Louisiana should pass a similar statute enacted in Texas in which only the actual PAID medical expenses are reimbursable in a tort action. Presently the incurred expenses, even if not actually paid, are reimbursable (unless Medicaid paid the costs).
We ALL know that often what was incurred is never actually PAID. If there were some way to curtail pre-litigation expenses, then perhaps we would see a quicker resolution to cases.
Often a plaintiff, with a minor soft-tissuei njury, will see a chiropractor for several months incurring a bill of $5000 to $10,000, to be paid at the conclusion of the case. We KNOW that these bills are likely discounted significantly, but presently the insurance companies are required to pay the entire cost of INCURRED EXPENSES.
Recently, I had case in which a plaintiff went to a chiropractor AND a physical therapist, often on the SAME DAY, getting the same treatment. I am not sure it rises to the level of fraud, but it certainly seems VERY close. I could hire an expert to review the costs of treatment, but he cannot testify about whether the treatment was necessary; only if the costs were reasonable.
This may be worth doing in some cases, but by the time we hire the expert, evaluate the costs, report his findings then we have incurred additional defense costs. That does not even get us to the trial stage, where we may have to call the expert to testify.
For a case that probably should settle for UNDER $15,000 for four months of treatment with chiropractic treatment, settlements may be more than $20,000 just because the medical costs are so high. Even though many of the costs are for duplicative treatment, they were INCURRED COSTS.
I am certain that if the plaintiff or her attorney Actually PAID those costs, then the expenses would NOT have incurred. This problem bleeds over into the overall cost of health care in Louisiana.
SIX out of the TOP TEN cities in the nation with the highest healthcare costs were from Louisiana. Rebecca Catalanello, of The New Orleans Times-Picayune, reported:
Six of the 10 most expensive places to buy health care in the nation are in Louisiana, including Metairie, Baton Rouge and Lafayette.
That’s according to a new Institute of Medicine study that attempted to examine geographic differences in health care spending among Medicare, Medicaid, privately insured and uninsured populations.
With Louisiana near the top of many of the country’s "worst of" health lists — asthma, diabetes, heart disease, obesity — it could be tempting to credit this distinction to our state’s particularly unhealthy population. But the study, which was commissioned under the terms of the federal Patient Protection and Affordable Care Act, found that differences in traditional, fee-for-service health care spending exist in spite of age, sex and health status.
Jonathan Skinner, a professor of economics at Dartmouth College, who has studied variations in health care spending for years, said that Louisiana has several strikes against it, even when studies like this one control for poverty, race and health status.
Besides having an incredibly unhealthy population, he said, individual patient care between hospitals and community clinicians is often fragmented, leading to high percentages of hospital readmissions soon after discharge. Louisiana also has a robust market for what he called "entrepreneurial home health providers" that clearly plays a role.
"To me," Skinner said of the study, "the spending differences are important, but what worries me more is that this is an indicator of poor care."
Federal prosecutors appear to count Medicare fraud as a priority in Louisiana, where about 718,000 people are on Medicare. Baton Rouge is one of nine U.S. cities to house a Medicare Strike Force Team, a national effort to weed out fraud on the local level.
Kathy Kliebert, secretary for the Louisiana Department of Health and Hospitals, said she hadn’t yet read the report. But she said Louisiana is working hard to address overspending in the state-run Medicaid system by developing a stronger system of managed care through its Bayou Health program — a systematic attempt to reduce cost by better matching price to quality while discouraging the use of unnecessary or redundant services.
"If you can’t tie costs to outcomes," Kliebert
Dr. Rebekah Gee, Louisiana’s Medicaid medical director, said that though the findings are largely based on Medicare data, she believes the report tells a story about what is happening across Louisiana in private and public health care spending.
This problem is NOT going to be resolved in the courts because the courts must apply the law. We MUST have some legislative guidance and courage.
What can we do to resolve this problem? I have posted this report on Linkedin and requested ideas. David A. Anderson said:
Mark: I feel your frustration. All that one can do is request all the meds and go over them and the bills with a fine tooth comb. What I am seeing is expensive testing which reveals no injuries but it really drives the cost up. I just settled a minor case where a 7 year old fell from a bench swing or they claimed she fell, meds were over 17K with nothing more than a neck sprain. It was difficult to dismiss them as unnecessary since the ER ordered them. If you come up with a solution, I am all ears.
Please share your suggestions on how we can resolve this problem.
Mark Perkins
Perkins & Associates, LLC
318-222-2426
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