South Carolina Nursing Home Blog : South Carolina Nursing Home Lawyer & Attorney : Poliakoff & Associates Law Firm : Elderly Care, Senior Care

The Society of Actuaries is an educational, research and professional organization dedicated to serving the public, its members and its candidates. The SOA's mission is to advance actuarial knowledge and to enhance the ability of actuaries to provide expert advice and relevant solutions for financial, business and societal problems. The SOA's vision is for actuaries to be the leading professionals in the measurement and management of risk.

Findings from a new study released by the SOA estimate that measurable medical errors cost the U.S. economy $19.5 billion in 2008.  The study shows how 1.5 million medical errors compromise quality of American healthcare and cause unnecessary waste in the system

Commissioned by the Society of Actuaries (SOA) and completed by consultants with Milliman, Inc., the report used claims data to provide an actuarially sound measurement of costs for avoidable medical injuries. Of the approximately $80 billion in costs associated with medical injuries, around 25 percent were the result of avoidable medical errors.

Jim Toole, managing director of MBA Actuaries, Inc., said  "Of the $19.5 billion in total costs, approximately $17 billion was the result of providing inpatient, outpatient and prescription drug services to individuals who were affected by medical errors. While this cost is staggering, it also highlights the need to reduce errors and improve quality and efficiency in American healthcare."

Medical errors are a significant source of lost healthcare funds every year. For example, the study found that $1.1 billion was from lost productivity due to related short-term disability claims, and $1.4 billion was lost from increased death rates among individuals who experienced medical errors. According to a recent SOA survey, which identified ways to bend the national healthcare cost curve, 87 percent of actuaries believe that reducing medical errors is an effective way to control healthcare cost trends for the commercial population, and 88 percent believe this to be true for the Medicare population.

"We used a conservative methodology and still found 1.5 million measureable medical errors occurred in 2008," says Jonathan Shreve, FSA, MAAA, consulting actuary for Milliman and co-author of the report. "This number includes only the errors that we could identify through claims data, so the total economic impact of medical errors is in fact greater than what we have reported."

Key findings from the study include:

There were 6.3 million measureable medical injuries in the U.S. in 2008; of the 6.3 million injuries, the SOA and Milliman estimate that 1.5 million were associated with a medical error.
The average total cost per error was approximately $13,000.   In an inpatient setting, seven percent of admissions are estimated to result in some type of medical injury. The measurable medical errors resulted in more than 2,500 avoidable deaths and more than 10 million excess days missed from work due to short-term disability.

The study also identifies the 10 medical errors that are most costly to the U.S. economy each year. Approximately 55 percent of the total error costs were the result of five common errors:

Pressure ulcers
Postoperative infections
Mechanical complications of devices, implants, or grafts
Postlaminectomy syndrome
Hemorrhages complicating a procedure

The SOA and Milliman findings were based upon an analysis of an extensive claims database. Measureable costs of medical errors included increased medical costs, costs related to increased mortality rates, and costs related to lost productivity of an error.

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The National Quality Forum has studied and evaluated medical errors.  They have created a limited number of "never events" meaning, of course, that they should never happen.   See article here.   Most of these mistakes happen while a patient is being cared for in a nursing home.

Here are some that you often see in nursing home litigation: 
-Patient death or serious disability associated with the use or function of a device in patient care in which the device is used or functions other than as intended 
-Patient death or serious disability associated with patient disappearance for more than four hours 
-Patient death or serious disability associated with a medication error 
-Patient death or serious disability associated with hypoglycemia, the onset of which occurs while the patient is being cared for in a healthcare facility 
-Stage 3 or 4 pressure ulcers acquired after admission to a healthcare facility 
-Patient death or serious disability associated with a burn incurred from any source while being cared for in a healthcare facility
-Patient death associated with a fall while being cared for in a healthcare facility
-Patient death or serious disability associated with the use of restraints or bedrails while being cared for in a healthcare facility 
-Any instance of care ordered by or provided by someone impersonating a physician, nurse, pharmacist, or other licensed healthcare provider 
-Sexual assault on a patient within or on the grounds of a healthcare facility
-Death or significant injury of a patient or staff member resulting from a physical assault (i.e., battery) that occurs within or on the grounds of a healthcare facility

To learn more about this list, and the criteria for including a medical error on this list, visit the Center for Medicaid and Medicare Services website.

