Fort Lauderdale HMO Negligence Lawyer
Injured Due to Medical Malpractice? We Can Help.
The injection of HMOs into the medical system and between the doctor and
the patient is an unfortunate, recent trend in medicine. The problem is
more than just rationing healthcare - it destroys healthcare in several
ways. If you have reason to believe that you may have an HMO negligence claim,
contact Kelley/Uustal. A Fort Lauderdale medical malpractice attorney from our firm would be
happy to meet with you for free to discuss the details of your case.
Why Capitation Can Be Dangerous for Patients
Capitation is a system that HMOs use to compensate doctors. A capitated
physician is usually paid a set amount of money per patient on his or
her "list" each month - commonly an amount between $5 and $10.
As a result, the only way a doctor can make more money is to have more
patients on his or her list. But the more patients on the list, the less
time spent with each and the greater the chance that
medical malpractice will occur.
Dangers of capitation:
- Capitation often includes provisions that financially discourage the doctor
from ordering testing. Their contracts frequently contain a list of testing
procedures that must be paid out of the doctor's own pocket. Sometimes
the ordering of tests will cost the doctor more than he or she makes for
the year of having the patient on their list! This creates a serious disincentive
to perform necessary testing and follow-ups.
- Doctors want to maintain their "preferred provider status." HMOs
rate their doctors based on their utilization - a fancy way of saying
they monitor how much a doctor costs them in test requests and hospital
stays. Doctors fear that if they order what the HMO might consider to
be too much testing they might lose their preferred provider status, and
a large portion of their patients, which can be a significant deterrent.
- Many times hospital stays and expensive testing or treatment must be pre-approved
by the HMO - and sometimes they say no! Unfortunately, they sometimes
say no to medical testing and treatment that could have saved a person's life.
How Kelley/Uustal Helps Victims of HMO Negligence
Kelley/Uustal was involved in an HMO negligence case involving the death
of a 6-year-old girl. She was taken to her pediatrician for treatment
of persistent vomiting. Her doctor correctly recognized that this could
be a sign of a brain tumor. As a result, he ordered a CT scan. The request
was rejected by the HMO for the reason that it was “not medically
Months later, the little girl started screaming and holding her head. The
tumor had expanded to the point that it eventually resulted in her death.
It turned out to be a fast-growing benign tumor that would have been treatable
back when the HMO rejected the doctor’s request for a CT scan. With
the family was able to recover $7 million in damages.
Misuse of ERISA
ERISA is a federal law that was originally designed to protect people from
big insurance companies. However, a very small section of this act provides
that an individual has the right to file a grievance against their HMO.
Another provision of the law says that
ERISA preempts state law. Some courts have put these two together and concluded
that ERISA's right to file a grievance against an HMO preempts state
medical malpractice law in Florida.
HMOs do not have absolute immunity in Florida. If you think you have been
injured by an HMO's negligence,
contact us. Our Fort Lauderdale medical malpractice lawyers
at Kelley/Uustal are experienced in handling cases involving HMO negligence.