In ‘Sweetie’ and ‘Dear,’ a Hurt for the Elderly
By JOHN LELAND - The New York Times - October 6, 2008
Professionals call it elderspeak, the sweetly belittling form of address that has always rankled older people: the doctor who talks to their child rather than to them about their health; the store clerk who assumes that an older person does not know how to work a computer, or needs to be addressed slowly or in a loud voice. Then there are those who address any elderly person as “dear.”
“People think they’re being nice,” said Elvira Nagle, 83, of Dublin, Calif., “but when I hear it, it raises my hackles.”
Now studies are finding that the insults can have health consequences, especially if people mutely accept the attitudes behind them, said Becca Levy, an associate professor of epidemiology and psychology at Yale University, who studies the health effects of such messages on elderly people.
“Those little insults can lead to more negative images of aging,” Dr. Levy said. “And those who have more negative images of aging have worse functional health over time, including lower rates of survival.”
In a long-term survey of 660 people over age 50 in a small Ohio town, published in 2002, Dr. Levy and her fellow researchers found that those who had positive perceptions of aging lived an average of 7.5 years longer, a bigger increase than that associated with exercising or not smoking. The findings held up even when the researchers controlled for differences in the participants’ health conditions.
In her forthcoming study, Dr. Levy found that older people exposed to negative images of aging, including words like “forgetful,” “feeble” and “shaky,” performed significantly worse on memory and balance tests; in previous experiments, they also showed higher levels of stress.
Despite such research, the worst offenders are often health care workers, said Kristine Williams, a nurse gerontologist and associate professor at the University of Kansas School of Nursing.
To study the effects of elderspeak on people with mild to moderate dementia, Dr. Williams and a team of researchers videotaped interactions in a nursing home between 20 residents and staff members. They found that when nurses used phrases like “good girl” or “How are we feeling?” patients were more aggressive and less cooperative or receptive to care. If addressed as infants, some showed their irritation by grimacing, screaming or refusing to do what staff members asked of them.
The researchers, who will publish their findings in The American Journal of Alzheimer’s Disease and Other Dementias, concluded that elderspeak sent a message that the patient was incompetent and “begins a negative downward spiral for older persons, who react with decreased self-esteem, depression, withdrawal and the assumption of dependent behaviors.”
Dr. Williams said health care workers often thought that using words like “dear” or “sweetie” conveyed that they cared and made them easier to understand. “But they don’t realize the implications,” she said, “that it’s also giving messages to older adults that they’re incompetent.”
“The main task for a person with Alzheimer’s is to maintain a sense of self or personhood,” Dr. Williams said. “If you know you’re losing your cognitive abilities and trying to maintain your personhood, and someone talks to you like a baby, it’s upsetting to you.”
She added that patients who reacted aggressively against elderspeak might receive less care.
For people without cognitive problems, elderspeak can sometimes make them livid. When Sarah Plummer’s pharmacy changed her monthly prescription for cancer drugs from a vial to a contraption she could not open, she said, the pharmacist explained that the packaging was intended to help her remember her daily dose.
“I exploded,” Ms. Plummer wrote to a New York Times blog, The New Old Age, which asked readers about how they were treated in their daily life.
“Who says I don’t take my medicine as prescribed?” wrote Ms. Plummer, 61, who lives in Champaign, Ill. “I am alive right now because I take these pills! What am I supposed to do? Hold it with vice grips and cut it with a hack saw?’”
She added, “I believed my dignity and integrity were being assaulted.”
Health care workers are often not trained to avoid elderspeak, said Vicki Rosebrook, the executive director of the Macklin Intergenerational Institute in Findlay, Ohio, a combined facility for elderly people and children that is part of a retirement community.
Dr. Rosebrook said that even in her facility, “we have 300 elders who are ‘sweetie’d’ here. Our kids talk to elders with more respect than some of our professional care providers.”
She said she considered elderspeak a form of bullying. “It’s talking down to them,” she said. “We do it to children so well. And it’s natural for the sandwich generation, since they address children that way.”
Not all older people object to being called sweetie or dear, and some, like Jan Rowell, 61, of West Linn, Ore., say they appreciate the underlying warmth. “We’re all reaching across the chasm,” Ms. Rowell said. “If someone calls us sweetie or honey, it’s not diminishing us; it’s just their way to connect, in a positive way.”
She added, “What would reinforce negative stereotypes is the idea that old people are filled with pet peeves, taking offense at innocent attempts to be friendly.”
But Ellen Kirschman, 68, a police psychologist in Northern California, said she objected to people calling her “young lady,” which she called “mocking and disingenuous.” She added: “As I get older, I don’t want to be recognized for my age. I want to be recognized for my accomplishments, for my wisdom.”
To avoid stereotyping, Ms. Kirschman said, she often sprinkles her conversation with profanities when she is among people who do not know her. “That makes them think, This is someone to be reckoned with,” she said. “A little sharpness seems to help.”
Bea Howard, 77, a retired teacher in Berkeley, Calif., said she objected less to the ways people addressed her than to their ignoring her altogether. At recent meals with a younger friend, Ms. Howard said, the restaurant’s staff spoke only to the friend.
“They ask my friend, ‘How are you; how are you feeling?’ just turning on the charm to my partner,” Ms. Howard said. “Then they ask for my order. I say: ‘I feel you’re ignoring me; I’m at this table, too.’ And they immediately deny it. They say, no, not at all. And they may not even know they’re doing it.”
Dr. Levy of Yale said that even among professionals, there appeared to be little movement to reduce elderspeak. Words like “dear,” she said, have a life of their own. “It’s harder to change,” Dr. Levy said, “because people spend so much of their lives observing it without having a stake in it, not realizing it’s belittling to call someone that.”
In the meantime, people who are offended might do well to follow the advice of Warren Cassell of Portland, Ore., who said it irritated him when “teenage store clerks and about 95 percent of the rest of society” called him by his first name. “It’s the faux familiarity,” said Mr. Cassell, 78.
But he mostly shrugs it off, he said. “I’m irked by it, but I can’t think about it that much,” he said. “There are too many more important things to think about.”
Read more in The New York Times
Wednesday, October 8, 2008
Monday, October 6, 2008
Rampant Medicare fraud suspected in Miami
By Julie Appleby - USA TODAY - Oct. 6, 2008
Home health care costs charged to Medicare in the Miami area have risen 20 times the national average in the past five years, prompting a federal investigation of suspected fraudulent billing.
Miami-Dade County is on track to cost Medicare a projected $1.3 billion for home health care services this fiscal year, up 1,300% in just five years, government data show.
SLEUTHS: Going door to door to sniff out fraud
Investigators suspect that fraud is helping to drive the increase because the population of Medicare beneficiaries in the county grew only 10.2% between 2004 and 2007, the latest government data show.
"You definitely have a problem down here," says Randall Culp, an FBI supervisory special agent who oversees a team that works with a Medicare Fraud Strike Force in Miami.
FIND MORE STORIES IN: Detroit | Houston | Justice Department | Los Angeles County | Centers for Medicare | Miami-Dade County | Kerry Weems | Criminal Division | Southern District of Florida | Randall Culp
In South Florida, investigators say, some agencies are billing Medicare for millions of dollars in services that are unnecessary, overused or not provided at all.
Investigators elsewhere are paying attention because South Florida is a bellwether for scams that later surface in other large cities, such as Los Angeles and Houston. Scams involving fake AIDS treatments, for example, popped up in Detroit and several other cities after a crackdown in Miami, Culp and others say.
"Typically, Miami is ground zero. Then we see it move to the other high-fraud areas," says Suzanne Bradley, an investigator with the Centers for Medicare and Medicaid Service's field office in Miami.
Home health agencies send nurses and aides to assist homebound elderly and disabled beneficiaries. Nationally, Medicare expects to spend $16.5 billion on home health care this year, up 65% from five years ago.
Medicare spent six times more on home health care services in Miami-Dade County during the first five months of this year than in Los Angeles County, where the Medicare population is three times larger, agency data show.
"It jumps off the page as out of proportion," says Kirk Ogrosky, deputy chief in the Criminal Division's Fraud Section of the Justice Department.
Today, acting Medicare chief Kerry Weems says he will announce new anti-fraud efforts, some targeted at home care agencies in Miami.
"It does affect everyone because everyone is paying into Medicare," says Peggy Sposato, a nurse investigator with the U.S. attorney in the Southern District of Florida, who combs through data looking for unusual billings.
Read more in USA Today
Home health care costs charged to Medicare in the Miami area have risen 20 times the national average in the past five years, prompting a federal investigation of suspected fraudulent billing.
Miami-Dade County is on track to cost Medicare a projected $1.3 billion for home health care services this fiscal year, up 1,300% in just five years, government data show.
SLEUTHS: Going door to door to sniff out fraud
Investigators suspect that fraud is helping to drive the increase because the population of Medicare beneficiaries in the county grew only 10.2% between 2004 and 2007, the latest government data show.
"You definitely have a problem down here," says Randall Culp, an FBI supervisory special agent who oversees a team that works with a Medicare Fraud Strike Force in Miami.
FIND MORE STORIES IN: Detroit | Houston | Justice Department | Los Angeles County | Centers for Medicare | Miami-Dade County | Kerry Weems | Criminal Division | Southern District of Florida | Randall Culp
In South Florida, investigators say, some agencies are billing Medicare for millions of dollars in services that are unnecessary, overused or not provided at all.
Investigators elsewhere are paying attention because South Florida is a bellwether for scams that later surface in other large cities, such as Los Angeles and Houston. Scams involving fake AIDS treatments, for example, popped up in Detroit and several other cities after a crackdown in Miami, Culp and others say.
"Typically, Miami is ground zero. Then we see it move to the other high-fraud areas," says Suzanne Bradley, an investigator with the Centers for Medicare and Medicaid Service's field office in Miami.
Home health agencies send nurses and aides to assist homebound elderly and disabled beneficiaries. Nationally, Medicare expects to spend $16.5 billion on home health care this year, up 65% from five years ago.
Medicare spent six times more on home health care services in Miami-Dade County during the first five months of this year than in Los Angeles County, where the Medicare population is three times larger, agency data show.
