Archives for May 2014

Does healthcare insurance lower mortality rates?

The death rate in Massachusetts dropped following the 2006 adoption of mandatory healthcare insurance. Is this a coincidence, or is mandatory healthcare insurance responsible for the decreased mortality rate?

Is preventative care key?The New York Times reports that from a recent study of mortality rates in Massachusetts, which compares the death rates to counties with similar populations outside the state, we don’t yet know the answer to the question. However, the study, published in the Annals of Internal Medicine, provides some evidence that healthcare insurance may be closely linked to reducing mortality.

With coverage now being more widely available and accessible to those who would otherwise be uninsured, doctors and hospitals have observed a difference in the willingness of patients to pursue treatment. The New York Times referenced multiple reports by doctors in which uninsured patients would delay or forego medical care and treatment. More often than not, the ultimate reason they chose to do so was the financial cost involved. Unfortunately, medical conditions for some untreated patients grew into more serious (and costly) health issues that might have been avoided had treatment been sought early on.

As alluded to by the study, if more patients have healthcare insurance, they are more likely to pursue and receive preventative care, which leads to a healthier population, reduces overall healthcare costs, and relieves taxpayers of the burden of government care for the uninsured. It further suggests that to be effective, healthcare insurance must be within the financial means of families and individuals. Unfortunately, our current healthcare delivery system allows for hidden and questionable healthcare expenses that continually drive costs higher, making it unreachable for many.

If you, your family, or a loved one believe you have been overcharged, denied proper treatment or provided unnecessary treatment in connection with insurance or billing issues, you may have legal rights to pursue justice. Contact Brownstein and Nguyen, your Atlanta healthcare whistleblower attorneys, for assistance regarding healthcare coverage issues, medical expenses and billing fraud.

What should you do if you are the victim of medical malpractice?

Ask Key QuestionsAll patients have certain rights and responsibilities as outlined by the National Health Council. The saying “a patient is his own best advocate” is true. For the best possible healthcare, a patient should be informed and take the initiative. Investigating and asking questions about general care, health issues and potential procedures is necessary to be proactive regarding one’s health. Having all questions answered before a major or even minor procedure is especially important.

While medical professionals are highly trained and strive to provide the best care possible, medical errors do occur in the healthcare industry. Medical malpractice encompasses a variety of areas and can include many types of errors or mistakes made by a doctor, surgeon, nurse, or other healthcare provider.

If you are a loved one has suffered from medical malpractice, or even suspect that wrongdoing may have occurred, here are a few important suggested steps to follow:

1. Gain access to medical records

It is important to gain prompt access to complete medical records relating to a procedure or event, including the healthcare provider’s records and hospital or facility records. A timely legal and medical review of relevant records must be done to determine if malpractice occurred. Contact medical professionals, hospitals or other facilities involved so that records can be promptly obtained after suspected malpractice has occurred. The law has strict time limits on bringing claims for malpractice; obtaining all records as soon as possible is a critical part of the process.

2. Ask key questions

Not only is it important to be proactive about one’s health before a medical procedure, but it is equally important to be proactive afterwards. If a medical outcome is not as expected or hoped, or there is any uncertainty, ask your doctor or medical professional specific questions to determine if a problem exists and how it might be remedied. If you’re unsatisfied with any answers, seek a second opinion from another medical  professional. Again, as the patient you are your own best advocate.

3. Contact an attorney

Since malpractice laws vary from state to state, it is highly recommended that an experienced attorney be contacted if malpractice is suspected. The medical malpractice attorneys at Brownstein and Nguyen have over 20 years of experience in medical malpractice cases in the greater Atlanta metropolitan area. They will review your case free of charge, discuss your potential claim(s), and provide expert legal advice regarding your options.

Contact Brownstein and Nguyen regarding any medical malpractice questions or concerns that you may have.

Bedsore Prevention and Awareness

Pressure ulcers or decubitus ulcers, commonly referred to as bedsores, are serious and sometimes fatal injuries typically afflicting the elderly, bedridden and wheelchair populations including stroke victims, paralysis and dementia patients. Most bedsores occur in hospital or nursing home settings. With proper care and prevention, however, the risk of bedsores and resulting complications can be greatly reduced, if not eliminated, for at-risk patients.

High risk population for bedsoresWhat is a pressure ulcer or bedsore?