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The Center for Medicare Advocacy has been publishing a series of alerts regarding the Patient Protection and Affordability Care Act of 2010 and Health Care and Education Reconciliation Act of 2010. See link to their most recent one which focuses on the nursing home provisions of the bill.

Title IV, Subtitle B, of PPACA – Nursing Home Transparency and Improvement – addresses a variety of nursing home issues.

Part 1: Improving Transparency of Information

PPACA § 6101. Disclosure of Ownership and Additional Disclosable Parties. Effective immediately and upon request, skilled nursing facilities (SNFs) and nursing facilities (NFs) must make available to the Secretary of Health and Human Services (HHS), HHS Inspector General, the state, and the state long-term care ombudsman information about nursing home ownership (specifically, each member of the governing board, additional disclosable entities [which are defined as persons or entities that (1) exercise operational, financial, or managerial control over the facility or part of the facility or that provide policies and procedures or financial or cash management services; (2) lease or sublease real property to the facility; or (3) provide management or administrative services, management or clinical consulting services, or accounting of financial services to the facility]). Two years after enactment of the law (March 2012), the Secretary of HHS must publish final regulations. Ninety days after final regulations are published (June 2012), SNFs and NFs must report the information to the Secretary in a standardized format. One year after final regulations are published (March 2013), the Secretary must make the information available to the public.

PPACA § 6102. Accountability Requirements for Skilled Nursing Facilities and Nursing Facilities. Two years after enactment of the law (March 2012), HHS must publish final regulations for an effective compliance and ethics program, which may include a model compliance program. Three years after enactment of the law (March 2013), SNFs and NFs must have compliance and ethics programs in operation to prevent and detect criminal, civil, and administrative violations of the Act and to promote quality of care. Three years after final regulations are promulgated (March 2015), HHS must evaluate whether the compliance and ethics programs changed deficiency citations or made other changes to measures of quality, and must submit a report to Congress. HHS must also implement, by regulations, a Quality Assurance and Performance Improvement Program (QAPI) by December 31, 2011, which facilities must implement one year later.

PPACA § 6103. Nursing Home Compare Medicare Website. HHS must add to the official nursing home website, Nursing Home Compare, information about:

(1) Staffing data, including staffing turnover and tenure;

(2) Links to state internet sites, including links to the statements of deficiencies (reported on form #2567 and referred to as "2567s") and facility plans of correction;

(3) Standardized complaint form;

(4) Summary information on the number, type, severity, and outcome of substantiated complaints;

(5) Number of adjudicated instances of criminal violations by a facility or its employees that were committed in the facility, including those that involve abuse, neglect, exploitation, "or other violations or crimes that resulted in serious bodily injury."

The information must be presented "in a manner that is prominent, updated on a timely basis, easily accessible, readily understandable to consumers of long-term care services, and searchable."

HHS must establish a process to review the "accuracy, clarity of presentation, timeliness, and comprehensiveness" of information on Nursing Home Compare and make appropriate changes a year after enactment (March 2011).

To improve the timeliness of information on Nursing Home Compare, states must submit survey information to HHS no later than the date they send such information to facilities, and HHS must use the information to update the website "as expeditiously as practicable but not less frequently than quarterly."

The Special Focus Facility (SFF) program is mandated by statute. SFFs, defined as facilities that have "substantially failed to meet applicable requirements," must be surveyed at least every six months.

SNFs and NFs must have, and make available to anyone on request, reports about surveys and complaint investigations conducted within the prior three years. SNFs and NFs must post notice in a prominent and publicly accessible place that these reports are available.

HHS must provide guidance to states on establishing links to survey reports (2567s). States must maintain "a consumer-oriented website providing useful information to consumers," including 2567s, complaint investigation reports, and facility plans of correction.

HHS must develop a Consumer Rights Information Page on Nursing Home Compare that includes information and links on consumer rights and the survey process and state-specific information about services available through the state long-term care ombudsman.

PPACA § 6104. Reporting of Expenditures. Within one year after enactment (March 2011), HHS must redesign Medicare cost reports to require separate reporting of SNF expenditures for wages and benefits for direct care staff, including nurses and other medical and therapy staff. SNFs must begin using the new cost reports within two years of enactment (March 2012). Within 30 months of enactment (September 2013), HHS must categorize annual expenditures into four functional categories:

(1) Direct care staff;

(2) Indirect care (including housekeeping and dietary services);

(3) Capital assets; and

(4) Administrative services costs.

HHS must make the information available to interested parties on request.