"It jumps off the page as out of proportion," says Kirk Ogrosky, deputy chief in the Criminal Division's Fraud Section of the Justice Department.
Today, acting Medicare chief Kerry Weems says he will announce new anti-fraud efforts, some targeted at home care agencies in Miami.
"It does affect everyone because everyone is paying into Medicare," says Peggy Sposato, a nurse investigator with the U.S. attorney in the Southern District of Florida, who combs through data looking for unusual billings.
Read more in USA Today
Monday, August 4, 2008
Prescription Data Used To Assess Consumers - Records Aid Insurers but Prompt Privacy Concerns
By Ellen Nakashima - Washington Post Staff Writer - Monday, August 4, 2008
Health and life insurance companies have access to a powerful new tool for evaluating whether to cover individual consumers: a health "credit report" drawn from databases containing prescription drug records on more than 200 million Americans.
Collecting and analyzing personal health information in commercial databases is a fledgling industry, but one poised to take off as the nation enters the age of electronic medical records. While lawmakers debate how best to oversee the shift to computerized records, some insurers have already begun testing systems that tap into not only prescription drug information, but also data about patients held by clinical and pathological laboratories.
Traditionally, insurance companies have judged an applicant's risk by gathering medical records from physicians' offices. But the new tools offer the advantage of being "electronic, fast and cheap," said Mark Franzen, managing director of Milliman IntelliScript, which provides consumers' personal drug profiles to insurers.
The trend holds promise for improved health care and cost savings, but privacy and consumer advocates fear it is taking place largely outside the scrutiny of federal health regulators and lawmakers.
Ingenix, a Minnesota-based health information services company that had $1.3 billion in sales last year -- and Wisconsin-based rival Milliman -- say the drug profiles are an accurate, less expensive alternative to seeking physician records, which can take months and hundreds of dollars to obtain. They note that consumers authorize the data release and that the services can save insurance companies millions of dollars and benefit consumers anxious for a decision.
"Some insurers can make a decision in the same day, or right on the spot," Franzen said. "That's the real 'value-add.' "
But the practice also illustrates how electronic data gathered for one purpose can be used and marketed for another -- often without consumers' knowledge, privacy advocates say. And they argue that although consumers sign consent forms, they effectively have to authorize the data release if they want insurance.
Ingenix and Milliman create the profiles by plumbing rich databases of prescription drug histories kept by pharmacy benefit managers (PBMs), which help insurers process drug claims. Ingenix, for instance, has servers in the PBM data centers, updating the drug files as frequently as once a day, said John Stenson, senior vice president of consulting for Ingenix, which is a division of UnitedHealth Group. The corporation also owns UnitedHealthcare, the nation's second-largest insurer.
When an insurer makes an online query about an applicant, Ingenix or Milliman's servers scour the data and within minutes or less return reports to a central server at the company. The server aggregates the information going back as far as five years, including the drugs and dosages prescribed, dates filled and refilled, the therapeutic class and the name and address of the prescribing doctor.
Then comes the analysis.
Ingenix's MedPoint tool provides insurers a "pharmacy risk score," or a number that represents an "expected risk" for a group of people, such as 30- to 35-year-old women who have taken prescription drugs, Stenson said. Higher scores imply higher medical costs.
Milliman's IntelliScript codes drugs red, yellow or green, according to the insurer's instructions, with red signaling the greatest risk, Franzen said. Red codes could include the so-called AIDS cocktail drugs and cancer medications, he said.
The companies receive data only on individuals who are in clients in PBMs' databases, generally excluding, say, people who pay for drugs in cash. The profiles cost insurers about $15 a search. IntelliScript gets about 1 million queries from insurers a year, largely individual health insurers.
The system can save money for insurers, said Richard Dick, an entrepreneur who built the database system that Ingenix acquired in 2002.
For instance, if MedPoint produces a report that an individual has been on the highest dose of the cholesterol-reducing drug Zocor for 18 monts, the insurer "would be able to know that you have a very high, near-intractable cholesterol problem," Dick said, and could avoid a costly blood test.
From a business standpoint, it makes no sense for an insurer to sell a plan with a $200 monthly premium if the company knows that the consumer is taking medications that cost $400 every six months, industry experts said. That is why having access to an "objective" source of third-party information is valuable, said Tia Goss Sawhney, a Chicago area health insurance actuary who has used both companies' tools. "Though most people tell the truth most of the time, there are people out there who don't, who leave out something that's incredibly relevant, who may even be able to defraud a company," she said. "That's important because ultimately the people who tell the truth have to pay for those who don't."
Franzen, whose firm expects revenue of $575 million this year, said his clients tell him that about 10 percent of applicants do not disclose pertinent medical conditions in their applications that are later revealed by prescription drug history.
Some health experts worry that insurance companies can make faulty assumptions by looking at prescription drug records, because many drugs have multiple uses.
The field is growing rapidly. Realtime Solutions Group, a company in Woodridge, Ill., is testing whether lab data can be aggregated with prescription and other data for underwriting purposes. The firm is working with two major commercial labs and three large insurers, using thousands of real applicants. Initial results are promising enough that the company plans to proceed to the data-analysis stage, company co-founder Tedd Determan said.
Services such as MedPoint are just "one of many tools" underwriters use to make coverage decisions, said Tyler Mason, a spokesman for UnitedHealthcare, which uses MedPoint. A high-risk score on a profile will often lead to requests for more information from the applicant, he said.
Ingenix and Milliman officials stress that they provide data only with the patient's consent, as required by the Health Insurance Portability and Accountability Act (HIPAA), a 1996 law that governs personal health records information. But HIPAA does not give the Department of Health and Human Services the ability to directly investigate or hold accountable entities, such as pharmacy benefit managers or companies such as Ingenix and Milliman, who are not covered by HIPAA.
A health privacy proposal pending in Congress would expand federal officials' ability to regulate such "downstream" organizations, audit their activities and impose civil fines. The bill also includes a prohibition on the sale of electronic medical records.
Tim Sparapani, senior legislative counsel at the American Civil Liberties Union, said that the products that Ingenix and Milliman are marketing represent the "commodification" of electronic medical records by third parties. "We've got to stop these practices before the marketplace is fully developed and patients lose all control over their medical information," he said.
The field is growing rapidly. Realtime Solutions Group, a company in Woodridge, Ill., is testing whether lab data can be aggregated with prescription and other data for underwriting purposes. The firm is working with two major commercial labs and three large insurers, using thousands of real applicants. Initial results are promising enough that the company plans to proceed to the data-analysis stage, company co-founder Tedd Determan said.
"A lot of insurance companies are starting to use this type of data," said Determan, who co-founded IntelRx, a company that mined prescription databases and was sold to Milliman in 2005. "They said, 'All right. Prescription data is working, let's go and look at other types of data, too.' It's because of the success of one, that we're going after others."
In February, the Federal Trade Commission issued an order saying that MedPoint and IntelliScript are consumer reports under the Fair Credit Reporting Act, so the companies must notify insurers that consumers denied insurance on the basis of these reports have the right to request a copy of the report and that errors be corrected. The FTC's order followed a settlement of allegations that the companies violated the credit-reporting law by failing to provide such notice to insurers.
Bob Gellman, an independent privacy consultant in Washington, said the FTC's decision not to fine the companies sends "the message that it is okay to ignore the law." That, he said, "is absolutely outrageous."
As more health records become electronic, he said, more parties will compete to sell more comprehensive patient data to insurers, driving down data prices. "It will all likely be lawful," Gellman said, "but consumers will likely continue to have no real meaningful choices if they want insurance."
But now, he said, "there's a huge case for it being opened up for all legitimate access," whether for a patient in an emergency room or for federal government purposes. The key, he said, is full transparency.
He said he has created a privacy tool that requires users to consent before specific data, such as prescription histories, can be released. To work, he said, the tool must be independent of all who hold the data.
"Otherwise," he said, "you have the fox in charge of the henhouse."
Staff researcher Magda Jean-Louis
Read more in the Washington Post
Health and life insurance companies have access to a powerful new tool for evaluating whether to cover individual consumers: a health "credit report" drawn from databases containing prescription drug records on more than 200 million Americans.
Collecting and analyzing personal health information in commercial databases is a fledgling industry, but one poised to take off as the nation enters the age of electronic medical records. While lawmakers debate how best to oversee the shift to computerized records, some insurers have already begun testing systems that tap into not only prescription drug information, but also data about patients held by clinical and pathological laboratories.
Traditionally, insurance companies have judged an applicant's risk by gathering medical records from physicians' offices. But the new tools offer the advantage of being "electronic, fast and cheap," said Mark Franzen, managing director of Milliman IntelliScript, which provides consumers' personal drug profiles to insurers.
The trend holds promise for improved health care and cost savings, but privacy and consumer advocates fear it is taking place largely outside the scrutiny of federal health regulators and lawmakers.
Ingenix, a Minnesota-based health information services company that had $1.3 billion in sales last year -- and Wisconsin-based rival Milliman -- say the drug profiles are an accurate, less expensive alternative to seeking physician records, which can take months and hundreds of dollars to obtain. They note that consumers authorize the data release and that the services can save insurance companies millions of dollars and benefit consumers anxious for a decision.
"Some insurers can make a decision in the same day, or right on the spot," Franzen said. "That's the real 'value-add.' "
But the practice also illustrates how electronic data gathered for one purpose can be used and marketed for another -- often without consumers' knowledge, privacy advocates say. And they argue that although consumers sign consent forms, they effectively have to authorize the data release if they want insurance.
"As health care moves into the digital age, there are more and more companies holding vast amounts of patients' health information," said Joy Pritts, research professor at Georgetown University's Health Policy Institute. "Most people don't even know these organizations exist. Unfortunately the federal health privacy rule does not cover many of them. . . . The lack of transparency with how all of this works is disturbing."
