The Dangerous Mix of Money and Medicine

As San Francisco medical malpractice lawyers, the Brod Law Firm is keenly aware of the many ways in which money and other financial factors can influence medical decision-making. Sadly, sometimes patients are harmed when doctors make decisions based on cost rather than focusing on what is best for the patient. When patients are harmed, whether as the result of a decision made by a doctor or an insurance company, a San Francisco medical injury attorney can help determine if improper financial motivations resulted in medical care falling below the required standard of care.

It seems like every few weeks we come across a new story about the way money and medicine intersect. The San Francisco Chronicle recently explored the link between changes in Medicare payments and an increase in a specific diagnosis. Unfortunately, this practice is common enough to have its own name and is referred to as “upcoding” in the insurance field. The Chronicle’s article focused on the Chino Valley Medical Center in San Bernadino County and its parent company, Prime Healthcare services. The companies deny any wrongdoing but authorities are investigating a suspicious surge in the hospital diagnosing “acute heart failure.” In the 2008 to 2010 time frame, 35.2% of the hospital’s Medicare patients were listed as having the condition, six times the state average. The diagnosis triggered bonus payments from Medicare of thousands of dollars for every patient. This surge followed a rule change entitling a hospital to increased payments for patients with certain major complications.

It is not clear whether the alleged upcoding impacted patient care or just resulted in changes in paperwork filing. Of course, improper reporting does have a financial impact, particularly concerning when it involves a public program like Medicare. However, the financial influence on medicine can also have a direct impact on the quality of care. There are many factors at play including the rates at which insurers reimburse for different procedures and concerns related to medical malpractice insurance fees. These factors can influence the decision-making process, either at the physician or the insurance company level, and patient care can suffer.

In general, a California medical malpractice claim must be brought within one year from the discovery of the negligence and, with limited exceptions, within three years of the injury itself. Where it is a factor, the patient’s own negligence can reduce the amount of recovery but it will not eliminate recovery where others are also at fault. An injured plaintiff who proves medical malpractice is entitled to economic damages, covering expenses or lost income, and also non-economic damages for pain and suffering. In some cases, medical malpractice cases may be covered by an arbitration agreement meaning the case will appear before an arbitrator rather than in a courtroom.

If you or a loved one is injured as a result of substandard medical care it is vital that you contact a San Francisco medical malpractice attorney. We have the expertise to explore whether you have a legal claim against an insurer or a medical provider. We can, however, only help if you reach out to us. Whether your injury is due to the negligence of a provider or an insurance company, please call the Brod Law Firm for a free consultation to speak with our trained legal team.