Denial Letters Headed to Some 275 NECC Claimants

By Walter F. Roche Jr.

While some 1,350 victims of the 2012 fungal meningitis outbreak will be getting approval letters on their claims, some 275 other claimants will be getting notices that their claims have been denied in full.
According to Fredric Ellis, a Boston attorney representing victims, the denial letters are expected to be mailed during the week of Feb. 1. He added that those getting the denials will be given a chance to cure any deficiency or seek review under a separate category.
Those preliminary numbers come at the same time victims of the 2012 fatal outbreak are being told that before any distributions from a $200 million trust fund can be made, agreements must be reached with the U.S. Centers for Medicare and Medicaid Services and major insurance carriers who paid for victims medical care.
After the full denial letters are issued, Ellis said an estimated 450 letters will go out to victims who qualified for the basic distribution but who were denied upward adjustments for special circumstances.
Those claimants will also have an opportunity to appeal and cure any deficiencies.
Just when any funds will be distributed hinges on the negotiations with CMS and early indications for a quick resolution do not appear promising. According to sources familiar with the negotiations, the proposal from CMS could result in some victims losing more from their awards than the actual cost of their medical care.

A separate effort is underway to convince Health and Human Services Secretary Sylvia Burwell to simply waive any recovery payments. A letter from four U.S. Senators has been followed by similar letters from other members of congress.

Overall there were some 3,500 claims filed by patients who contend they were injected with fungus riddled injectable drugs produced by the defunct New England Compounding Center of Framingham, Mass.
The notices are the latest development in the aftermath of the 2012 fungal meningitis outbreak which sickened some 778 patients in more than 20 states, killing 76 of them.
The trust fund was established under a liquidation plan for NECC approved by a federal bankruptcy judge. Contributions to the fund came from NECC's former owners, insurance companies and other firms who provided services to NECC.
Awards to victims are based on the severity of their illnesses. Points, valued at a little under $1,300  apiece, will be allotted based on seven separate severity levels. Initial awards based on that $1,300 figure will be limited to about half of the total points each victim is entitled to. The balance will be paid at a later date.
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