Ingenix and Milliman create the profiles by plumbing rich databases of prescription drug histories kept by pharmacy benefit managers (PBMs), which help insurers process drug claims. Ingenix, for instance, has servers in the PBM data centers, updating the drug files as frequently as once a day, said John Stenson, senior vice president of consulting for Ingenix, which is a division of UnitedHealth Group. The corporation also owns UnitedHealthcare, the nation's second-largest insurer.
When an insurer makes an online query about an applicant, Ingenix or Milliman's servers scour the data and within minutes or less return reports to a central server at the company. The server aggregates the information going back as far as five years, including the drugs and dosages prescribed, dates filled and refilled, the therapeutic class and the name and address of the prescribing doctor.
Then comes the analysis.
Ingenix's MedPoint tool provides insurers a "pharmacy risk score," or a number that represents an "expected risk" for a group of people, such as 30- to 35-year-old women who have taken prescription drugs, Stenson said. Higher scores imply higher medical costs.
Milliman's IntelliScript codes drugs red, yellow or green, according to the insurer's instructions, with red signaling the greatest risk, Franzen said. Red codes could include the so-called AIDS cocktail drugs and cancer medications, he said.
The companies receive data only on individuals who are in clients in PBMs' databases, generally excluding, say, people who pay for drugs in cash. The profiles cost insurers about $15 a search. IntelliScript gets about 1 million queries from insurers a year, largely individual health insurers.
The system can save money for insurers, said Richard Dick, an entrepreneur who built the database system that Ingenix acquired in 2002.
For instance, if MedPoint produces a report that an individual has been on the highest dose of the cholesterol-reducing drug Zocor for 18 monts, the insurer "would be able to know that you have a very high, near-intractable cholesterol problem," Dick said, and could avoid a costly blood test.
From a business standpoint, it makes no sense for an insurer to sell a plan with a $200 monthly premium if the company knows that the consumer is taking medications that cost $400 every six months, industry experts said. That is why having access to an "objective" source of third-party information is valuable, said Tia Goss Sawhney, a Chicago area health insurance actuary who has used both companies' tools. "Though most people tell the truth most of the time, there are people out there who don't, who leave out something that's incredibly relevant, who may even be able to defraud a company," she said. "That's important because ultimately the people who tell the truth have to pay for those who don't."
Franzen, whose firm expects revenue of $575 million this year, said his clients tell him that about 10 percent of applicants do not disclose pertinent medical conditions in their applications that are later revealed by prescription drug history.
Some health experts worry that insurance companies can make faulty assumptions by looking at prescription drug records, because many drugs have multiple uses.
"I had a patient on Amitriptyline for migraines and they were denied life insurance because it's also an antidepressant," said physician Kate Atkinson of Amherst, Mass. "I had to explain it wasn't being used for depression." Another patient was on Prozac -- not for depression, but for menopausal hot flashes. "I wrote an appeal letter, and they still wouldn't give it to her," Atkinson said.
The field is growing rapidly. Realtime Solutions Group, a company in Woodridge, Ill., is testing whether lab data can be aggregated with prescription and other data for underwriting purposes. The firm is working with two major commercial labs and three large insurers, using thousands of real applicants. Initial results are promising enough that the company plans to proceed to the data-analysis stage, company co-founder Tedd Determan said.
Services such as MedPoint are just "one of many tools" underwriters use to make coverage decisions, said Tyler Mason, a spokesman for UnitedHealthcare, which uses MedPoint. A high-risk score on a profile will often lead to requests for more information from the applicant, he said.
Ingenix and Milliman officials stress that they provide data only with the patient's consent, as required by the Health Insurance Portability and Accountability Act (HIPAA), a 1996 law that governs personal health records information. But HIPAA does not give the Department of Health and Human Services the ability to directly investigate or hold accountable entities, such as pharmacy benefit managers or companies such as Ingenix and Milliman, who are not covered by HIPAA.
A health privacy proposal pending in Congress would expand federal officials' ability to regulate such "downstream" organizations, audit their activities and impose civil fines. The bill also includes a prohibition on the sale of electronic medical records.
Tim Sparapani, senior legislative counsel at the American Civil Liberties Union, said that the products that Ingenix and Milliman are marketing represent the "commodification" of electronic medical records by third parties. "We've got to stop these practices before the marketplace is fully developed and patients lose all control over their medical information," he said.
The field is growing rapidly. Realtime Solutions Group, a company in Woodridge, Ill., is testing whether lab data can be aggregated with prescription and other data for underwriting purposes. The firm is working with two major commercial labs and three large insurers, using thousands of real applicants. Initial results are promising enough that the company plans to proceed to the data-analysis stage, company co-founder Tedd Determan said.
"A lot of insurance companies are starting to use this type of data," said Determan, who co-founded IntelRx, a company that mined prescription databases and was sold to Milliman in 2005. "They said, 'All right. Prescription data is working, let's go and look at other types of data, too.' It's because of the success of one, that we're going after others."
In February, the Federal Trade Commission issued an order saying that MedPoint and IntelliScript are consumer reports under the Fair Credit Reporting Act, so the companies must notify insurers that consumers denied insurance on the basis of these reports have the right to request a copy of the report and that errors be corrected. The FTC's order followed a settlement of allegations that the companies violated the credit-reporting law by failing to provide such notice to insurers.
Bob Gellman, an independent privacy consultant in Washington, said the FTC's decision not to fine the companies sends "the message that it is okay to ignore the law." That, he said, "is absolutely outrageous."
As more health records become electronic, he said, more parties will compete to sell more comprehensive patient data to insurers, driving down data prices. "It will all likely be lawful," Gellman said, "but consumers will likely continue to have no real meaningful choices if they want insurance."
Dick, who conceived the idea of linking the pharmacy databases for underwriting purposes a decade ago, said the pharmacy benefit managers understood the system's privacy implications. He said their attitude seemed one of, " 'Ooh, this is a 60 Minutes' story in the making.' Generally, they wanted to make it a super-secret database, restricted to underwriting."
But now, he said, "there's a huge case for it being opened up for all legitimate access," whether for a patient in an emergency room or for federal government purposes. The key, he said, is full transparency.
He said he has created a privacy tool that requires users to consent before specific data, such as prescription histories, can be released. To work, he said, the tool must be independent of all who hold the data.
"Otherwise," he said, "you have the fox in charge of the henhouse."
Staff researcher Magda Jean-Louis
Read more in the Washington Post
Wednesday, July 16, 2008
More Republicans Defect on Medicare Veto Override
By Ben Persing - Capitol Briefings - Tuesday, July 15, 2008
UPDATE 7:05 PM: The Senate has now also voted to override the veto, 70-26. Four Republicans switched from voting against the measure previously to voting in favor of the override today: Kit Bond (Mo.), Thad Cochran (Miss.), Roger Wicker (Miss.) and Richard Lugar (Ind.).
The House had voted to override President Bush's veto of a bill to block cuts in payments to doctors under Medicare, and the caravan of Republicans moving away from the president on the issue turned into a stampede.
The chamber voted 383-41 to override the veto, with 153 Republicans joining all 230 Democrats present to vote "aye." That's an increase of 24 Republicans in favor since the bill's original passage last month. The administration and GOP leaders did their best in both the House and Senate to prevent the measure from passing the first time around, urging their members to vote "no" so they could try to negotiate a better bill, but many rank-and-file Republicans didn't listen. Even more ignored Bush's wishes today.
The Senate vote to override is scheduled to happen within the hour.
Read more in the Federal Insider
UPDATE 7:05 PM: The Senate has now also voted to override the veto, 70-26. Four Republicans switched from voting against the measure previously to voting in favor of the override today: Kit Bond (Mo.), Thad Cochran (Miss.), Roger Wicker (Miss.) and Richard Lugar (Ind.).
The House had voted to override President Bush's veto of a bill to block cuts in payments to doctors under Medicare, and the caravan of Republicans moving away from the president on the issue turned into a stampede.
The chamber voted 383-41 to override the veto, with 153 Republicans joining all 230 Democrats present to vote "aye." That's an increase of 24 Republicans in favor since the bill's original passage last month. The administration and GOP leaders did their best in both the House and Senate to prevent the measure from passing the first time around, urging their members to vote "no" so they could try to negotiate a better bill, but many rank-and-file Republicans didn't listen. Even more ignored Bush's wishes today.
The Senate vote to override is scheduled to happen within the hour.
Read more in the Federal Insider
Medicare Advantage: Congress rightly overrides President Bush's veto of a bill that levels the playing field between health-care providers
By Washington Post - Wed., July 16, 2008
WHY DID President Bush veto the Medicare bill, only to be swiftly overridden by both houses of Congress? It's not because he disagrees with the fundamental purpose, to reverse a 10.6 percent cut in Medicare payments to doctors. The administration's main beef is paying the cost, $13.8 billion over five years, by reducing projected payments to Medicare Advantage plans. These are the private plans -- HMOs or preferred-provider networks -- set up to compete with traditional fee-for-service Medicare, in which seniors go to doctors of their choice who accept Medicare reimbursements.
Medicare Advantage plans, which currently enroll about 20 percent of Medicare beneficiaries, could be a cost-effective alternative to traditional Medicare. The problem is that these plans now enjoy an undue advantage: They are paid, on average, 13 percent more per beneficiary than traditional Medicare costs. Numerous experts have recommended leveling the playing field between private plans and traditional Medicare. The legislation takes a few small, sensible steps in that direction.
How small? The savings from Medicare Advantage plans would amount to less than 2 percent of the money the government is projected to spend on them in the next five years. The Congressional Budget Office projects that enrollment in Medicare Advantage plans would still grow by 25 percent over that period. The changes would eliminate double payments for educational activities (since the plans don't engage in these) and impose new requirements on so-called private fee-for-service plans, which operate much like traditional Medicare but end up costing more.
The president said he vetoed the bill because "taking choices away from seniors to pay physicians is wrong." But no choices are taken away. The changes in the costly private fee-for-service plans, for instance, apply only in areas where at least two other Medicare Advantage plans are operating. Enrollment in these plans is projected to grow 39 percent by 2013 under the new rules. The CBO estimates only that the slightly more level playing field would result in about 2 million fewer seniors choosing the private plans than would have otherwise. It's telling that not even lawmakers of his own party were cowed by the president's effort to scare seniors.