A pressure ulcer or bedsore is as an area of unrelieved pressure in a defined area, usually over a bony prominence (such as the tailbone, ankle or elbow), resulting in ischemia, cell death, and tissue necrosis. Essentially, the pressure prevents blood from getting to the tissue, which breaks down and eventually dies. Once a bedsore develops, depending upon age, nutrition and other medical factors, the skin may not heal and a life-threatening systemic infection can result. Risk factors for pressure ulcers include inactivity, immobility, diabetes, advanced age, impaired cognition, and bowel or bladder incontinence.

Pressure ulcers are classified and treated according to clinical “stage” based on certain criteria. Assigning a pressure ulcer stage is based on visual inspection to determine the extent of tissue destruction and wound depth. Pressure ulcer staging also requires an understanding of the anatomy of skin and underlying tissues. In stage I, the skin is not broken but is red or discolored without fading thirty (30) minutes after pressure is removed. By stage II, the topmost layer of skin is broken, creating a shallow, open, painful sore.  A stage III pressure ulcer is a full-thickness skin loss involving damage or necrosis of the underlying tissue that may extend down to, but not through, muscle or bone. Drainage may or may not be present in stage II and stage III pressure ulcers. Stage IV describes a pressure ulcer involving extensive destruction of tissue with tissue necrosis or damage to muscle, bone, or supporting structures. Usually, dead tissue and drainage are present in stage IV pressure ulcers.

According to the National Quality Forum, a non-partisan consortium of healthcare professionals and organizations, stage III and IV and unstageable pressure ulcers that develop after admission to a facility are considered Serious Reportable Events (SRE) that are preventable and should never occur. Unfortunately, bedridden, wheelchair bound and other at-risk patients don’t always receive the necessary care to prevent pressure ulcers. All too often, infected pressure ulcers lead to systems failures and ultimately death for at-risk patients at hospitals, nursing homes, acute and long-term care facilities. According to the National Pressure Ulcer Advisory Panel, a non-profit devoted to the prevention and care of pressure ulcers, each year approximately 2.5 million patients are treated for pressure ulcers in U.S. acute care facilities and as many as 60,000 U.S. hospital patients die each year from pressure ulcer complications.

Causes and prevention of bedsores

Pressure ulcers or bedsores are commonly caused by a combination of four factors: pressure, shearing forces, friction and moisture. The key to prevention is pressure reduction.

Good skin care begins with an initial risk assessment and the creation of a skin care plan specifically tailored to the patient’s condition and setting. Prevention of skin breakdown, pressure ulcers and tissue or blood infections is an essential aspect of care. Upon admission to a hospital, acute care or other facility, patients should be evaluated by a physician, qualified nurse of other medical professional for the risk of skin breakdown taking into account numerous variables and risk factors. Thereafter, regular skin assessments should be performed on a regular basis (daily in an acute care setting), especially if a skin problem is suspected or has been observed. Initial and periodic assessments should contain accurate measurements of the length, width, and depth of a wound. Drainage type, color and odor, and the color of wound tissue should be noted, as well as staging of the wound.

At a minimum, patients identified as at-risk for skin breakdown should be repositioned at least every two (2) hours. However, regular repositioning may not be enough for patients at higher risk levels or if a pressure ulcer has already formed. A pressure-reducing surface like a foam or inflatable mattress cushion should be used for those patients. To minimize the risk of skin breakdown from shearing forces, the head of the bed should be maintained at the lowest degree of elevation necessary based on medical conditions and other factors. Friction injuries may be reduced by the use of protective dressings and barriers. Pressure ulcers must be kept clean, dry and protected from sources of contamination such as feces and urine. This typically requires frequent cleaning of the patient and changing of the wound dressing.

What to look for?

Pressure ulcers can develop quickly – within days or even hours – depending on a patient’s condition and setting. The most common site where pressure ulcers occur in bedridden patients is the buttocks area, over the tailbone. Because of this, developing bedsores may be difficult to detect for family members not involved in the daily care of a patient. There are, however, certain observable factors and symptoms might indicate the presence of a bedsore warranting further examination and treatment. They can include:

  • lengthy period of immobility
  • generalized or local discomfort or pain when not being moved or touched
  • generalized or local discomfort or pain when being repositioned, turned, or moved
  • foul odor from of undetermined origin
  • evidence of lack of proper turning or re-positioning
  • poor hydration and/or nutrition
  • lack of proper hygiene and cleaning of incontinent patients

What to do?

