Keynote - Leadership: The Transfer of Belief Creates the Future
A perspective on leadership and the future.Back to top
SESSION 1 - Scope of Practice for Nurse Practitioners and Physician Assistants - Expanding to Meet Consumer Demand: Risks and Benefits
In today’s healthcare arena, it is expected that a broader scope of practice will be evolving for Nurse Practitioners (NPs) and Physician Assistants (PAs). Many states are considering changes to existing laws that regulate scope of practice for NPs, including independent prescribing privileges while PAs strive to require less supervision and more autonomy. Anticipated changes in prescribing laws among the states include the independent authority to prescribe, restrictions on prescribing controlled substances, or the necessity for collaboration with an attending physician.
This session will focus on the current and future roles for NPs and PAs and their collaboration with physicians and other healthcare professionals. Identifying the risks and benefits, and strategies to mitigate exposure.Back to top
SESSION 1 - The Prescription Drug War: A Medical/Legal/Claims Perspective on the National Painkiller Crackdown
Jeremy Cayton, Liberty Mutual
Mark Pew, Preferred Medical Network
Jessica Smythe, ISO Claims Partners
This is an advanced session for claims executives, claims professionals, medical directors and attorneys about the war on prescription drug abuse, including a discussion of the merits of rescheduling certain prescription drugs and the attempted outlawing of Zohydro. As the industry adopts new ways to medically and legally crack down on prescription drug abuse, are our efforts too focused on supply, and not the creation of the demand, for these types of drugs? How has this crackdown changed medical case management of prescription drugs in the claims handling context? This presentation will also explore how prescription drug rescheduling has changed MSA submission requirements for MSAs submitted to CMS after January 1, 2015 and how the implementation of the new WCMSA prescription drug portal has changed MSA prescription drug allocations.Back to top
SESSION 2 - Birth Injury Claims: How to Effectively Evaluate, Defend and Resolve These Catastrophic Claims
Kati Bynon, Beazley
Scott Hoover, Ringler
Joseph P. Menello, Wicker, Smith, O'Hara, McCoy & Ford, P.A.
Ana Watson, Clark Hill LLC
Obstetrical brain damage cases are challenging for the defense. The injured party, a newborn baby, is the most defenseless and sympathetic of potential plaintiffs. The recoveries in these cases are quite high. Damages include the cost of maintaining the child for the remainder of its life, as well as noneconomic damages such as the loss of enjoyment of life, pain and suffering, and mental anguish. This presentation will provide a road map to defending these claims as both an attorney and risk manager.Back to top
SESSION 2 - Marijuana in Workers' Compensation - Medical and Legal Challenges
Marcos Iglesias, Travelers
Francis X. Wickersham, Marshall Dennehey
Scott Yasko, Preferred Medical Network
The combined legalization of both medical and recreational marijuana in this country has given rise to new and evolving difficulties in the medical management of workers compensation claims. Not only has cannabis begun to creep into prescription drug regimens with regularity, but with recent court rulings in states such as New Mexico, marijuana has shown potential to be the responsibility of the workers compensation payer. The purpose of this session is to give an overview of marijuana and its medical efficacy – especially pertaining to those diagnoses we often see within the workers compensation industry. Additionally, the panel will present a legal update and interpretation of recent rulings as well as strategies and solutions when marijuana is present on a workers compensation claim.Back to top
SESSION 3 - Electronic Medical Records: Problems, Liability Issues Related to ACA Requirements and HIPAA
Charles Cole, Lewis Brisbois Bisgaard & Smith, LLP
Tracy Maddox, Community Health Choice
Melanie Pita, Foundation AI
This discussion is focused on the growing necessity, particularly in the field of medical malpractice, to adhere to ACA and HIPAA compliant practices – as well as the pros and cons of electronic medical records as they relate to this compliancy. As this panel will contain an expert in EMRs, an expert in medical malpractice, and an expert in HIPAA it plans on featuring why this is such a priority from each perspective and provide greater insight into the relationships and responsibilities of all three entities.
SESSION 3 - The Affordable Care Act's Impact on Liability Insurance: Coverage, Cost and New Exposures
Nichol Bunn, Lewis Brisbois Bisgaard & Smith, LLP
Robert Hall, Optum
Kathleen Lyons, AXIS Reinsurance
This is an intermediate session for claims executives, claims professionals, medical directors, corporate/staff counsel, and attorneys about how the Affordable Care Act changed the landscape of health insurance. As the dust settles after the roll out, it is time to see how the ACA will impact liability insurance costs. Our panel will look at how the ACA has created new exposures in various lines of business and how these risks can affect business. They will talk the effect of the ACA on future medical care costs and look at solutions to mitigate some of the risks. The panel will discuss: Medical Professional Lines: supply and demand issues including shortage of primary care physicians; the expanding scope of practice and the use of nurse practitioners, physicians assistants; and retail medicine, electronic health records, and telemedicine. Workers Compensation and Auto PIP: possible lower costs as claimants rely on private insurance to cover co-morbidities that are not related to the injury, which should decrease cost shifting. D&O and E&O claims: antitrust issues associated with consolidation and information sharing. Fiduciary: The effect of the ACA on ERISA requirements and potential civil and equitable claims by health plan participants to enforce coverage requirements. Settlement strategy: potential decrease in costs of annuities with underlying coverage.