PPACA § 6105. Standardized Complaint Form. Within one year after enactment (March 2011), HHS must develop a standardized complaint form that residents or persons acting on their behalf may use to file a complaint with a state survey agency or long-term care ombudsman program. States must establish a complaint resolution process that includes

(1) Procedures to assure accurate tracking of complaints,

(2) Procedures to determine the severity of complaints

(3) Procedures for complaint investigations, and

(4) Deadlines for responding to complaints.

In addition to the standardized form, complaints may still be submitted in other ways and formats, including orally.

PPACA § 6106. Ensuring Staffing Accountability. Within two years after enactment (March 2012), SNFs and NFs must submit, electronically to HHS, direct care staffing information (including agency and contract staff), "based on payroll and other verifiable and auditable data in a uniform format." Staffing information must:

(1) Specify the category of worker;

(2) Include information on resident census and case mix;

(3) Include a regular reporting schedule;

(4) Include information on employee turnover and tenure and hours of care per resident per day for each category of worker.

PPACA § 6107. GAO Study and Report on Five-Star Quality Rating System. Within two years of enactment (March 2012), the Government Accountability Office must submit a report to Congress on the Centers for Medicare & Medicaid Services's (CMS) Five-Star Quality Rating System, addressing how the system is being implemented, problems, and suggested improvements.

Part 2: Targeting Enforcement

PPACA § 6111. Civil money penalties. HHS may reduce a civil money penalty (CMP) by not more than 50% if a SNF or NF "self-reports and promptly corrects a deficiency for which a penalty was imposed." A reduction is not available for (1) a deficiency if HHS had reduced a CMP in the previous year with respect to a repeat deficiency and (2) a deficiency reflecting a pattern of harm or widespread harm, immediate jeopardy, or a resident's death. HHS must publish regulations providing for independent informal dispute resolution (IIDR). HHS may require placement of CMPs in an escrow account. SNFs or NFs that succeed on their appeals may receive the amounts collected plus interest.

CMP funds may be used for (1) activities "that benefit residents," including protecting residents whose facility closes or is decertified; (2) projects supporting resident and family councils and other consumer involvement in assuring quality care in facilities; and (3) facility improvement initiatives approved by HHS, including joint training of facility staff and surveyors, technical assistance, and appointment of temporary management firms.

Note: In an apparent drafting error, the law provides that per-day CMPs "may not be imposed" for any day during the period beginning on the initial day of the imposition of the penalty and ending on the day on which the [independent] informal dispute resolution process is completed. It is presumed that Congress meant that penalties would not be required to be placed in escrow accounts until completion of the IIDR process.

PPACA § 6112. National Independent Monitor Demonstration Project. Within one year of enactment (March 2011), HHS must begin a two-year demonstration project "to develop, test, and implement an independent monitor program to oversee interstate and large intrastate chains" of SNFs and NFs. HHS will choose chains from among those that apply for the project, focusing on chains with "serious safety and quality of care problems." The independent monitor analyzes the chain's compliance; conducts sustained oversight; analyzes management; reports his/her findings to the chain, HHS, and relevant states; and publishes the results. A chain must respond to the monitor's findings by submitting a report within 10 days, indicating corrective actions it will take or the reasons it will not implement the recommendations. A chain is responsible for "a portion of the costs associated" with the monitor. HHS must evaluate the demonstration in a report to Congress.

PPACA § 6113. Notification of Facility Closure. A SNF or NF administrator must provide written notice of a voluntary closure to HHS, state long-term care ombudsman, residents, and legal representatives 60 days in advance of the closure. Advance notice of a termination will be at the discretion of HHS. The administrator must ensure that no new residents are admitted after the date that written notice of closure is provided. The notice of closure must include (1) a plan (approved by the state) for the transfer and adequate relocation of all residents and (2) assurances that the residents will be transferred to the most appropriate facility or other setting in terms of quality, services, and location, taking into consideration the needs, choice, and best interests of each resident. HHS may continue payments until all residents are successfully relocated. An administrator who fails to comply with these requirements may be subject to a CMP of up to $100,000 and may be excluded from federal payment programs.

PPACA § 6114. National Demonstration Projects on Culture Change and Use of Information Technology in Nursing Homes. Within one year of enactment (March 2011), HHS will implement two three-year demonstration projects, one on "culture change" and the other on the use of information technology in nursing homes.