If you suspect that a family member or loved one is at-risk or suffering from a bedsore, you should immediately notify the healthcare professionals in charge of their care. Proactive oversight and management of your loved one’s care is the best way to ensure they are receiving the proper care.

If your loved one is the victim of negligent care resulting in a pressure ulcer or decubitus, contact the experienced Atlanta Georgia elder care, bedsore and medical malpractice attorneys at Brownstein & Nguyen today for a free consultation. We handle cases involving preventable bedsores and the serious health complications and deaths that result. We’ll confidentially review the case, and discuss your legal rights with you.

Private Whistleblowers Help Fight Healthcare Fraud

The Primer on Whistleblowing in Healthcare, co-authored by Atlanta attorney Jay Brownstein, is an excellent resource regarding healthcare fraud. Healthcare fraud, including false and deceptive billing practices, costs taxpayers upwards of $80 billion each year. Healthcare fraud comes in many shapes and varieties, including fraudulent billing, kickback schemes, and other illegal practices. With Medicare and Medicaid paying the majority of these expenses, taxpayers ultimately pay the bill for healthcare fraud.Healthcare Fraud Spends Tax Dollars

In their article, Jay Brownstein and Kevin Little educate the public on what whistleblowing is, how it relates to the area of healthcare fraud, and what to do should healthcare fraud be suspected. They point out that healthcare providers and employees need to be aware of their rights, as there are many state and federal laws in place to protect them in whistleblowing instances. Additionally, an outline of what to look for in billing fraud, illegal referral fees or kickback schemes, and drug manufacturer or medical device fraud is included. The article also identifies steps to take to help protect oneself before reporting fraud or wrongdoing in the healthcare industry.

Each year, many courageous private citizens bring qui taim, or whistleblower lawsuits, to help the government recover billions of dollars in fraudulent healthcare claims. The Primer on Whistleblowing in Healthcare is a quick, informative read for those interested in the topic.

Detention of Immigrants: Good for Business?

While recent headlines have focused on the ongoing debate in Washington and around the country about immigration reform, very little attention has been given to the intersection between private, for-profit businesses and the detention of immigrants. We would like to share some important facts about profits and immigration policy in our country.

Private Prisons-Immigration detention-Atlanta Immigration LawImmigration and Customs Enforcement (ICE) follows a congressional mandate that the government must detain and house  34,000 immigrants each day. William Selway and Margaret Newkirk outline that this quota does not come cheap for taxpayers; each of those slots costs about $120 per day to keep filled. In total, the United States spends over $2 billion in taxpayer dollars a year to detain immigrants who are awaiting government action on their cases (which can take years). Over half of that amount – more than $1 billion – is spent on private prison facilities. Public financial information from the country’s largest private prison operators shows that the private prison industry is profiting from our country’s current immigration detention policies.

Does the current detention mandate make sense? Should private corporations that spend millions lobbying in Washington profit from the detainment of immigrants?

At Brownstein and Nguyen, we do not claim to have the answers to these policy questions. However, we have seen firsthand the often harsh effects of the government’s detention policies in the lives of honest, hard-working immigrants and the families who depend on them. We are proud to state that we have been able to help thousands of immigrants over the years who seek only a fair chance at a better life for themselves and their families in the United States.

Please do not hesitate to contact Brownstein and Nguyen, your Atlanta immigration law experts regarding immigration custody and detention and other immigration concerns. We have a proven track record of success, showing time and again that our knowledge and experience in immigration law provide clients with the best possible representation when they need it most.

Shocked by those hospital bills? You are not alone.

Have you ever looked at a hospital bill with utter disbelief? You are not alone. Medical bills are the number one cause of personal bankruptcy filings in the United States. The cost of hospital care can be extraordinary, especially in light of the fact that many hospitals are operated as non-profits. Exacerbating the problem is the fact that most often patients in need of urgent care have no ability or opportunity to comparison shop. Hospitals essentially operate free from market constraints.

Medical BillsIt has recently come to light that due to the manner in which hospitals establish pricing for services, the retail or gross charges to patients (before insurance payments or discounts) are entirely arbitrary. Last year, author Steven Brill outlined some of the exorbitant costs of medical care in an important Time magazine special report titled “Bitter Pill”. Using the specific examples and powerful personal narratives of ordinary people who have suffered from unreasonably high medical expenses, Brill has exposed previously hidden truths about our healthcare system that help unravel the mystery of spiraling healthcare costs. Hopefully, Brill’s research and undeniable conclusions will help create a level playing field for the general public and policymakers in understanding how to combat and perhaps one day solve the problem.

