You might have been afraid to attend the American Bar Association’s white-collar crime conference last week. But the Health Blog, armed with the First Amendment, endured the topic and the tropical clime of Miami to check out a panel on health-care fraud.

The government and the corporate defenders were there. Big Pharma bogeywoman Susan Winkler, chief of the health-care fraud unit at the U.S. Attorney’s Boston office, shared the dais with defense attorneys Ty Cobb, Nicholas C. Theodorou, Katherine Lauer and Thomas Dwyer.

The group ran though the health-fraud hit parade: off-label marketing, assessing the value of a case and how a company, once cornered, can strike a productive note with the feds.

But the thing that jumped out at us was the group’s consensus that smaller companies–biotechs and device companies—are expected to be the next big hunting ground for fraud and wrong-doing. “Small cap companies, biotech and medical device companies, their resources are limited in terms of compliance,” Theodorou said. And, he added, “they’re very sales and marketing driven.”

Winkler agreed, saying, “We’re going to see more and more off-label with medical devices.” The U.S. Attorney’s office in Boston has been a leader in rooting out health- care fraud, including cases against a host of drug companies. Sketchy pricing schemes and off-label marketing, or pitching a drug for uses beyond those approved by FDA, have been regular fraud fodder.

But Big Pharma, said the panel, has learned from its lumps after battling government investigations and charges. “There are a lot of drug executives walking around with huge dents in their heads,” Cobb said. “They’ve been beaten with rules and compliance.” It’s the little guys, particularly single-product companies, who don’t have the resources and infrastructure to set up checks and balances. The legal stakes can break a company, Cobb said. “I got a case where the first person I called wasn’t the forensics guy, but the bankruptcy guy.”

Doctors and lawyers in Montgomery County are doing something unusual: working together.

Members of the county's bar association and medical society, along with Abington Memorial Hospital, tomorrow are launching a pilot project they hope will keep more malpractice disputes out of court.

Lawyers and doctors will work in teams to mediate conflicts between patients and the hospital or doctors. The hope is that the new approach will resolve problems more quickly and humanely, without the demonization of both sides that can occur in malpractice battles.

Whether it will save money remains to be seen. Project leaders say that is not the primary goal.

John J. Kelly, Abington Memorial's chief of staff, said he wanted to avoid the "harshness" of litigation. "At the end of the day, I think everybody walks away feeling like it's a much more productive process, and it's a healing process," he said of mediation.

"I think litigation makes everything so much more painful for everyone, and I'm not sure healing ever occurs."

Planning for the project started three years ago after a nudge from the state Supreme Court. It encouraged counties to look at alternatives to traditional court battles as doctors threatened to leave Pennsylvania because of skyrocketing malpractice-insurance rates. Not much has happened elsewhere in the state, but doctors and lawyers here pursued it because "there's got to be a better way to do things than the way we've been doing them," said Mark Lopatin, a rheumatologist, who led the medical society's part of the effort.

People on both sides say the current system is emotionally draining, even when you win.

"Clients hate courtrooms," said Robert Morris, president of the Montgomery County Bar Association. "I haven't ever had a client that wanted to get in the witness stand."

The project deals with unhappy patients and their families through a two-step process. In the first, doctors and nurses at Abington have been trained to listen to such patients and explain what happened in as much detail as possible. Project leaders say many people who sue do so primarily to find out what happened.

If that is not enough, patients can move to mediation, a process that helps them hammer out a settlement with their doctors. The mediator shuttles between the sides, bringing their positions together. Unlike a judge or arbitrator, the mediator does not decide the case. Instead, the patient and doctor - or more likely their attorneys - determine an acceptable outcome. Usually that involves money, but patients also often want an apology and assurance that steps will be taken to prevent future mistakes.

If the sides are still fighting, patients still have the option of going to court.

In this region, Drexel University College of Medicine's doctors have the longest-running mediation program. Theirs often uses a team approach, pairing lawyers who typically represent patients with those who defend doctors. Abington's new program creates even more unusual teams. A lawyer with health experience will be the lead mediator, and a doctor will be his "medical partner."

"It's precedent-setting, this project," said Jane Ruddell, a former health-system lawyer who now runs a company devoted to alternative dispute resolution. "It's really trying to change a culture."

Ruddell ran a training session last week in the bar association's Norristown office to train about 30 doctors and lawyers to be mediators. Many of the lawyers had previous experience with mediation, but the daylong program was an eye-opener for the doctors, who understood for the first time how hard and time-consuming it was to sort through strong emotion and find common ground.

In a training exercise, the doctors and lawyers were split into groups for some role-playing. Abington Memorial obstetrician-gynecologist Robert Michaelson played the mediator for one. The bar association's Morris was an angry woman with cancer, and Mark Pyfer, president of the Montgromery County Medical Society, was her even angrier husband.

The patient in the case had had foot pain, which the doctor thought was caused by a pinched nerve. The patient decided not to have surgery the doctor recommended and later lost part of her leg after the cancer was discovered.

Michaelson got into trouble almost immediately, waiting too long to separate the warring parties. He ran out of time without getting close to a settlement, but Morris, who is a trained mediator, and Pyfer, a novice, proved a good team.

"I thought she was negligent because she never paid much attention to me," Morris said petulantly.

"Dr. Reynolds can say she's sorry, but I don't think she has any idea what it's like to go through life with one leg," Pyfer chimed in. Then he asked for $10 million.

Doctors came away from the experience understanding why the lawyers will take the lead in mediations, at least in the beginning.

"The most striking thing about this was . . . how difficult this is," said Lopatin, the rheumatologist.