Read more in the Washington Post
WHY DID President Bush veto the Medicare bill, only to be swiftly overridden by both houses of Congress? It's not because he disagrees with the fundamental purpose, to reverse a 10.6 percent cut in Medicare payments to doctors. The administration's main beef is paying the cost, $13.8 billion over five years, by reducing projected payments to Medicare Advantage plans. These are the private plans -- HMOs or preferred-provider networks -- set up to compete with traditional fee-for-service Medicare, in which seniors go to doctors of their choice who accept Medicare reimbursements.
Medicare Advantage plans, which currently enroll about 20 percent of Medicare beneficiaries, could be a cost-effective alternative to traditional Medicare. The problem is that these plans now enjoy an undue advantage: They are paid, on average, 13 percent more per beneficiary than traditional Medicare costs. Numerous experts have recommended leveling the playing field between private plans and traditional Medicare. The legislation takes a few small, sensible steps in that direction.
How small? The savings from Medicare Advantage plans would amount to less than 2 percent of the money the government is projected to spend on them in the next five years. The Congressional Budget Office projects that enrollment in Medicare Advantage plans would still grow by 25 percent over that period. The changes would eliminate double payments for educational activities (since the plans don't engage in these) and impose new requirements on so-called private fee-for-service plans, which operate much like traditional Medicare but end up costing more.
The president said he vetoed the bill because "taking choices away from seniors to pay physicians is wrong." But no choices are taken away. The changes in the costly private fee-for-service plans, for instance, apply only in areas where at least two other Medicare Advantage plans are operating. Enrollment in these plans is projected to grow 39 percent by 2013 under the new rules. The CBO estimates only that the slightly more level playing field would result in about 2 million fewer seniors choosing the private plans than would have otherwise. It's telling that not even lawmakers of his own party were cowed by the president's effort to scare seniors.
Read more in the Washington Post
Monday, July 14, 2008
Fibromyalgia: Little understood, often frustrating
By Judy Fortin - CNN Medical Correspondent - Monday, July 14, 2008
ATLANTA, Georgia (CNN) -- You wouldn't know it by looking at her, but at any given moment Dana Poole hurts all over.
"It's kind of like a burning, but an ache. It's almost like you have the flu," said Poole, 31, a receptionist from Canton, Georgia.
Poole is one of almost 6 million Americans who suffer from a chronic condition called fibromyalgia.
In addition to widespread pain, patients may complain about fatigue and sleep disturbances, depression, headaches, irritable bowel syndrome and heightened sensitivity.
"Dana is typical of a lot of fibromyalgia patients," said Dr. Jefrey Lieberman, an Atlanta, Georgia-based rheumatologist. "She came into my office complaining of a lot of diffuse pain all over her body and fatigue. She really didn't know why she was getting it."
That's part of the frustration of having fibromyalgia. Experts aren't sure what causes it, but many believe many factors are involved.
Some think the condition, which is not progressive or life-threatening, may be triggered by an emotional or traumatic event.
Lieberman believed it is related to a disordered sleep pattern and poor exercise. "It appears to be more of a neuro-chemical process," he said. "In other words, there really is no inflammation in patients with fibromyalgia." Health Minute: More on identifying fibromyalgia »
Getting a proper diagnosis can sometimes be just as frustrating as finding out what's behind the disease.
"Fibromyalgia is to some extent a diagnosis of exclusion," Lieberman said. "There are lot of things it can be confused with such as thyroid disorders, metabolic disorders and certain rheumatologic inflammatory conditions."
For almost five years, Poole jumped from doctor to doctor trying to figure out what was causing her symptoms. "They were constantly saying I'm a tall, thin female. 'You're getting older -- your body is going to change,' and it was frustrating."
Lieberman understood Poole's frustration. "Sometimes fibromyalgia is used as a wastebasket term if a patient has pain and they don't know what it is from," he said. "It is frequently misdiagnosed. In fact, it is overdiagnosed and it is underdiagnosed."
Specialists such as Lieberman can make a proper diagnosis based on criteria set by the American College of Rheumatology.
"Those criteria are diffuse pain in three or more quadrants of the body and the presence of what are called tender points in the body," Lieberman explained. "There are 18 total tender points, and by definition we like to see 11 of those tender points being present."
It's estimated that up to 90 percent of patients are women. Most of them start feeling symptoms in early and middle adulthood.
Poole remembered that the pain first started when she was 20. It wasn't until she met Lieberman about five years ago that she got some relief.
She took part in a drug study for Cymbalta, one of two medications approved for the management of fibromyalgia. The other drug is called Lyrica.
"Both of them are geared toward the patient's well-being as well as improving their pain," Lieberman said.
He also encouraged Poole to control her condition through a healthy diet, stress reduction, getting enough sleep and regular low-impact exercise.
"We think that aerobic exercise helps to stimulate endorphins and enkephlins from the body which are your own natural pain relievers," Lieberman said.
The doctor is quick to point out that even with proper medication and adequate exercise, fibromyalgia has no cure.
Although Lieberman said some of his patients report the symptoms tapering off in their mid-50s and -60s, others are faced with years of managing the condition.
"For most of my patients, I tell them that I can get you 50 to 75 percent better and many of those patients will jump at that," he said.
Poole is one of them, but knowing that she'll need to follow a careful daily regimen can be daunting, she said. "It wears you out, mentally, physically and emotionally."
READ MORE ON CNN
ATLANTA, Georgia (CNN) -- You wouldn't know it by looking at her, but at any given moment Dana Poole hurts all over.
"It's kind of like a burning, but an ache. It's almost like you have the flu," said Poole, 31, a receptionist from Canton, Georgia.
Poole is one of almost 6 million Americans who suffer from a chronic condition called fibromyalgia.
In addition to widespread pain, patients may complain about fatigue and sleep disturbances, depression, headaches, irritable bowel syndrome and heightened sensitivity.
"Dana is typical of a lot of fibromyalgia patients," said Dr. Jefrey Lieberman, an Atlanta, Georgia-based rheumatologist. "She came into my office complaining of a lot of diffuse pain all over her body and fatigue. She really didn't know why she was getting it."
That's part of the frustration of having fibromyalgia. Experts aren't sure what causes it, but many believe many factors are involved.
Some think the condition, which is not progressive or life-threatening, may be triggered by an emotional or traumatic event.
Lieberman believed it is related to a disordered sleep pattern and poor exercise. "It appears to be more of a neuro-chemical process," he said. "In other words, there really is no inflammation in patients with fibromyalgia." Health Minute: More on identifying fibromyalgia »
Getting a proper diagnosis can sometimes be just as frustrating as finding out what's behind the disease.
"Fibromyalgia is to some extent a diagnosis of exclusion," Lieberman said. "There are lot of things it can be confused with such as thyroid disorders, metabolic disorders and certain rheumatologic inflammatory conditions."
For almost five years, Poole jumped from doctor to doctor trying to figure out what was causing her symptoms. "They were constantly saying I'm a tall, thin female. 'You're getting older -- your body is going to change,' and it was frustrating."
Lieberman understood Poole's frustration. "Sometimes fibromyalgia is used as a wastebasket term if a patient has pain and they don't know what it is from," he said. "It is frequently misdiagnosed. In fact, it is overdiagnosed and it is underdiagnosed."
Specialists such as Lieberman can make a proper diagnosis based on criteria set by the American College of Rheumatology.
"Those criteria are diffuse pain in three or more quadrants of the body and the presence of what are called tender points in the body," Lieberman explained. "There are 18 total tender points, and by definition we like to see 11 of those tender points being present."
It's estimated that up to 90 percent of patients are women. Most of them start feeling symptoms in early and middle adulthood.
Poole remembered that the pain first started when she was 20. It wasn't until she met Lieberman about five years ago that she got some relief.
She took part in a drug study for Cymbalta, one of two medications approved for the management of fibromyalgia. The other drug is called Lyrica.
"Both of them are geared toward the patient's well-being as well as improving their pain," Lieberman said.
He also encouraged Poole to control her condition through a healthy diet, stress reduction, getting enough sleep and regular low-impact exercise.
"We think that aerobic exercise helps to stimulate endorphins and enkephlins from the body which are your own natural pain relievers," Lieberman said.
The doctor is quick to point out that even with proper medication and adequate exercise, fibromyalgia has no cure.
Although Lieberman said some of his patients report the symptoms tapering off in their mid-50s and -60s, others are faced with years of managing the condition.
"For most of my patients, I tell them that I can get you 50 to 75 percent better and many of those patients will jump at that," he said.
Poole is one of them, but knowing that she'll need to follow a careful daily regimen can be daunting, she said. "It wears you out, mentally, physically and emotionally."
READ MORE ON CNN
Tuesday, June 3, 2008
Study Finds State Gains in Insurance
By KEVIN SACK - The New York Times - June 3, 2008
Massachusetts reduced its proportion of uninsured adults by nearly half in the first year of mandatory health coverage and made gains in the share of people receiving routine preventive care, according to the first major study of the 2006 law.
The decline in the share of residents without insurance was nearly equivalent for those with low or moderate incomes and those with higher incomes.
The study, conducted by the Urban Institute and scheduled for online publication Tuesday by the journal Health Affairs, found no evidence that residents were dropping private health coverage to take advantage of state-subsidized policies, or that employers viewed the availability of new public programs as a reason to eliminate health benefits.
“The entire increase in coverage appears to have been drawn from the ranks of the uninsured, because there is no evidence that publicly funded programs are crowding out employer coverage,” wrote the study’s author, Sharon K. Long, a principal research associate with the Urban Institute, a nonpartisan research group in Washington.
Indeed, contrary to national trends, the share of residents receiving insurance through their employers increased in Massachusetts by nearly three percentage points from fall 2006 to fall 2007. Nationally, the percentages of employers that offer benefits and of workers who receive them have been sliding steadily throughout the decade.
Undercutting the positive trends for Massachusetts are signs that the state’s supply of primary care physicians is not sufficient to handle the increased demand created by newly insured residents. Though there were overall declines in the percentage of residents who said they were not receiving needed care, the study showed increases in the share who said they did not get care because they could not find a doctor.
