/10/15 03:08

General Motors Corp. said Monday that it expects to transfer $16 billion from its internal health-care trusts, in addition to a $2.5 billion cash infusion, to a new United Auto Workers trust in order to fund a new independent voluntary employees' beneficiary association, or VEBA.

The VEBA, seen as a critical element of a new contract between the two parties, effectively will free the auto maker from UAW hourly retiree health-care liabilities permanently, the company said, and the UAW will no longer be able to negotiate such benefits.

Instead, the UAW will manage the trust, allowing GM to cut its own retiree health-care liability to an estimated range of $2 billion to $9 billion by 2013, down from more than $60 billion currently.

The move should deliver an estimated $2.6 billion to $3.4 billion in annual pretax savings, primarily due to changing the plan. GM expects its net UAW hourly health-care balance sheet liability to be about $6 billion to $13 billion in 2010. It currently carries an estimated $47 billion in UAW hourly health-care obligations.

GM outlined some of its financial expectations for the contract in a slide deck posted on its investor Web site in advance of a 9:30 a.m. Eastern conference call. The company also addressed its VEBA contribution in a filing with the Securities and Exchange Commission.

GM shares soared Thursday and Friday, hitting their highest level in three years, amid optimism about the savings that will be realized as a result of the UAW deal. GM shares have gained nearly 50% since early September.

By 2010, GM sees positive VEBA cash-flow, reversing a negative $3.3 billion outflow it currently reports based on retiree health care. It expects to post $3.3 billion in positive cash-flow associated with VEBA-related savings by 2011. Year-end liquidity will fall by $2.6 billion due to an exclusion of short-term VEBA assets it currently accounts for.

Among other savings highlights: the establishment of a second-tier pay and benefits scale for new noncore hires. These people will make an "all-in" compensation -- including benefits -- of $25.65 an hour in 2008, with increases thereafter. GM's "U.S. hourly people cost" will fall to an estimated $10.1 billion in 2007 from $18.4 billion in 2003.

About 65% to 75% of GM current UAW hourly employees will be eligible for retirement during the current contract, which expires in late 2011.



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