One element of Brill’s research that seemed the most surprising was the existence and function of a hospital “chargemaster.” Before “Bitter Pill,” most of us had likely never heard of a chargemaster. As the name hints, a chargemaster is responsible for assigning the retail charges for all medical procedures, services, medications and supplies at a hospital. Using supporting visual references such as hospital bills and receipts, Mr. Brill does a superb job of documenting how charges can vary depending on a patient’s coverage. One example he uses is that of a chest X-ray in which a patient was charged $333.00. The same X-ray is covered for a Medicare patient at a rate of $23.83. Another example is a case in which a patient is charged $1.50 for one acetaminophen tablet (acetaminophen is the main ingredient found in the brand name painkiller Tylenol). The price for one tablet is in the same ballpark as what an entire bottle of the generic drug may be purchased for.

Bitter Pill is a great stepping stone into the discussion of fraudulent billing. More information can be found regarding the matter of fraudulent billing of Medicaid in the Primer on Whistleblowing in Healthcare , an article co-authored by Brownstein & Nguyen attorney Jay Brownstein. An experienced attorney who handles complex litigation matters, Jay Brownstein has consulted and represented clients in whistleblower cases. If you suspect that you have been overbilled or “up-coded” as a result of a hospital or nursing home stay, contact our trusted Atlanta attorneys for a free consultation regarding healthcare whistleblowing.

Buyer Beware: Online Legal Forms & Non-Lawyer Services

If you’ve ever been tempted to use a point-and-click legal form or other non-lawyer service offered online by numerous websites, you’re not alone. According to the U.S. Bureau of Economic Statistics, in 2012 U.S. households spent over $8 billion on legal services, a 33% increase from 2005. For some consumers, online forms and other legal services appear to offer inexpensive alternatives to hiring an attorney for what they consider are “simple” legal matters, such as wills and contracts. However, there can be unforeseen dangers and hidden costs to utilizing online forms and non-lawyer legal services for personal or business matters.

Business Litigation AtlantaWhile online forms and legal services websites might appear to be easy to use and relatively inexpensive, they can actually end up costing much more than hiring an attorney to perform the same tasks. This is true mainly because there is no such thing as a standard, “one size fits all” contract, will or legal matter, nor is there any substitute for personal legal advice following a direct consultation with a licensed attorney experienced in the relevant law in your state. Just as no two people are exactly alike (except perhaps identical twins), every legal situation is unique and must be carefully analyzed to determine the proper approach and needed solution.

Not only are lawyers knowledgeable in the laws of the state(s) where they are licensed, but they are also professionally trained to gather and sift through facts and identify important legal issues that should be addressed under the circumstances. With standardized forms (even ones purporting to be “valid” in particular states), there is a greater chance that relevant details will be missed and that the form selected and filled out by a consumer will either fail to adequately cover important legal issues or will not comply with applicable state law, or worse, both.

Unfortunately, as more consumers look to online forms and services instead of obtaining personal legal advice for their particular situation, many will find themselves dealing with the unintended cleanup efforts that can result. The story of Ann Aldrich illustrates the serious consequences that can arise when using online forms to create important legal documents such as wills or contracts. In Ms. Aldrich’s case, she created a last will using a form provided by online provider E-Z Legal Forms. Unfortunately, the form did not contain the necessary language to carry out Ms. Aldrich’s intent, which was to leave her entire estate to her sister first and then to Ms. Aldrich’s brother if her sister died before she did. The Florida Supreme Court ruled in favor of two nieces who challenged the will, holding they were entitled to receive bank accounts that were not specifically listed in the will. Not only were Ms. Aldrich’s true wishes not carried out, but unnecessary and costly litigation resulted from the defective will.

If something is worth doing – such as memorializing a business deal with a well-written contract or leaving clear instructions on passing your worldly belongings to your heirs – it is worth doing correctly. Taking shortcuts in important legal matters often leads to headaches and heartache as families, business partners and courts are left to figure out what actually was intended.

The Atlanta business litigation and counsel lawyers of Brownstein and Nguyen offer years of experience and legal expertise in business representation. No matter the legal issue, our lawyers will meet with you to discuss your particular situation, review your documents and offer advice on the legal issues presented, and prepare the necessary legal documents to proactively protect your business interests and anticipate potential future issues. If a dispute arises, our attorneys can effectively and efficiently represent your interests in court. Contact us today for assistance with your legal business needs.