That finding may support anecdotal reports from internists and family practitioners that they have been stretched by an influx of newly insured patients, causing long delays for some appointments. The study actually found a slight increase in the share of low-income residents who sought treatment in hospital emergency rooms for conditions that were not urgent.
“It would appear that there are opportunities to improve access to community-based care,” Ms. Long wrote.
Jon M. Kingsdale, director of the state authority that oversees the health plan, questioned whether the unmet demand for primary care was more severe in Massachusetts than elsewhere. Regarding emergency room use, he said the state was sometimes finding it easier to enroll the uninsured than to break their longstanding links to local hospitals.
“We’ve clearly identified that as behavior that has to be changed,” Mr. Kingsdale said.
The Massachusetts law, which took effect last year, made the state the largest to strive for universal coverage and a laboratory for federal policies proposed by Democratic presidential candidates. Senator Hillary Rodham Clinton has proposed mandatory coverage for all Americans, similar to the Massachusetts plan, while Senator Barack Obama would require coverage only for children, promising to make premiums affordable enough for adults that no mandate would be necessary.
Massachusetts residents were required to obtain insurance beginning in 2007, and state subsidies were provided on a sliding scale to make policies affordable for low-income residents. The 86,000 residents who did not comply faced modest first-year tax penalties of $219. The penalties will stiffen this year.
Mr. Kingsdale said that more than 350,000 of the estimated 600,000 residents who were uninsured before the program began had since gained coverage. Exemptions were granted to about 60,000 people who demonstrated that they could not afford even subsidized insurance. Enrollment in the subsidized plans has exceeded projections, and lawmakers and Gov. Deval Patrick, a Democrat, are negotiating a tobacco-tax increase to help sustain the program.
The Urban Institute survey found that 7 percent of Massachusetts adults ages 18 to 64 remained uninsured in the fall of 2007, compared with 13 percent in 2006. Those still uninsured are largely male, low-income and healthy, and a third of them said they did not know health insurance was now mandatory.
For adults with family incomes of less than three times the federal poverty level, or $66,600 for a family of four, the uninsured dropped to 13 percent from 24 percent. For those earning more, the rate dropped to 3 percent from 5 percent.
Among the lower-income group, 70 percent said they had received preventive care in the previous year, compared with 65 percent who said they had in 2006. Fifty-nine percent said they had visited a dentist in the past year, compared with 49 percent in 2006. There was a drop of 10 percentage points in the share who said they had deferred needed care in the past year because of cost, to 17 percent from 27 percent.
Massachusetts reduced its proportion of uninsured adults by nearly half in the first year of mandatory health coverage and made gains in the share of people receiving routine preventive care, according to the first major study of the 2006 law.
The decline in the share of residents without insurance was nearly equivalent for those with low or moderate incomes and those with higher incomes.
The study, conducted by the Urban Institute and scheduled for online publication Tuesday by the journal Health Affairs, found no evidence that residents were dropping private health coverage to take advantage of state-subsidized policies, or that employers viewed the availability of new public programs as a reason to eliminate health benefits.
“The entire increase in coverage appears to have been drawn from the ranks of the uninsured, because there is no evidence that publicly funded programs are crowding out employer coverage,” wrote the study’s author, Sharon K. Long, a principal research associate with the Urban Institute, a nonpartisan research group in Washington.
Indeed, contrary to national trends, the share of residents receiving insurance through their employers increased in Massachusetts by nearly three percentage points from fall 2006 to fall 2007. Nationally, the percentages of employers that offer benefits and of workers who receive them have been sliding steadily throughout the decade.
Undercutting the positive trends for Massachusetts are signs that the state’s supply of primary care physicians is not sufficient to handle the increased demand created by newly insured residents. Though there were overall declines in the percentage of residents who said they were not receiving needed care, the study showed increases in the share who said they did not get care because they could not find a doctor.
That finding may support anecdotal reports from internists and family practitioners that they have been stretched by an influx of newly insured patients, causing long delays for some appointments. The study actually found a slight increase in the share of low-income residents who sought treatment in hospital emergency rooms for conditions that were not urgent.
“It would appear that there are opportunities to improve access to community-based care,” Ms. Long wrote.
Jon M. Kingsdale, director of the state authority that oversees the health plan, questioned whether the unmet demand for primary care was more severe in Massachusetts than elsewhere. Regarding emergency room use, he said the state was sometimes finding it easier to enroll the uninsured than to break their longstanding links to local hospitals.
“We’ve clearly identified that as behavior that has to be changed,” Mr. Kingsdale said.
The Massachusetts law, which took effect last year, made the state the largest to strive for universal coverage and a laboratory for federal policies proposed by Democratic presidential candidates. Senator Hillary Rodham Clinton has proposed mandatory coverage for all Americans, similar to the Massachusetts plan, while Senator Barack Obama would require coverage only for children, promising to make premiums affordable enough for adults that no mandate would be necessary.
Massachusetts residents were required to obtain insurance beginning in 2007, and state subsidies were provided on a sliding scale to make policies affordable for low-income residents. The 86,000 residents who did not comply faced modest first-year tax penalties of $219. The penalties will stiffen this year.
Mr. Kingsdale said that more than 350,000 of the estimated 600,000 residents who were uninsured before the program began had since gained coverage. Exemptions were granted to about 60,000 people who demonstrated that they could not afford even subsidized insurance. Enrollment in the subsidized plans has exceeded projections, and lawmakers and Gov. Deval Patrick, a Democrat, are negotiating a tobacco-tax increase to help sustain the program.
The Urban Institute survey found that 7 percent of Massachusetts adults ages 18 to 64 remained uninsured in the fall of 2007, compared with 13 percent in 2006. Those still uninsured are largely male, low-income and healthy, and a third of them said they did not know health insurance was now mandatory.
For adults with family incomes of less than three times the federal poverty level, or $66,600 for a family of four, the uninsured dropped to 13 percent from 24 percent. For those earning more, the rate dropped to 3 percent from 5 percent.
Among the lower-income group, 70 percent said they had received preventive care in the previous year, compared with 65 percent who said they had in 2006. Fifty-nine percent said they had visited a dentist in the past year, compared with 49 percent in 2006. There was a drop of 10 percentage points in the share who said they had deferred needed care in the past year because of cost, to 17 percent from 27 percent.
Sunday, June 1, 2008
Texas advisory panel calls for state oversight of PPO health insurance plans
By TERRENCE STUTZ - The Dallas Morning News - Wednesday, May 21, 2008
AUSTIN – A state commission, citing the fact that four out of five insured Texans now receive health care through preferred provider organizations, urged the Legislature on Wednesday to protect consumers by placing all PPOs under state regulation for the first time.
The staff of the Texas Sunset Advisory Commission said the lack of state authority over PPOs is "outdated" in the current health care environment and may result in harm to a large number of consumers if the situation remains unchanged.
A report from the commission on the Texas Department of Insurance called for the state agency to begin licensing of all PPOs in the state similar to the way HMOs are now regulated. The commission periodically evaluates all state agencies for effectiveness and recommends changes to the Legislature.
In addition, the Sunset Commission staff recommended that the Office of Public Insurance Counsel – a state agency that represents insurance consumers – be abolished and its employees and duties into the shifted into the insurance department.
It also called for changes in state regulation of auto and home insurance rates that Sunset Commission staffers said would improve the current system for setting rates. Under the current system, called "file-and-use," insurers can put rate hikes into effect immediately after notifying the state Insurance Department.
The insurance commissioner has authority deem rate increases as excessive and to deny them, but in recent years that authority mainly has been used against the largest companies in the state.
AUSTIN – A state commission, citing the fact that four out of five insured Texans now receive health care through preferred provider organizations, urged the Legislature on Wednesday to protect consumers by placing all PPOs under state regulation for the first time.
The staff of the Texas Sunset Advisory Commission said the lack of state authority over PPOs is "outdated" in the current health care environment and may result in harm to a large number of consumers if the situation remains unchanged.
A report from the commission on the Texas Department of Insurance called for the state agency to begin licensing of all PPOs in the state similar to the way HMOs are now regulated. The commission periodically evaluates all state agencies for effectiveness and recommends changes to the Legislature.
In addition, the Sunset Commission staff recommended that the Office of Public Insurance Counsel – a state agency that represents insurance consumers – be abolished and its employees and duties into the shifted into the insurance department.
It also called for changes in state regulation of auto and home insurance rates that Sunset Commission staffers said would improve the current system for setting rates. Under the current system, called "file-and-use," insurers can put rate hikes into effect immediately after notifying the state Insurance Department.
The insurance commissioner has authority deem rate increases as excessive and to deny them, but in recent years that authority mainly has been used against the largest companies in the state.
Wednesday, May 28, 2008
Justices Say Law Bars Retaliation Over Bias Claims
By LINDA GREENHOUSE - The New York Times - Published: May 28, 2008
WASHINGTON — The Supreme Court on Tuesday ruled that employees are protected from retaliation when they complain about discrimination in the workplace, adopting a broad interpretation of workers’ rights under two federal civil rights laws.
By decisions of 7 to 2 in one case and 6 to 3 in the other, the court found that the two statutes afford protection from retaliation even though Congress did not explicitly say so.
The decisions are significant both as a practical matter and as evidence of a new tone and direction from the court this year, following a term in which there were sharp divisions and an abrupt conservative turn.
The new rulings were in distinct contrast to one of the signature decisions of the last term, a 5-to-4 decision that placed tight time limits on plaintiffs seeking to file pay-discrimination cases. Justice Samuel A. Alito Jr., who wrote the majority opinion almost exactly a year ago in that case, Ledbetter v. Goodyear Tire and Rubber Company, wrote one of the two majority opinions on Tuesday. Justice Stephen G. Breyer wrote the other.
One of the cases began as a lawsuit by a clerk for the United States Postal Service in Puerto Rico. The plaintiff, Myrna Gómez-Pérez, 45 at the time, complained that she had been denied a transfer to a different office because of age discrimination. Her lawsuit alleged that as a result of her complaint, she became the target of retaliatory actions by her supervisors.
