http://bestlawfirms.usnews.com/mass-tort-litigation-class-actions-plaintiffs
https://www.medicare.gov/claims-and-appeals/file-a-complaint/complaint.html
www.painnewsnetwork.org/stories/2017/1/12/medicare-takes-big-brother-approach-to-opioid-abuse
https://www.ada.gov/filing_complaint.htm
CMS is suppose to be the guardian of our Medicare/Medicaid healthcare system.. They created a Star Rating System a couple of years ago and they are suppose to be the focal point for pts filing grievances against healthcare providers (hospitals, doctors, pharmacies/pharmacists, Part D, Medicare Advantage Providers) for providing poor/bad care.
Now CMS has put forth edicts for Pharmacists to act as judge/jury/executor for docs that Pharmacist feel MAY BE providing controlled substances in excessive amounts and pts that they BELIEVE are getting excessive amount of controlled substances.
As bad as this edict is.. it is highly concerning to me because Pharmacists are not trained to diagnose diseases and do not have the legal authority – by the various states’ Pharmacy practice act to diagnose or prescribe.. but that is what it seems that the CMS is dictating what Pharmacists do.. but only concerning controlled meds.
It is illegal for a physician to diagnose/prescribe for a pt that they have not done a in person physical exam and yet according to this edict Pharmacists are suppose to perform a similar feat.. without doing a in person physical exam nor having access to the pt’s entire medical records.. they will have to come to “medical conclusion” based just on the pt’s prescription history – which may or may not be complete and MAYBE a couple of ICD10 diagnostic codes.
It also appears that Pharmacists will be left on their own to determine where “the bar” is in regards to a prescriber’s excessive prescribing and/or the pt getting/taking excessive doses. So “the bar” can be – or most likely will be – HIGHLY VARIABLE from Pharmacist to Pharmacist.
The CDC guidelines on opiate dosing may be a “blessing in disguise”…..suggest you read this “The guideline is intended to ensure that clinicians and patients consider safer and more effective treatment, improve patient outcomes such as reduced pain and improved function.”
“Clinicians should consider the circumstances and unique needs of each patient when providing care.”
“Clinical decision making should be based on a relationship between the clinician and patient, and an understanding of the patient’s clinical situation, functioning, and life context.”
“This guideline provides recommendations for primary care clinicians who are prescribing opioids for chronic pain outside of active cancer treatment, palliative care, and end-of-life care.”
https://www.cdc.gov/mmwr/volumes/65/rr/
The above four quotes are directly from the CDC guidelines.. I am not an attorney, I would think that groups of physicians and/or corporate entities (hospitals) who employ prescribers.. if they “adopt” the CDC guidelines and place arbitrary mgs/day limits on ALL PATIENTS… regardless of CYP450 opiate metabolism status, or other extenuating circumstances …regarding pt’s appropriate care… are in violation of the intend of the CDC guidelines… the corporate entities in particular… could be guilty of practicing medicine without a license …using their corporate policies and procedures to dictate “cookie cutter medicine – medicine by the numbers”
According the World Health Organization https://palliative.stanford.edu/
Most/all chronic pain pts could be classified as in need of palliative care. Exempting chronic pain pts from the mgs/day limits… Apparently most bureaucrats believe that palliative care is part of Hospice… when in reality palliative care can be its own care modality .. for those pts who are classified as high acuity and thus palliative care is normally furnished as PART OF HOSPICE CARE, but not exclusive to Hospice.
I would think that those physicians or organizations that profess to be adopting the CDC guidelines but in reality have sliced/diced the guidelines into portion that they wish to adhere to and other portions they wish to ignore could have exceed their legal authority.
I believe that the legal case could be made against these group practices or organizations and their employed prescribers.. that in doing so are failing to meet best practices and standard of care… resulting is pt/senior abuse, guilt of malpractice, ADA violation of (civil rights) discrimination for starters.
