Archive for May, 2011

Massachusetts makes health provider price disparities transparent

May 27, 2011 1 comment

The Massachusetts Department of Health Care Finance and Policy issued its annual Massachusetts Health Care Cost Trends report that outlines price variation in Health Care Services. This report continues down the path of heightened transparency of provider pricing as required under Massachusetts’s ground-breaking 2006 Health Care Reform Act.

The report outlines continued large disparities in the price of common procedures. For example, the cost of a Caesarean Section at Mass General Hospital is listed at $10,517 versus only $4957 across the river at Cambridge Health Alliance. However, higher-priced facilities like Mass General (and its parent, Partners Health Care) defended itself by noting that its rates need to be higher to support its research, teaching and other money-losing health care services to the region. Read more…

A look at the recent MBTA pass scam – would crime insurance pay?

Massachusetts prosecutors announced a case against an employee of a contractor of the public transit agency, the MBTA. The contractor produced the monthly transit fare cards sold to tens of thousands of persons each month. The employee allegedly made many more of the passes and then sold them on websites like eBay and Craig’s List.

The scam had been going on since 2007 and is alleged to have garnered the employee in question as much as $4 million. The case was exposed by a train conductor who became suspicious that one of the cards did not look appropriate. Otherwise, they may not have been stopped since the cards worked in all of the transit agency turnstiles.

The MBTA General Manager has announced the agency’s intention to pursue full reimbursement from the contractor for its lost revenues. He also announced Read more…

Lessons from last week’s doomsday predictions about risk

The May 21st predictions of the end of the world as we know it have proved wrong. Harold Camping and his followers, despite their most confident and infallible prediction (according to them) have been proven wrong. And while I don’t want to give any credence to Mr. Camping and his predictions (nor do I wish to belittle his faith either), there is some value for a risk professional in the sad reality of the wild and seemingly impossible predictions from these doomsday believers.

Risk management is built around the premise that adverse events need to be considered, planned for and that actions need to be taken in order to mitigate the negative impact these events. These actions can be both proactive and reactive in nature. However, these actions are all based on the assumptions about the nature of risk Read more…

Anti-bullying law increases liability for educators and schools

Massachusetts Governor Deval Patrick recently signed into law a new anti-bullying statute intended to reduce the likelihood of the bullying of students at all levels of school.  This comes in the wake of student suicides in Massachusetts schools arising out of cyber and other forms of bullying.

A good description of the law is outlined in a white paper from the law firm of Eckert Seamans that outlines the key components of the legislation.

Increased regulation for schools and educators will, however, serve to increase legal liability for educators should they fail to adhere to the letter or spirit of the law.  A close review of General Liability and other insurance policies would be in order for educational institutions.

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Nursing homes & home care agencies seek health law exemptions

May 18, 2011 2 comments

An interesting article in Sunday’s New York Times points to the financial difficulties many nursing homes and home health care agencies will face starting in 2014 in order to comply with the new federal health care law. The new health care law is supposed to guarantee access to affordable coverage for all. But many nursing homes and home care agencies have started lobbying efforts seeking some kind of exemption or special treatment. Starting in 2014, the law will require employers with 50 or more full-time employees to offer affordable coverage or risk paying a penalty. For a midsize nursing home, that penalty could easily exceed $200,000 a year. The American Health Care Association, the largest trade group for nursing homes, says the problem is that reimbursement rates for Medicaid and Medicare do not pay them enough to offer their employees medical coverage. Read more…

Beware proper usage of internet searches for employment purposes

May 13, 2011 1 comment

A presentation at the Risk & Insurance Management Society’s (RIMs) Annual Conference last week in Vancouver outlined the latest developments in Social Media Risks. Among the more surprising results was a report on liability associated with the use of information available on the internet that may be used to determine employment decisions. Tamara Russell, an attorney at Barran Liebman LLP in Portland, Oregon was quoted in Business Insurance magazine as saying: “You cannot ask certain questions online that you wouldn’t and shouldn’t ask during an interview”. Read more…

Active month on the legal front for PPACA

Beginning this week and over the next month, round two of the legal challenges and defense of the Patient Protection and Affordable Care Act (PPACA) hit the appellate courts. In summary:

  • Tuesday, May 10: The Fourth Circuit court will judge two different rulings in Virginia about the law. One ruling in Richmond federal court found the individual mandate unconstitutional while the opposing ruling in Lynchburg upheld the constitutionality of the individual mandate.
  • Wednesday, June 1: The Sixth Circuit in Cincinnati will hear an appeal against a lower court ruling that upheld the law. This multi-state lawsuit Read more…