The other case was brought by a former assistant manager of a Cracker Barrel restaurant, a black man named Hedrick G. Humphries. Mr. Humphries had complained that a white assistant manager had been motivated by racial discrimination in dismissing a black employee. In his lawsuit, Mr. Humphries claimed that he then lost his own job in retaliation for his complaint.
Retaliation complaints are a growing subset of workplace discrimination cases, because it is often easier for employees to demonstrate that they were retaliated against than that they were victims of discrimination in the first place. Retaliation complaints filed annually with the Equal Employment Opportunity Commission doubled in the last 15 years to 22,000 from 11,000.
Congress has provided explicit protection against retaliation in two major federal statutes. One is Title VII of the Civil Rights Act of 1964, which prohibits employment discrimination on the basis of race and sex. The other is the provision of the Age Discrimination in Employment Act that applies in the private sector.
However, there is no such explicit protection in the portion of the age-discrimination law that applies to federal government workers. Nor is there explicit language in a post-Civil War-era statute that gives “all persons” the same right “as is enjoyed by white citizens” when it comes to making and enforcing contracts, such as contracts of employment. Those were the two statutes that the court interpreted on Tuesday.
In both decisions, the majority relied heavily on precedent, reasoning by analogy from recent cases that dealt with claims of retaliation under other statutes. The most recent such case was a ruling issued in 2005, before either Justice Alito or Chief Justice John G. Roberts Jr. joined the court. By a vote of 5 to 4, the court held then that a law known as Title IX, which bars sex discrimination in schools and colleges that receive federal money, also prohibits school officials from retaliating against those who bring sex-discrimination complaints. The statute itself does not mention retaliation.
In his opinion on Tuesday in the federal age-discrimination case, Justice Alito said that the provision in question, broadly prohibiting “discrimination based on age,” was “not materially different” from the anti-discrimination language the court had interpreted both in the Title IX case and in an earlier decision from 1969, interpreting a Reconstruction-era statute that bars racial discrimination in property ownership.
“The context in which the statutory language appears is the same in all three cases,” Justice Alito said. “That is, all three cases involve remedial provisions aimed at prohibiting discrimination.”
In the Postal Service case, Gómez-Pérez v. Potter, No. 06-1321, the federal appeals court in Boston, which has jurisdiction over federal cases from Puerto Rico, dismissed the suit on the ground that the age-discrimination provision that applies to federal workers does not cover retaliation claims.
In his opinion, which overturned the appeals court and reinstated the lawsuit, Justice Alito said that understood in the context of its enactment, the provision did cover retaliation. He noted that while the basic age-discrimination law was passed in 1967, it was not extended to federal workers until 1974.
In the interval, the Supreme Court had issued its decision deeming that the 19th-century property-rights law covered retaliation. Congress was “presumably familiar” with that case, Justice Alito said, and “had reason to expect” that the new age-discrimination provision would be interpreted with similar breadth.
In a dissenting opinion, Chief Justice Roberts said that, to the contrary, Congress was “well aware” that the Civil Service Commission had issued detailed regulations protecting federal employees against retaliation. The chief justice said that Congress should be understood to have made a judgment that retaliation problems in the federal work force should be dealt with administratively rather than judicially.
Justices Antonin Scalia and Clarence Thomas joined the dissenting opinion.
These two justices were the only dissenters in Mr. Humphries’s case, CBOCS West, Inc. v. Humphries, No. 06-1431, which held that Congress intended to cover retaliation claims brought under the provision of the Civil Rights Act of 1866 that is usually referred to as Section 1981. The court upheld a ruling by the federal appeals court in Chicago, rejecting an appeal brought by the company that operates the Cracker Barrel restaurant chain.
The Supreme Court’s decision last September to hear the company’s appeal was a surprise, because all the federal appeals courts that had weighed in on the question interpreted Section 1981 as covering retaliation. Resolving disputes among the lower federal courts is the Supreme Court’s main reason for accepting a case. The decision to grant this case in the absence of such a dispute spread alarm throughout the civil rights community on the assumption that a majority was prepared to shut the door on retaliation claims.
There was ample reason for that assumption, since Chief Justice Roberts had earlier made clear his distaste for precedents in which the court has gone beyond a statute’s text to infer a basis for a lawsuit.
It was especially significant, therefore, that both he and Justice Alito signed on to Justice Breyer’s discussion of the importance of “stare decisis,” the court’s doctrine of adherence to precedent. Even if the court’s approach to statutory interpretation was changing, Justice Breyer wrote, “we could not agree that the existence of such a change would justify re-examination of well-established prior law.”
He added: “Principles of stare decisis, after all, demand respect for precedent whether judicial methods of interpretation change or stay the same. Were that not so, those principles would fail to achieve the legal stability that they seek and upon which the rule of law depends.”
In a dissenting opinion, Justice Thomas, joined by Justice Scalia, accused the majority of hiding behind “the fig leaf of ersatz stare decisis,” relying on precedents that had been incorrectly decided in the first place.
See Text Opinion: Gomez -Perez v. Potter and CBOCS West, Inc. v. Humphries
WASHINGTON — The Supreme Court on Tuesday ruled that employees are protected from retaliation when they complain about discrimination in the workplace, adopting a broad interpretation of workers’ rights under two federal civil rights laws.
By decisions of 7 to 2 in one case and 6 to 3 in the other, the court found that the two statutes afford protection from retaliation even though Congress did not explicitly say so.
The decisions are significant both as a practical matter and as evidence of a new tone and direction from the court this year, following a term in which there were sharp divisions and an abrupt conservative turn.
The new rulings were in distinct contrast to one of the signature decisions of the last term, a 5-to-4 decision that placed tight time limits on plaintiffs seeking to file pay-discrimination cases. Justice Samuel A. Alito Jr., who wrote the majority opinion almost exactly a year ago in that case, Ledbetter v. Goodyear Tire and Rubber Company, wrote one of the two majority opinions on Tuesday. Justice Stephen G. Breyer wrote the other.
One of the cases began as a lawsuit by a clerk for the United States Postal Service in Puerto Rico. The plaintiff, Myrna Gómez-Pérez, 45 at the time, complained that she had been denied a transfer to a different office because of age discrimination. Her lawsuit alleged that as a result of her complaint, she became the target of retaliatory actions by her supervisors.
The other case was brought by a former assistant manager of a Cracker Barrel restaurant, a black man named Hedrick G. Humphries. Mr. Humphries had complained that a white assistant manager had been motivated by racial discrimination in dismissing a black employee. In his lawsuit, Mr. Humphries claimed that he then lost his own job in retaliation for his complaint.
Retaliation complaints are a growing subset of workplace discrimination cases, because it is often easier for employees to demonstrate that they were retaliated against than that they were victims of discrimination in the first place. Retaliation complaints filed annually with the Equal Employment Opportunity Commission doubled in the last 15 years to 22,000 from 11,000.
Congress has provided explicit protection against retaliation in two major federal statutes. One is Title VII of the Civil Rights Act of 1964, which prohibits employment discrimination on the basis of race and sex. The other is the provision of the Age Discrimination in Employment Act that applies in the private sector.
However, there is no such explicit protection in the portion of the age-discrimination law that applies to federal government workers. Nor is there explicit language in a post-Civil War-era statute that gives “all persons” the same right “as is enjoyed by white citizens” when it comes to making and enforcing contracts, such as contracts of employment. Those were the two statutes that the court interpreted on Tuesday.
In both decisions, the majority relied heavily on precedent, reasoning by analogy from recent cases that dealt with claims of retaliation under other statutes. The most recent such case was a ruling issued in 2005, before either Justice Alito or Chief Justice John G. Roberts Jr. joined the court. By a vote of 5 to 4, the court held then that a law known as Title IX, which bars sex discrimination in schools and colleges that receive federal money, also prohibits school officials from retaliating against those who bring sex-discrimination complaints. The statute itself does not mention retaliation.
In his opinion on Tuesday in the federal age-discrimination case, Justice Alito said that the provision in question, broadly prohibiting “discrimination based on age,” was “not materially different” from the anti-discrimination language the court had interpreted both in the Title IX case and in an earlier decision from 1969, interpreting a Reconstruction-era statute that bars racial discrimination in property ownership.
“The context in which the statutory language appears is the same in all three cases,” Justice Alito said. “That is, all three cases involve remedial provisions aimed at prohibiting discrimination.”
In the Postal Service case, Gómez-Pérez v. Potter, No. 06-1321, the federal appeals court in Boston, which has jurisdiction over federal cases from Puerto Rico, dismissed the suit on the ground that the age-discrimination provision that applies to federal workers does not cover retaliation claims.
In his opinion, which overturned the appeals court and reinstated the lawsuit, Justice Alito said that understood in the context of its enactment, the provision did cover retaliation. He noted that while the basic age-discrimination law was passed in 1967, it was not extended to federal workers until 1974.
In the interval, the Supreme Court had issued its decision deeming that the 19th-century property-rights law covered retaliation. Congress was “presumably familiar” with that case, Justice Alito said, and “had reason to expect” that the new age-discrimination provision would be interpreted with similar breadth.
In a dissenting opinion, Chief Justice Roberts said that, to the contrary, Congress was “well aware” that the Civil Service Commission had issued detailed regulations protecting federal employees against retaliation. The chief justice said that Congress should be understood to have made a judgment that retaliation problems in the federal work force should be dealt with administratively rather than judicially.
Justices Antonin Scalia and Clarence Thomas joined the dissenting opinion.
These two justices were the only dissenters in Mr. Humphries’s case, CBOCS West, Inc. v. Humphries, No. 06-1431, which held that Congress intended to cover retaliation claims brought under the provision of the Civil Rights Act of 1866 that is usually referred to as Section 1981. The court upheld a ruling by the federal appeals court in Chicago, rejecting an appeal brought by the company that operates the Cracker Barrel restaurant chain.
