California to Review Dropped Health Insurance Policies

We’ve all heard about it, big insurance companies happily accepting premiums for years and years until a customer submits a large medical bill. Then, that person’s medical records are reviewed and either because of an inadvertent or insignificant omission of information, their coverage is dropped. Now, the person is uninsurable, and probably lacking the capital necessary to properly treat their disease. Insurers defend these practices, saying protecting themselves from fraud keeps premiums low for everyone (and profits high for them).

Now, a California regulatory agency is reviewing the “recission” practices of five major insurers, WellPoint Inc.’s Anthem Blue Cross, UnitedHealth Group Inc.’s PacifiCare, Health Net Inc., the Kaiser Foundation Health Plan and Blue Shield of California. The state will be pouring through the companies’ records over the past four years, and allowing independent arbitrators decide whether or not they acted in good faith. If it is determined that a policy was wrongly canceled, it will be immediately restored, and the insurer will be responsible to pay all medical bills incurred by the consumer over the time they were without insurance.

Today’s announcement could mean the restoration of thousands insurance policies across the state. Read more here.

This isn’t the first move California has made against insurance companies’ policies. Last fall, the state fined Health Net $1 million for failing to disclose a link between employee bonuses and the cancellation of individual insurance policies. And on Wednesday of this week, Los Angeles City Attorney, Rocky Delgado, filed a $1 billion lawsuit against Anthem Blue, for their questionable practices. In another lawsuit against Health Net, the insurer was forced to pay nearly $9 million to a woman whose battle with breast cancer left her without coverage and facing mounting medical bills.

The Govenator has pledged his support in the fight against these harmful practices. In a released statement he said he would work with the legislature to “ensure this egregious practice is stopped.” He went on to say, “It’s outrageous that innocent patients have to live in fear of losing their health care coverage.”

Merck’s Questionable Ethics Explored

Two new reports in the Journal of the American Medical Association have raised concerns that Merck employed questionable ethics in pushing their dangerous drug, Vioxx, onto the market. You’re shocked, I’m sure.

The reports were based on court documents discovered throughout the course of the 4.85 billion settlement involving 47,000 patients injured by the drug.

The first report alleges (read about it) that Merck was well-aware of the fact patients taking Vioxx in clinical trials were three times as likely to die as those taking placebo. Instead, Merck reported the drug was “well-tolerated,” failing to report the findings of their study to the FDA and the public in a timely fashion. Vioxx was eventually withdrawn from the market in 2004.

The second report (as described here) indicates that Merck used company-hired individuals to write their studies, then paid well-respected academic scientists to take credit for them. The Journal indicated that this is common, but questionable practice in today’s medicine, and urged reform.

Merck denies the reports, saying they were “false and misleading.” And they know all about false and misleading!

Who Needs Tort Reform When You Have a Functioning Court System?

Proving once more that no tort reform is necessary in Pennsylvania, the Supreme Court of PA announced yesterday that medical malpractice cases are down 40.8% statewide, and down over 50% in Philadelphia County.

Med mal cases have been on a steady decline since 2003, when a rule change required a medical expert certify all malpractice cases to ensure that there was deviation from the standard of care. The rule change also required cases to be heard in the same county where the alleged harm occurred, which eliminated so-called “venue shopping.”

In a release, Chief Justice Ronald D. Castille said, “The latest statistics provide additional evidence that the sharp drop in medical malpractice litigation, which began in 2003, was not a temporary correction, but a sustained response to the procedural rule changes adopted by the Supreme Court and the statutory changes enacted by the General Assembly.” He went on to say that “Ongoing review and enhancements to our procedures will ensure that both plaintiffs and defendants can rely on an accessible court system where professional liability actions are impartially and promptly resolved.”

Read the report released by the PA Supreme Court here.

Supreme Court to Hear Case of Former LA Prosecutor

Yesterday, the Supreme Court decided it would take up the case of a former LA prosecutor in what could be a challenge to prosecutorial immunity. The case, Van de Kamp vs. Goldstein, will examine whether or not a head prosecutor can be held liable for an individual’s wrongful conviction.

Back in 1976, when the Court heard a similar argument, it was determined that the rule of “absolute immunity” is in effect whenever a prosecutor acts within the scope of his/her prosecutorial duties.

This case stems from the 1980 murder conviction of Thomas Goldstein, a Marine Corp veteran living in Long Beach, CA. Goldstein was tried and convicted of shooting his neighbor. The case heavily relied on jailhouse informants, some of which were found to be disreputable. Goldstein maintained his innocence for the 24 years he was incarcerated before his conviction was overturned in 2004. Goldstein filed suit against the former prosecutor of Los Angeles, John Van de Kamp, for the use of unreliable witnesses. Read more about the case here.

Lawyers for Van de Kamp said the case should be dismissed based on the Court’s ‘76 ruling; however, the other side made the argument that the case is not about how Goldstein was prosecuted, but rather how Van de Kamp’s poorly managed D.A.’s office contributed to his wrongful conviction.

The Court will hear arguments from both sides this fall.