In the company of the world’s largest coffee manufacturer, there is a serious problem that has developed within the company and has been ignored for years. As the Davita Coffee Company continues to lose millions each year due to this negligence on the part of the Coffee Company, they have hired an on-site litigation department to seek justice for their employees who have been injured while working for them. While no monetary compensation can ever erase the damage done to the injured parties, they can seek justice in court to receive compensation for their pain and suffering.
According to the Davita employee lawsuit, which was filed by former employee Amy Giraldo, she suffered a back injury while working at the company’s factory in 2007. Later in the month, Giraldo was diagnosed with kidney failure, which required immediate dialysis treatment. Despite being told by her employer that she qualified for dialysis, she continued to work at her job without ever taking time off to go to the hospital to collect the needed medications. At the end of the month, Giraldo went home where she died of congestive heart failure at age 29.
The next month, the Florida Blue Cross/Blue Shield health plans and the Florida Medi-Cal Medicare program, which is jointly run by the two Florida companies, became involved in the lawsuit. They decided to defend their colleague Giraldo against her wrongful death claim, despite having received a letter from the deceased that stated her own death story. In a meeting between the healthcare partners, it was decided that Giraldo had indeed died as the result of a work-related accident, not a stroke or heart attack as was initially reported in the media. The decision, according to the lawsuit, was made by the healthcare partners’ insurance carriers, despite the fact that the county medical examiner had determined that the cause of her death was “a probable error of administration.”
Following the decision, the Florida Department of Law placed the two companies, Care Health Choice and Avita, into what is known as the Medi-Cal Futures Managed Care Plan Review Panel, or MMAP. The purpose of this panel is to ensure that “care services” provided by companies such as Avita and Care Health Choice comply with the state’s laws regarding “medicare benefits” and “reimbursement of those benefits.” Once on the MMAP, the companies are required to undergo three different reviews within three months of service. After each review, the providers are provided with feedback explaining what worked and what did not.
The next step for the Florida Blue Cross/Blue Shield health plans and Avita is to decide whether or not the organizations will “pay for miscellaneous costs associated with their [filing’s] and/or litigation.” The terms of reference for these costs vary depending on which step of the process the complaint moves through. If the lawsuit proceeds to a settlement conference, for example, Avita is not required to pay anything beyond their normal attorney fees. If the case proceeds to a trial or appeal phase, however, the healthcare partners are required to come up with all funds necessary to pay their own expert witnesses, other attorneys, medical experts, and other expenses, and the cost of their litigation support activities. It is not uncommon for healthcare partners to ask their own lawyers to come up with these amounts.
In the end, the outcome of the Avita Employee Litigation and Disability Insurance case could have far reaching consequences for healthcare providers in the Florida individual market. In addition to requiring providers to change their fee structures, it could also force healthcare providers to turn to outside insurance companies to provide for their long term financial obligations. This could significantly alter the structure of insurance markets in the state. For example, if one provider decided not to participate in a Medicare Part B program, and another provider decided to participate, then the impact on the Florida Medicare rolls would be significant. The court may rule that the new plan would be significantly less expensive than the original plan, thereby increasing competition in the Florida individual market.