The Supreme Court’s decision last September to hear the company’s appeal was a surprise, because all the federal appeals courts that had weighed in on the question interpreted Section 1981 as covering retaliation. Resolving disputes among the lower federal courts is the Supreme Court’s main reason for accepting a case. The decision to grant this case in the absence of such a dispute spread alarm throughout the civil rights community on the assumption that a majority was prepared to shut the door on retaliation claims.
There was ample reason for that assumption, since Chief Justice Roberts had earlier made clear his distaste for precedents in which the court has gone beyond a statute’s text to infer a basis for a lawsuit.
It was especially significant, therefore, that both he and Justice Alito signed on to Justice Breyer’s discussion of the importance of “stare decisis,” the court’s doctrine of adherence to precedent. Even if the court’s approach to statutory interpretation was changing, Justice Breyer wrote, “we could not agree that the existence of such a change would justify re-examination of well-established prior law.”
He added: “Principles of stare decisis, after all, demand respect for precedent whether judicial methods of interpretation change or stay the same. Were that not so, those principles would fail to achieve the legal stability that they seek and upon which the rule of law depends.”
In a dissenting opinion, Justice Thomas, joined by Justice Scalia, accused the majority of hiding behind “the fig leaf of ersatz stare decisis,” relying on precedents that had been incorrectly decided in the first place.
See Text Opinion: Gomez -Perez v. Potter and CBOCS West, Inc. v. Humphries
Tuesday, April 15, 2008
AP Exclusive: Hundreds of employees mistreated Texas patients
By JEFF CARLTON - Associated Press Writer - Tuesday, April 15, 2001
DALLAS -- More than 800 employees at Texas' 13 large facilities for the mentally and developmentally disabled have been suspended or fired for abusing patients since fiscal year 2004, state officials said Tuesday.
In response to an open records request from The Associated Press, the Department of Aging and Disability Services said that 239 employees were fired in fiscal year 2007 for the abuse, neglect or exploitation of residents.
There were 200 such disciplinary actions in 2006, 203 in 2005 and 180 in 2004, according to state records. The breakdown by school was unavailable. The 13 state schools and centers combined have about 12,000 full-time employees.
The revelations come a month after Gov. Rick Perry's office confirmed that the civil rights department at the U.S. Department of Justice is investigating allegations of abuse and neglect at the Denton State School, the state's largest with about 650 residents. It's at least the second such investigation into state facilities, including one at the Lubbock State School in 2006 that revealed widespread abuse.
An advocate for the mentally retarded called the number of employees disciplined "stunning."
"It indicates to me that there is clearly a culture of abuse or neglect in these facilities," said Jeff Garrison-Tate, president of San Antonio-based Community Now.
Texas has 13 large institutions, called state schools or centers, in which nearly 5,000 mentally retarded or mentally ill residents live full-time with round-the-clock care. That's about five times the national average. By comparison, New York and California combined have about 4,600 residents living in 17 institutions, according to data compiled by United Cerebral Palsy.
State records show more than 450 incidents of verified abuse or neglect in fiscal year 2007, a year in which the Texas Department of Family and Protective Services investigated nearly 3,500 allegations at state schools. About 51 percent of the confirmed incidents involved neglect, 31 percent involved physical abuse and 16 percent involved emotional or verbal abuse. Less than one percent of the cases involved sexual abuse.
State officials also acknowledge at least three state school residents have died since 2002 in which abuse or neglect by caretakers was a factor.
Laura Albrecht, a spokeswoman for the Aging and Disability Services office, said the firings and suspensions reflect the state's "strict policy" on abuse and neglect.
"We have gotten even tougher," Albrecht said. "Our employees go through training to recognize abuse and neglect and to report any incidents."
Perry told The AP that the suspensions and firings indicate that state schools are trying to rid themselves of bad employees.
"What I make of it is that the agency is doing its job," Perry said. "If there are individuals who have broken those parameters of employment, they need to be removed, they need to be fired, need to be dealt with."
The Denton facility, where a notorious abuse case occurred in 2002, underwent its most recent comprehensive inspection last April. The school was cited 25 times for failing to meet federal standards.
Citations included:
- Failure to "ensure clients' rights were protected, including the right to be free from abuse, neglect and mistreatment."
- Failure to "have or to use policies and procedures that prohibit mistreatment, neglect or abuse of clients."
- Failure to "have evidence to show that all allegations of abuse, neglect, or mistreatment were thoroughly investigated.
A more recent inspection in January found that the Denton State School "failed to educate direct care staff on basic first aid, health, and emergency needs."
Perry was notified in March that the Justice Department was investigating the Denton school, said Perry spokeswoman Allison Castle. The notification letter, obtained by The AP, said the investigation "will focus on protection of residents from harm; medical and nursing care; habilitation and treatment; and the failure to place residents in the most integrated setting as required by the Americans with Disabilities Act ... ."
"We certainly welcome their findings and the governor wants to ensure all residents of state schools receive the highest quality care," Castle said.
State Rep. John Zerwas, a member of a legislative committee studying state schools, said lawmakers need to look into allegations of abuse coming from the institutions.
"If the state is going to assume some of the responsibility for the ongoing care for these individuals then we have to make sure they be provided the highest quality and the greatest safety," said Zerwas, R-Richmond.
Garrison-Tate said he has personally witnessed incidents of abuse and suspects only the most egregious cases result in firings and suspensions.
"The bottom line is people are getting really injured, and they are not safe," he said.
---
Associated Press reporter Kelley Shannon in Austin contributed to this story.
Read more in the Fort Worth Star Telegram
DALLAS -- More than 800 employees at Texas' 13 large facilities for the mentally and developmentally disabled have been suspended or fired for abusing patients since fiscal year 2004, state officials said Tuesday.
In response to an open records request from The Associated Press, the Department of Aging and Disability Services said that 239 employees were fired in fiscal year 2007 for the abuse, neglect or exploitation of residents.
There were 200 such disciplinary actions in 2006, 203 in 2005 and 180 in 2004, according to state records. The breakdown by school was unavailable. The 13 state schools and centers combined have about 12,000 full-time employees.
The revelations come a month after Gov. Rick Perry's office confirmed that the civil rights department at the U.S. Department of Justice is investigating allegations of abuse and neglect at the Denton State School, the state's largest with about 650 residents. It's at least the second such investigation into state facilities, including one at the Lubbock State School in 2006 that revealed widespread abuse.
An advocate for the mentally retarded called the number of employees disciplined "stunning."
"It indicates to me that there is clearly a culture of abuse or neglect in these facilities," said Jeff Garrison-Tate, president of San Antonio-based Community Now.
Texas has 13 large institutions, called state schools or centers, in which nearly 5,000 mentally retarded or mentally ill residents live full-time with round-the-clock care. That's about five times the national average. By comparison, New York and California combined have about 4,600 residents living in 17 institutions, according to data compiled by United Cerebral Palsy.
State records show more than 450 incidents of verified abuse or neglect in fiscal year 2007, a year in which the Texas Department of Family and Protective Services investigated nearly 3,500 allegations at state schools. About 51 percent of the confirmed incidents involved neglect, 31 percent involved physical abuse and 16 percent involved emotional or verbal abuse. Less than one percent of the cases involved sexual abuse.
State officials also acknowledge at least three state school residents have died since 2002 in which abuse or neglect by caretakers was a factor.
Laura Albrecht, a spokeswoman for the Aging and Disability Services office, said the firings and suspensions reflect the state's "strict policy" on abuse and neglect.
"We have gotten even tougher," Albrecht said. "Our employees go through training to recognize abuse and neglect and to report any incidents."
Perry told The AP that the suspensions and firings indicate that state schools are trying to rid themselves of bad employees.
"What I make of it is that the agency is doing its job," Perry said. "If there are individuals who have broken those parameters of employment, they need to be removed, they need to be fired, need to be dealt with."
The Denton facility, where a notorious abuse case occurred in 2002, underwent its most recent comprehensive inspection last April. The school was cited 25 times for failing to meet federal standards.
Citations included:
- Failure to "ensure clients' rights were protected, including the right to be free from abuse, neglect and mistreatment."
- Failure to "have or to use policies and procedures that prohibit mistreatment, neglect or abuse of clients."
- Failure to "have evidence to show that all allegations of abuse, neglect, or mistreatment were thoroughly investigated.
A more recent inspection in January found that the Denton State School "failed to educate direct care staff on basic first aid, health, and emergency needs."
Perry was notified in March that the Justice Department was investigating the Denton school, said Perry spokeswoman Allison Castle. The notification letter, obtained by The AP, said the investigation "will focus on protection of residents from harm; medical and nursing care; habilitation and treatment; and the failure to place residents in the most integrated setting as required by the Americans with Disabilities Act ... ."
"We certainly welcome their findings and the governor wants to ensure all residents of state schools receive the highest quality care," Castle said.
State Rep. John Zerwas, a member of a legislative committee studying state schools, said lawmakers need to look into allegations of abuse coming from the institutions.
"If the state is going to assume some of the responsibility for the ongoing care for these individuals then we have to make sure they be provided the highest quality and the greatest safety," said Zerwas, R-Richmond.
Garrison-Tate said he has personally witnessed incidents of abuse and suspects only the most egregious cases result in firings and suspensions.
"The bottom line is people are getting really injured, and they are not safe," he said.
---
Associated Press reporter Kelley Shannon in Austin contributed to this story.
Read more in the Fort Worth Star Telegram
Friday, February 15, 2008
INSURANCE: Fort Worth death that wasn't puts us all on notice
By Gina Best - Special to the Star-Telegram - Feb. 12, 2008
Longtime Fort Worth resident Mary G. Anderson recently had a near-death experience of the most perplexing kind.
Her unusual story began Nov. 18 when an obituary for Mary Ann Anderson, an 83-year-old Alvord homemaker, was published in the Star-Telegram. Her survivors include a daughter and grandchildren.
The obituary caught the eye of a staff member at the Employees' Retirement Fund of Fort Worth who apparently scans the obituary columns daily looking for pension recipients who have died. The employee inexplicably decided that the Alvord woman was in fact Mary G. Anderson, also 83, who receives a portion of her late husband's pension. Her husband, Guy Anderson, who died in 2004, worked for the city of Fort Worth for more than 30 years.