Part 3: Improving Staff Training

PPACA § 6121. Dementia and Abuse Training. Initial training for nurse aides must include "dementia management training and patient abuse prevention training." HHS may also require such training in aides' ongoing training.

ADDITIONAL PROVISIONS ADDRESSING NURSING HOME ISSUES

PPACA § 6201. Nationwide Program for National and State Background Checks on Direct Patient Access Employees of Long-Term Care Facilities and Providers. HHS must establish a nationwide program "to identify efficient, effective, and economical procedures" for background checks of workers with direct patient access, modeled on the pilot program conducted under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. The procedures must include search of state-based abuse and neglect registries, state and Federal criminal history records, and a fingerprint check. States must:

(1) Conduct the screening and criminal history background checks;

(2) Monitor compliance by long-term care facilities and providers;

(3) Provide for provisional employment, up to 60 days, for employees and for direct on-site supervision for employees pending completion of an appeal process;

(4) Provide for an independent appeal process for a provisional employee or employee to dispute the accuracy of information;

(5) Provide for a single state agency to be responsible for overseeing the process (including specifying the disqualifying offenses).

The federal match for a state program must be three times the state amount, not exceeding $3 million. The nationwide program applies to SNFs, NFs, home health agencies, hospice providers, adult day care providers, and residential care providers that arrange for or directly provide long-term care services, "including an assisted living facility that provides a level of care established by the Secretary." The Office of Inspector General must evaluate the nationwide program and submit a report to Congress.

PPACA § 6703. Grants and Training to the Ombudsman Program on Abuse and Neglect. This provision, part of the Elder Justice Act, provides grants and training to the ombudsman program on abuse and neglect. It also establishes a National Training Institute for Federal and State Surveyors to improve surveyor training in abuse and neglect, provides for grants to improve state survey agencies' complaint investigation systems, and requires a study on establishing a national nurse aide registry.

PPACA § 10325. Revision to Skilled Nursing Facility Prospective Payment System. Revisions to the Medicare prospective payment system (PPS) for SNFs are delayed from October 1, 2010 to October 1, 2011, except for changes to concurrent therapy and the look-back period, which were published in the final PPS regulations on August 11, 2009 (74 Fed. Reg. 40288). The Minimum Data Set 3.0 will become effective October 1, 2010.
 

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The State-Journal Register ran a story about the surprise visit at a Jacksonville nursing home.  More states should make random unannounced visits more often to check for violations of state law and regulations. The visit was the 11th such sweep in Illinois nursing homes in the past several months.  

Five former sex offenders were living at Golden Moments (among 50 residents) but were being housed in their own individual rooms, as required by a 2006 state law that required background checks of all residents.  Based on its own preliminary analysis of sex offenders’ backgrounds, the nursing home believes no one at Golden Moments is being put at risk by the ex-offenders’ presence.

Golden Moments was fined $50,000 by the state earlier this year for poor care connected with the Oct. 3 death of a 74-year-old resident who choked on food.

A Chicago Tribune series about rapes, attacks and murders at Illinois nursing homes proved that many residents with outstanding warrants were living in the facilities. The series prompted Gov. Pat Quinn to create a Nursing Home Safety Task Force, and the Illinois House and Senate have passed a bill designed to help reform the nursing home industry.

Senate Bill 326, which soon will be sent to Quinn’s desk for his signature, would set up a pilot project in which nursing home residents would be fingerprinted. That project would allow nursing homes to check on outstanding warrants.

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Bureau of Justice Statistics issued a Special Report on the number, type, and resolution of civil trials in the United States.  Some very interesting data is contained in the report.

Major findings from the 2005 Civil Justice Survey of State Courts include—
• A jury decided almost 70% of the approximately 26,950 general civil trials disposed of in 2005.
• About 60% of the general civil trials included in the survey involved a tort claim and about a third involved contractual issues.  Most of the tort cases involved motor vehicle accidents.
• Plaintiffs won in almost 60% of trials overall.
• The median damage award for plaintiffs who won monetary damages in general civil trials was $28,000.
• Punitive damages were awarded to only 5% of plaintiff winners in general civil trials in 2005.
• In the nation’s 75 most populous counties, the number of general civil cases disposed of by jury or bench trial declined by about 50% from 1992 to 2005.

Almost two-thirds (62%) of all plaintiff award winners were awarded $50,000 or less. A small percentage (about 4%) of all plaintiff award winners were awarded $1 million or more.

There were only 2,449 trials involving medical malpractice which amounts to 9.1%.  This is interesting since we know there are 100,000 deaths caused every year from medical malpractice.