Frank Murphy, a lawyer who attended the training, said it might be harder than the hospital anticipated to avoid malpractice filings and to persuade lawyers to be totally open with one another. Legal-filing deadlines, strategy, and payment agreements give lawyers an incentive to file in court and, sometimes, to stretch out the proceedings.

Advocates of mediation say it is often cheaper than court because there are fewer exhibits and medical experts to pay for.

Participants usually sign confidentiality agreements, a step that supporters say spares everyone embarrassment. The downside of the secrecy is that mediated cases create no legal precedent and leave no public record. Monetary settlements are reported to the National Practitioner Data Bank. But its information is available only to hospitals and professional groups, not consumers.

Some doctors also worry that mediation will be just one more step on the way to court. That has not been Drexel's experience. Of 40 cases that have gone to mediation, only three were unresolved.

Those involved in the Montgomery County experiment say it is more likely to give patients what they really want: early action, an apology, and information. "Patients want answers. That's what they want more than anything," said Sheila Stieritz, a former director of patient safety at Abington Memorial, who consulted on the pilot project. "And if it's something really serious, most patients want it not to happen to anybody else."

Intellectual Property is the product of your thinking that can be used for commercial value. In other words, you think of a song and write down the words – you have the legal right to prevent others from copying or making a song based on your lyrics. This right you have can make you money if someone is willing to pay you for your song. Maybe your boss asked you to write a computer program. Who owns the work? You may have designed a new mouse trap and have the design on computer. Or you have created a distinctive logo for your company. But Intellectual Property goes deeper than songs or even copyrights. Let’s examine the four main areas of Intellectual Property law: Trade Secrets, Copyrights, Trademarks and Patents.

Trade secrets give the owner a competitive edge. If some information has value to competitors and they don’t know about it – then it’s a trade secret. If the information was not kept reasonably safe (secret) then it’s not a trade secret. Trade secrets may be sold with the business or stolen from bad employees. Maybe a former employee didn’t sign a non-disclosure statement before going to work at the competition. Some also reverse engineer software to gain the source code. This highly protected source code for computers is their trade secret, giving them an advantage over the competition. The trick is you have to keep your trade secrets as such, secrets.

Copyrights protect all kinds of writing by singers, writers, programmers, artists, etc… These are the best known of all intellectual property. Registering with the US Copyright office can enhance the automatic protection. You must have your copyright material on paper, tape, or computer. Copyright protection applies to the “literal expression.” It doesn’t protect the “underlying” theme of the writing. It must have some creativity. You can’t copyright a simple list. You don’t actually have to have a copyright notice since March 1st, 1989. The recommended notice is “copyright” year author’s name. For example, this article will have a copyright. Copyright 2005 Stuart Simpson. But it is not necessary.

Trademarks must be a unique name, design, symbol, logo, color, container, etc…that businesses use to distinguish their goods from others in the same market. You should have a strong name for a mark, as common words receive less protection. Like Stuart’s Cold Ice Cream Company. My name and the descriptive term (cold) are weak marks. But a distinctive name like Netflix, is a strong mark. Netflix is technically a “service” mark. It falls into the same category as trademarks. Your trademark must be submitted to the US Patent and Trademark Office (PTO). But first, the mark must be put into use “in commerce that Congress may regulate.” This means you have to sell across state lines or have a business that caters to interstate or international travelers. After you do this, you can file another form to show the mark is actually being used. The PTO checks for similar marks. You can’t use the circled R just yet. You can only use this if your logo or mark has been registered.

Patent law gives inventor of new and special invention the right to use this invention for a fixed period of time. The US Patent and Trademark Office (PTO) must find that the invention qualifies for patent protection. Your invention has to be new and novel, not obvious. What do you do with a patent? Normally, the inventors get a license agreement with a company to produce the product for a period of time. In exchange, the company pays the inventor royalties for each item sold.

Intellectual property goes further in depth on each of these items. I wanted to give you a brief description to help broaden your knowledge base when writing, creating or inventing. If your work falls into one of the above categories, do more research.

by: Stuart Simpson

You can't go home again. After two federal criminal trials charging him with looting Westar Energy, David Wittig has become all too familiar with that aphorism in his six-year legal odyssey.

But if you do go home again, it seems, you should first reacquaint yourself with local legal rates, which are likely to be far less than the high prices charged on the East Coast.

That seems to be the message of he most recent legal sideshow in the Westar case, sometimes dubbed the Enron of Kansas.

First, some background: In 2002, Federal prosecutors accused Wittig and another Westar executive, Douglas Lake, of wire fraud, conspiracy, money laundering, and circumventing of internal controls in the process of "looting" Westar, an electrical utility in Topeka, Kansas.

Their first trial, in 2004, ended in a hung jury. In September 2005, the jury at their second trial convicted the men of multiple counts, but an appeals court overturned the verdicts in 2007. It also threw out many charges, saying prosecutors had failed to prove the men violated any federal regulations. Their third trial is scheduled to start on September 9.

Who has been paying Wittig's and Lake's multimillion-dollar legal bills while they have stymied their former employer all these years? Why, Westar itself. Under the company's bylaws, Wittig and Lake, as former officers, are entitled to payment of reasonable legal defense costs, at least until they are convicted of criminal wrongdoing.

Not surprisingly, Westar is getting tired of writing the checks. And so it has challenged how much it is on the hook to pay. Specifically, does "reasonable" defense costs mean reasonable for Kansas City, where Westar is based? Or reasonable for New York and Washington, D.C., where Wittig and Lake found lawyers they like?

Since 2005, Westar has fought payment of lawyers for both Wittig and Lake, suing them in separate lawsuits, claiming outrage over the high prices charged by lawyers from the East Coast — and, so far, failing miserably in each of these cases.