SESSION 4 - Amazing Medical Device Developments
Michael Bruyere, Self Employed
Carolyn Finch, Self Employed
Robert Wright, AmWINS Group, Inc.
Innovation and excitement are alive and well in the health care industry. Rapid developments in additive manufacturing (AM), or three-dimensional (3D) printing, along with Augmented Reality (AR), also known as virtual reality, are driving phenomenal improvements in patient care. AM promises an expansion of device production utilized to custom design and manufacture many products including medical devices and jet engine parts, among others. Some estimate that the growth of 3D printers will reach 200 percent in 2015 based upon its ability to fabricate cost-effective, safe, and reliable products with shortened production times and less equipment. AR presents unbelievable virtual environments to health care providers, not only for training, but also for real-time delivery of care. As with most innovation, the benefits of scientific and engineering breakthroughs such as AM and AR bring concomitant risks, including liability exposure and challenges in assessing the risk of producing products with short-run manufacturing in the case of AM products and device malfunction or failure for AR products. We will explore this topic in our seminar.
SESSION 5 - Debunking the Science of Complex Regional Pain Syndrome
Julie Fortune, Self Employed
David Randolph, Midwest Occupational Health Management
R. Douglas Vaughn, Deutsch Kerrigan, LLP
Are you an attorney defending a personal injury lawsuit or workers comp claim in which the plaintiff/claimant alleges Complex Regional Pain Syndrome (CRPS)? Are you a claims professional posed with the challenge of keeping a lid on damages and looking for an effective defense in the face of a treating physician’s opinions that such a patient will require extensive, expensive treatment? This presentation will provide a road map to mounting an effective challenge to such claims, educating attendees on reasons other than a workplace accident, a surgical complication or a traumatic occurrence for individuals to experience the complaints often wrongfully attributed to the events listed above.
The program will also dispel myths about CRPS as an unchallengeable diagnosis following such an occurrence and arm the defense professionals and counsel with the tools to counter opinions of treating physicians. Participants will walk away from the presentation with a firm understanding of the complaints that make up CRPS and factors that often provide an independent, alternate explanation for such complaints.
SESSION 5 - The RICO Act - How to Aggressively Use the Act Against the Unscrupulous in Medical Recovery Actions
G. Steven Baer, Self Employed
Catia Monforton-Farris, Allstate Insurance Company
Matthew J. Smith, Coalition Against Insurance Fraud
In 1970, Congress passed The Racketeer Influenced and Corrupt Organization Act (RICO) to prosecute organized crime activity. The Act allows those harmed by corrupt activities to triple their actual damages and legal fees. 33 states, as well as Puerto Rico and the Virgin Islands, have since adopted civil RICO statutes allowing similar state recoveries.
In recent years, insurers have begun to realize the potential of using civil RICO as a method to recover from unscrupulous medical providers and even attorneys involved in fraudulent activities. Insurers have successfully secured multi-million dollar recoveries against unscrupulous medical providers and their accomplices. However, insurers have also faced litigation and ensuing large damage awards when RICO actions have been filed against their own insureds and third parties.
When a RICO action is filed, the insurer must have sufficient evidence to support the allegations or face an immediate dismissal and possible damages. Though complex in nature, RICO cases assist insurers to effectively fight back against insurance fraud, specifically medical recovery.
Attendees will gain a detailed understanding of RICO history, how to properly investigate claims to look for a pattern and practice of impropriety, and learn about the successes and pitfalls associated with RICO investigations and filings.
SESSION 6 - Emerging Risk: Traumatic Brain Injury Claims in Low Exposure Carbon Monoxide Cases
This presentation will provide an overview of the emerging litigation trend of multi-million dollar permanent traumatic brain injury claims arising from low level carbon monoxide exposure. The seminar will explain how these claims are set up, the advanced brain scanning techniques and medical testing that is used to support them, the medical and legal issues that often arise when such claims are made, and how to defend them. It is designed to be a primer on both the legal framework for such claims and the medical and scientific literature on traumatic brain injury and low level carbon monoxide exposure. The presentation will be an informal lecture illustrated by jury verdict surveys, outlines of legal precedent, PowerPoint slides, photos and video.Back to top
SESSION 6 - Is There a Proctor in the House? The Liability of Proctors for the Negligence of Observed Physicians
Michele Rorie, Palmetto Health
Karen Salmon, GB Healthcare
Lee Weatherly, Copeland, Stair, Valz & Lovell, LLP
Across the United States, hospitals are using proctors to assist in the credentialing of physicians and surgeons. Similarly, many hospitals are requiring surgeons to be proctored for a number of procedures when they first begin to use new equipment, such as robotic laparoscopic devices. The potential liability of these observing physicians is real and rarely considered until lawsuits are filed after adverse outcomes.
By using real world case we will outline the steps hospital risk managers nationwide should take to insulate their surgical proctors from potential liability. Similarly, the seminar will show how to defend these physicians should they be sued for the negligence of the physicians they are observing. Finally, the seminar will explore the insurance coverage issues for proctors, often observing outside their home state.
Participants will leave presentation with a firm understanding of how to shield proctors from potential liability in the field and how to defend them should they be involved in lawsuits after adverse outcomes.
No Learning Objectives Available