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Interesting article about candidate for governor Rick Scott, the former CEO of Columbia/HCA, who resigned in scandal in 1997 amidst government investigators' charges of a Medicare fraud scheme.  The company admitted to “systematically overcharging the government by claiming marketing costs as reimbursable, by striking illegal deals with home care agencies, and by filing false data about how hospital space was being used.”  The company’s facilities also increased Medicare billings by exaggerating the seriousness of the illnesses treated in its hospitals, and “granting doctors partnerships in company hospitals as a kickback for the doctors referring patients to HCA.”  Clearly he was also involved in Medicare fraud by inflating cost reports.

Scott in 1987, bought a couple of hospitals with the help of financier Richard Rainwater and, took over HCA and built the nation’s largest for-profit hospital chain. In 1997, Scott’s empire unraveled and he was forced to resign from the company. In 2001, he founded Solantic Corp., which operates a chain of urgent-care centers.  Columbia/HCA only had to pay back $1.74 billion in fines and Rick Scott walked away with severance pay of $10 million, a 5-year consulting contract, and stock then valued at $300 million.

Fast forward to March 2009. Scott founded Conservatives for Patients Rights with $5 million of his own money “to promote free market healthcare reform.” The group opposed any reform of the health care industry.  Scott’s campaign doesn't understand the new legislation and refers to it  as a “government takeover of healthcare.”  Except Medicaid and Medicare and Veteran Administration are government programs and the baby boomers are getting older.

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Assisted Living Concepts Inc. (ALC), which operates a for profit chain of assisted living centers, reported significantly higher profit margins despite a drop in occupancy in its first quarter.  The company operates 211 assisted living centers in 20 states.  See full report here.  Revenue increased 1.4% to $57.9 million from $57.1 million.

The company reported net income of $3.6 million, or 31 cents a share, compared with a loss of $11.8 million, or 98 cents, a year ago. The year-ago quarter includes a non-cash write-off of $14.7 million in goodwill, an accounting entry that reflects the amount above book value paid for an acquisition. Excluding the write-off, the company earned $2.9 million in first quarter 2009.

An increase in private pay residents, who pay much higher rates than the Medicaid program, rate increase and lower labor and kitchen expenses contributed to the higher profits. It sounds like they stopped properly feeding the residents and provided less staff or less qualified employees.

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Many corporations provide insufficient staffing, training, and substandard care to pad their books and make outrageous profits.  Kindred Healthcare, Inc. recently announced its operating results for the first quarter ended March 31, 2010.

First Quarter Highlights:
• Consolidated revenues rose 2% to $1.1 billion
⎯ Each operating division reported revenue growth compared to last year
• Reported diluted earnings per share totaled $0.38, including $0.06 of certain charges
⎯ Excluding the charges, first quarter earnings were at the high end of the Company’s guidance
range of $0.35 to $0.45 per diluted share
• Hospital volumes continued to improve
⎯ Reported admissions grew 3% from last year
⎯ Same-facility aggregate admissions grew 3%; same-facility commercial admissions grew 12%
⎯ Volume growth in the quarter was partially offset by softer Medicare and commercial pricing
• Nursing and rehabilitation center admissions grew 5% in the first quarter compared to last year
⎯ Reimbursement rates were generally in line with expectations
• Peoplefirst Rehabilitation continued to demonstrate consistent operating results
⎯ Division signed 28 net additional unaffiliated contracts compared to a loss of three contracts in the first quarter last year

See report here.   But the nursing home industry will insist they can't make any money because of alleged cuts in Medicaid and Medicare reimbursements, and, of course, on "frivolous" lawsuits.  Ridiculous.

I hope all of our loved ones are safe on this Mother's Day.
 

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Ken Connor wrote a great article about the inherent injustice of tort reform on the Center for a Just Society.  Below is the full aricle:

On April 5, 2010, the community of Montcoal, West Virginia was devastated when an explosion at the Upper Big Branch mine took the lives of 29 men. For the families impacted by this disaster, coping with the unexpected loss of loved ones is only the beginning of what is sure to be a long and arduous quest for justice. Not only does the tragedy of Upper Big Branch demonstrate the inadequacy of regulations alone to protect vulnerable workers and their families, it highlights the vital importance of our nation's civil justice system as a means of compensating victims and punishing those whose reckless conduct harms others.