The pension fund employee didn't call the funeral home or survivors to confirm. She also didn't call Anderson's residence or send a certified letter. Instead, based solely on the obituary, the employee canceled the December pension check that had been automatically deposited into Mary G. Anderson's bank account. And the fund didn't remit her January pension deposit.
The two Marys lived in different cities and had different middle names and different birthdays.
Mary G. Anderson has lived and worked in Fort Worth her entire life, and her address must be on file with the retirement fund. Her middle name is Guthrie, her maiden name. And her birthday is in August; Mary Ann Anderson's was in March.
That mistake triggered another problem. When the pension fund canceled its deposit, the bank returned a December Social Security check that was supposed to be automatically deposited into Anderson's account.
Meanwhile, Anderson was unaware that anything was amiss until Jan. 11, when the Social Security Administration contacted her to ask about the returned check. "I had to prove to them that I am indeed alive," she said.
Her Social Security check was redeposited immediately.
She then contacted her bank, discovered the problem with her pension checks and realized that she hadn't received a statement from the retirement fund.
She called the fund, where a pension fund employee explained that her obituary had been printed in the newspaper.
Anderson asked why the pension fund didn't call or write to verify her death; the employee told her that "they did not have the staff to make telephone calls to people," Anderson said. The employee also said -- wrongly -- that the Alvord woman had the same birth date and Social Security number.
"I will never understand why they tried to tag me as deceased," she said. "They ought to have a better way to research it before they automatically declare somebody dead."
Anderson, who worked in the title business for more than 30 years, said she knows how important facts and figures are. "When I'd see something, you know, a red flag, I was never above making a telephone call."
A watchdog in her own right, Anderson had the situation resolved by late January, and because she had enough savings, she avoided an overdraft. She contacted The Watchdog because she doesn't want anyone else who receives a pension from the Fort Worth fund to face the same situation.
Wanda Valentine, deputy director of benefits and administration at the pension fund, said she has "apologized profusely" to Anderson. She also said her office is not understaffed.
Employees do scan obituaries to look for people who may have worked for the city and are of retirement age. They then key those names into the fund's database to see whether there is a match with a recipient. If it isn't clear, employees are supposed to take additional measures.
"The goal is to try to reach the retiree or some family member," Valentine said. If they can't talk to someone, employees are supposed to send a certified letter to the recipient's residence.
"This one just kind of fell through the cracks. ... We can't make an excuse for that," Valentine said.
The bank apparently handled the matter of Anderson's supposed death as it should.
It appears that when the pension fund reported Anderson as deceased to the clearinghouse that processes direct deposits, the clearinghouse notified the bank.
If a bank learns of the death of a recipient, it must return federal payments such as a Social Security deposit, said Tom Clark, a public affairs specialist for the Social Security Administration office in Fort Worth.
But Social Security takes steps to confirm a death. That also enables the administration to see whether someone else is eligible for the benefits of the deceased.
And so Mary G. Anderson was returned to the living. Mistakes such as the one she experienced can happen. But take comfort in this: There are everyday Watchdogs who walk among us, keeping an eye out for others. Thanks for sharing your story, Mary.
Need a watchdog?
Requests should be made in writing to watchdog@star- telegram.com or mailed to P.O. Box 1870, Fort Worth, TX 76101.
If you have a tip about an investigative story, contact the Star-Telegram investigative team at 817-390-7027.
watchdog@star-telegram.com
Read more in the Fort Worth Star-Telegram
Longtime Fort Worth resident Mary G. Anderson recently had a near-death experience of the most perplexing kind.
Her unusual story began Nov. 18 when an obituary for Mary Ann Anderson, an 83-year-old Alvord homemaker, was published in the Star-Telegram. Her survivors include a daughter and grandchildren.
The obituary caught the eye of a staff member at the Employees' Retirement Fund of Fort Worth who apparently scans the obituary columns daily looking for pension recipients who have died. The employee inexplicably decided that the Alvord woman was in fact Mary G. Anderson, also 83, who receives a portion of her late husband's pension. Her husband, Guy Anderson, who died in 2004, worked for the city of Fort Worth for more than 30 years.
The pension fund employee didn't call the funeral home or survivors to confirm. She also didn't call Anderson's residence or send a certified letter. Instead, based solely on the obituary, the employee canceled the December pension check that had been automatically deposited into Mary G. Anderson's bank account. And the fund didn't remit her January pension deposit.
The two Marys lived in different cities and had different middle names and different birthdays.
Mary G. Anderson has lived and worked in Fort Worth her entire life, and her address must be on file with the retirement fund. Her middle name is Guthrie, her maiden name. And her birthday is in August; Mary Ann Anderson's was in March.
That mistake triggered another problem. When the pension fund canceled its deposit, the bank returned a December Social Security check that was supposed to be automatically deposited into Anderson's account.
Meanwhile, Anderson was unaware that anything was amiss until Jan. 11, when the Social Security Administration contacted her to ask about the returned check. "I had to prove to them that I am indeed alive," she said.
Her Social Security check was redeposited immediately.
She then contacted her bank, discovered the problem with her pension checks and realized that she hadn't received a statement from the retirement fund.
She called the fund, where a pension fund employee explained that her obituary had been printed in the newspaper.
Anderson asked why the pension fund didn't call or write to verify her death; the employee told her that "they did not have the staff to make telephone calls to people," Anderson said. The employee also said -- wrongly -- that the Alvord woman had the same birth date and Social Security number.
"I will never understand why they tried to tag me as deceased," she said. "They ought to have a better way to research it before they automatically declare somebody dead."
Anderson, who worked in the title business for more than 30 years, said she knows how important facts and figures are. "When I'd see something, you know, a red flag, I was never above making a telephone call."
A watchdog in her own right, Anderson had the situation resolved by late January, and because she had enough savings, she avoided an overdraft. She contacted The Watchdog because she doesn't want anyone else who receives a pension from the Fort Worth fund to face the same situation.
Wanda Valentine, deputy director of benefits and administration at the pension fund, said she has "apologized profusely" to Anderson. She also said her office is not understaffed.
Employees do scan obituaries to look for people who may have worked for the city and are of retirement age. They then key those names into the fund's database to see whether there is a match with a recipient. If it isn't clear, employees are supposed to take additional measures.
"The goal is to try to reach the retiree or some family member," Valentine said. If they can't talk to someone, employees are supposed to send a certified letter to the recipient's residence.
"This one just kind of fell through the cracks. ... We can't make an excuse for that," Valentine said.
The bank apparently handled the matter of Anderson's supposed death as it should.
It appears that when the pension fund reported Anderson as deceased to the clearinghouse that processes direct deposits, the clearinghouse notified the bank.
If a bank learns of the death of a recipient, it must return federal payments such as a Social Security deposit, said Tom Clark, a public affairs specialist for the Social Security Administration office in Fort Worth.
But Social Security takes steps to confirm a death. That also enables the administration to see whether someone else is eligible for the benefits of the deceased.
And so Mary G. Anderson was returned to the living. Mistakes such as the one she experienced can happen. But take comfort in this: There are everyday Watchdogs who walk among us, keeping an eye out for others. Thanks for sharing your story, Mary.
Need a watchdog?
Requests should be made in writing to watchdog@star- telegram.com or mailed to P.O. Box 1870, Fort Worth, TX 76101.
If you have a tip about an investigative story, contact the Star-Telegram investigative team at 817-390-7027.
watchdog@star-telegram.com
Read more in the Fort Worth Star-Telegram
Sunday, January 13, 2008
Judge rules insurance company falsified document
By BRETT SHIPP - WFAA-TV - Jan. 10, 2008DALLAS - A Dallas judge ruled that the state's largest workers compensation insurance carrier committed fraud against an injured worker.
Texas Mutual Insurance Company has already been accused of callously denying claims against injured workers, but allegations of falsifying records could be a first.
Questions about Texas Mutual's business practices were first raised in a News 8 Investigation four years ago.
Injured workers complained that the insurance carrier was randomly denying their claims and robbing them of much needed medicine and benefits.
In an attempt to deny the claims of injured worker Juan Narvaez of Dallas, Texas Mutual is suing him in civil court.
Only now, Texas Mutual is on the defensive.
District Judge Martin Hoffman issued a ruling declaring "Texas Mutual Insurance Company committed fraud on this court" by "falsifying a critical medical record."
The record was a doctor's report in which someone added letters that tend to support the insurance company's position in the case.
"This fraudulent conduct was committed knowingly by agents and representatives of Texas Mutual Insurance Company," Judge Hoffman said.
"I'm upset by it, certainly," said Peter Rogers, who represents the injured worked.
Rogers said his client, who hurt his back on the job four years ago, is tired of fighting Texas Mutual for his care.
The judge ordered Texas Mutual to pay $30,000 and publish the court's ruling on their home page on the Internet.
State Workers Compensation officials said they are already reviewing the facts of the case. Texas Mutual officials have yet to respond.
Texas Mutual Insurance Company has already been accused of callously denying claims against injured workers, but allegations of falsifying records could be a first.
Questions about Texas Mutual's business practices were first raised in a News 8 Investigation four years ago.
Injured workers complained that the insurance carrier was randomly denying their claims and robbing them of much needed medicine and benefits.
In an attempt to deny the claims of injured worker Juan Narvaez of Dallas, Texas Mutual is suing him in civil court.
Only now, Texas Mutual is on the defensive.
District Judge Martin Hoffman issued a ruling declaring "Texas Mutual Insurance Company committed fraud on this court" by "falsifying a critical medical record."
The record was a doctor's report in which someone added letters that tend to support the insurance company's position in the case.
"This fraudulent conduct was committed knowingly by agents and representatives of Texas Mutual Insurance Company," Judge Hoffman said.
"I'm upset by it, certainly," said Peter Rogers, who represents the injured worked.
Rogers said his client, who hurt his back on the job four years ago, is tired of fighting Texas Mutual for his care.
The judge ordered Texas Mutual to pay $30,000 and publish the court's ruling on their home page on the Internet.
State Workers Compensation officials said they are already reviewing the facts of the case. Texas Mutual officials have yet to respond.
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