Since these decisions are being made by organizations and could be affecting sizeable number of chronic pain pts… and those organizations also represents a lot of “deep pockets”… would seem like the basic ingredients for a class action lawsuit.. I can see the TV commercials now… CALL 1-800- BADDOCS
I have been told many times by pts that they have contacted attorneys about suing prescribers , pharmacies/pharmacists and others for denial of care and/or ADA violation. Our legal system puts little/no value of the life of a person who is handicapped/disabled, elderly or unemployable. So I have not heard of the first attorney to take a case on a contingency basis.. because there is no financial upside for the law firm to take a case on a contingency basis.
I have put a link for the “BIG” legal firms that deal with class action… I am now being told that large medical practices and certain entities (hospitals, insurance companies) are creating policies and procedures that claim that they are implementing and following the CDC guidelines and then only following PORTIONS of the CDC guidelines.. meaning that hundreds or thousands of pts will probably be adversely impacted by these decision because they are deviating from what is called not meeting best practices and standard of care… when they state that they are implementing the CDC guidelines as their policy.. and then not follow the WHOLE POLICY..
IMO… the equation of the value of a large group of people who are disabled/handicapped, elderly or unemployable… has dramatically changed by the actions of these corporate entities. It could also be possible that all the employed prescribers for these entities are equally guilty of not meeting best practices and standard of care.. which is basically MALPRACTICE. It could also document violation of the Americans with Disability Act.. since most/all of the pts effected are covered under the ADA.
This whole thing – as it is evolving – IMO.. IS SO WRONG… in so many ways.
Filed under: General Problems
Shared. Even though this pisses me off, people need to be aware.
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I thought that cancer was to be exempt from this stupidity!? What is wrong with this world? When people found out what the Nazis did to human beings they were appalled, at least the ones who believed what their own eyes could see were. I just don’t understand?! Tre tree huggers will take water away from farmers to save some worthless fish yet say nothing (or worse yet say a lot of lies) when another human being is made to suffer unless it’s some terrorist in Gitmo! Something is just wrong!
I know the cancer society is not happy with all the needless pain and suffering. The WHO will not replying. I believed having stage 4 cancer covered me by ADA too but no one wants to get involved or help. No legimate pain suffering patients asked to suffer many there are no alternatives fixes or repairs but this has gone way to Far!
Sweet Lord, we didn’t ask for chronic pain and misdiagnosis,wrongful surgeries, genetic carryover diagnosis, drug sensitivities and Big Brother not looking for an alternative answer or passing medical marijuana, we now increase our anxiety which increases our pain. Were they dropped on their heads at birth? Henny Penny, the sky is falling, classic government over reacting.
Worst of all: reporting unproven allegations to a central database shared among insurers. That’s like your doctor saying “hmmmm that’s a little suspicious that John Doe did XYZ” and then emailing the information to every doctor in the state. Is HIPPAA dead? No wait, I forgot it just doesn’t apply to chronic pain patients. We don’t deserve rights. Hell no! We need to make some noise!
This whole thing just sucks beyond belief! Good doctors, good pharmacists, and good patients are all being stigmatized and it just stinks! The really bad part is that the people making all the misleading statements and telling outright lies will never have to deal with the real consequences because they don’t have to follow the same rules we do!
Unless CMS want’s to start handing out Medical Licenses to pharmacists, they can kiss my you know what. I am still fighting my insurance on my Botox injection which in October they approved, it was administered and they the re nigged on the approval after it was administered. Now they are outright denying it even though the documentation sent in is the same as my husband’s and his is the exact documentation. I’m talking to a flunky becaue they claim there is only ONE clinical RPh on duty. My neurologist’s nurse is hitting them from the other side. I have thil the 25th to get this approved, I pulled off your link Steve and gave it to her to let her know the flunky is practicing medicine without a license. I called benefits at my husbands work. My parents have agreed to pay for it if they refuse to pay so we have another 3 months to work on this. Apparently torticollis you have to have a major deformity to have it covered. I said no its the chronic migraine and that causes the the other. READ the notes. I’ll keep you posted. I’ve had chronic migraines for years and it was such a blessing to be pain free after the shots, you can’t imagine