As news of the explosion at Upper Big Branch unfolded, it wasn't long before details of the mine's troubling history began to surface. According to the New York Times, "the mine had been cited for hundreds of violations over the last year, including many serious ones."

Why then, did the mine continue to operate? The early evidence suggests that the owner was gaming the system to protect its bottom line, putting profits ahead of the safety of its workers.

In order to avoid steep fines and delay the need for compliance, the Massey Energy Company fostered bureaucratic gridlock by contesting most of the Upper Big Branch mine's safety violations. While regulatory officials at the Mine Safety and Health Administration (MSHA) waded through stacks of appeal documents, hamstrung by weaknesses in the 1977 Mine Safety Act, the mine continued to operate unimpeded. What's more, the mining industry (as with many other regulated industries) has long had a revolving door between the regulators and the regulated. The ranks of the regulators are often filled with folks who come out of the mining industry. Likewise, the industry provides opportunities for advancement for regulators who decide to leave government service. This calls into question the zeal with which some regulators carry out their duties. Does a regulator really want to get tough on the company that might provide him with his next job?

Of course, regulatory regimes do nothing to compensate the victims or their families for the damages they suffer in such catastrophes. The fines that errant corporations pay for violating government regulations go to government, not the victims of those violations. But justice requires that there be a means to ensure that wrongdoers are made to compensate for the harm they inflict on those who suffer as a result of their wrongdoing, and this is where the much maligned civil justice system – better known as the tort system – comes in.

The term "tort" refers to a private or civil wrong. Derived from the medieval Latin word tortum ("wrong"), the root of the word goes back to the ancient Latin verb torquere, which means to twist (compare our modern use of the word "torque"). The tort system is designed to "straighten out" the injustices suffered by the innocent at the hands of wrongdoers by requiring compensation for the harms they have suffered.

But the reach of Big Business extends even to the judicial system, and there is a dangerous move afoot to immunize corporate malefactors from full accountability to their victims. Under the rubric of so-called tort reform, corporate brigands like Massey Energy use their clout in the political arena (derived from generous campaign contributions) to secure the passage of laws that artificially "cap" the amount of damages innocent victims can recover. Caps as low as $250,000 are routinely advocated for "non-economic" damages like pain, suffering, disability, and disfigurement, regardless of how much the victims have suffered. Tort reform means that bureaucrats and special interests far from the scene determine the amount of damages an injured party can recover, rather than a jury drawn from the community where the wrongdoing occurred.

Not content to limit the compensatory damages available to victims of corporate wrongdoing, business interests also seek to limit the recovery of punitive damages as well. Punitive damages are awardable in cases where a wrongdoer engages in intentional or reckless misconduct. Historically, such damages are levied as punishment, with the purpose of deterring similar misconduct by others. In taking into account the amounts to be awarded, juries are permitted to consider such things as the reprehensibility of the misconduct, the vulnerability of the victim, the profit resulting from the misconduct, the financial condition of the wrongdoer, and the extent to which the wrongdoer tried to conceal the wrongdoing. Juries may only punish – they are not permitted to bankrupt – the perpetrators of such misconduct.

But wrongdoers don't like to be held accountable, so business interests – through lobby groups like the U.S. Chamber of Commerce – have launched a full scale assault on the civil justice system, seeking to emasculate the rights of innocent victims and their ability to hold wrongdoers fully accountable. In addition to advocating caps on damages, they try to shorten statutes of limitations, secure immunity from liability, and place other legal hurdles in the path of the victims.

Sadly, this campaign has had great success. And without robust legal mechanisms in place to send a message that it's cheaper to do business the right way than it is to cut corners, businesses like Massey Energy will continue to do things the wrong way, and the innocent and unwitting will continue to suffer the consequences. If tort reform continues to be successful, it is inevitable that more and more communities across America will find themselves, much like the families of Montcoal, West Virginia, at the center of a senseless industrial tragedy.
 

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Despite paying a $98 million settlement for kickback schemes, Omnicare managed to pull in 4th qtr profits over $80 million. Omnicare is the nation's largest nursing home pharmacy.  See article here.   The financial results for its fourth quarter, reporting nearly tripled profits compared to the previous year after settling fraud allegations with the U.S. Justice Department as recently as last November.  See report here.

Omnicare paid a $98 million settlement in 2009 to end a Justice Department investigation that  the company engaged in kickback schemes with two Atlanta nursing homes involving pharmacy service contracts.

I guess fraud, kickbacks, and paying lobbyists is profitable.

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