Ok here's one for the “good algorithms” that audit and track back and match up claims to ensure everything was in divine order.  With analytics those who bill for things out of the ordinary stick out like a sore thumb when a large dollar amount is shown and good to see it’s finally being used to track down fraud.  In addition to lawmakers efforts there’s also the HHS Most Wanted List you can check as well if you think you have seen any of the individuals out on the loose.  Chinese medicine that was administered obviously didn’t code right:)

HHS Creates 'Most Wanted' List Website for Healthcare Fraud - Office of the Inspector General

Last year it was announced that the data base analytics would be available for law enforcement to use when looking for Medicare fraud.  BD 

Medicare Federal Investigators Getting Algorithms to Analyze And Find Fraud-Good Move as Contractors Efforts Are Weak With Risking Loss Of Transaction Revenue

A doctor and an administrator at a Garden Grove medical clinic have been arrested for allegedly billing Medicare for physical therapy treatment that was never provided, the U.S. Attorney’s Office said Wednesday.

Dr. Byung Ho Pak and Mary Lim were arrested Wednesday morning as part of federal sweep in six regions of the U.S. Pak and Lim, while working at Seoul East West Medical Center, billed Medicare $2 million for physical therapy, according to an indictment. Patients, however, were given treatments that weren’t covered such as acupuncture and moxibustion, a traditional Chinese medicine skin treatment.

The clinic collected more than $1.4 million in payment, according to the indictment.

In all, the Medicare Fraud Strike Force charged 70 people across the U.S. with $264 million in Medicare fraud. The multi-agency team uses data analysis to help identity fraud.  Also arrested in the sweep was a Los Angeles doctor who once practiced in Fountain Valley. He was charged with fraud for allegedly performing unnecessary tests or billing for ones never performed. Dr. Owusu Firempong, 60, submitted $1.3 million in fraudulent claims, according to prosecutors.

http://www.ocregister.com/articles/fraud-315957-pak-million.html

Technorati Tags: HS,fraud,Medicare Fraud,healthcare reform,Office of the Inspector General,websites,report,tips,hotline,FBI

Wait a minute, this is the most relied upon data base in the US that everyone uses, right?  Well when you look at it though we still have clerical input errors and some part of the data chain that may not flow together correctly, but we are getting better with transparency in data.  The audit came up with 6000 folks that need to be identified and when you look at Social Security as a whole and how many collect, that’s not a big percentage and some were noted going back to the 90s.  By contrast though, paying health insurance on dead employees is to me much worse and someone was asleep at the wheel.  Didn’t anybody who worked with these folks look for them?  Obviously it was the paper and/or data trail here with an HR department who stressed out in their own words and as I understand it, they have to take the insurers who collected premium payments (no medical claims here free and bottom line profit) to court. 

City of Buffalo Has Paid Over $2 Million to Provide Health Insurance for Hundreds of Dead People-Some as Many as 4 Years

Probe finds dead doctors used in Medicare scams

Then of course we have all these online doctor referral sites who have their share of dead doctors, retired doctors and just flat out flawed information out there too.

Dead Doctors and Inaccurate MD Listings On the Web Can Be a Real Hunting Ground of Information to Mine For Crooks Relative to Fraudulent Medical Billing

Again, if it came down to 6000 individuals, that’s not a bad percentage at all for all the claims they handle on their old, but still steady as a rock COBOL data system.  BD

Pundits and policymakers love to brawl over who should be receiving Social Security benefits--but it's hard to imagine any of them vying for deceased Aunt Edna.

According to a Social Security Inspector General report, $40.3 million in social security benefits have been paid to the dead since 2008. Typically, family members or funeral homes are supposed to notify the Social Security Administration (SSA) that a person has died, at which point the information is put in the SSA’s Death Master File. However, people sometimes fail to report this information and even when they do—the SSA continues to make erroneous payments.

The report finds that the SSA has made payments to more than 6,000 beneficiaries for months or even years after receiving notice that the person has died. The IG estimates that about 1,760 of these people are actually dead—the rest of the entries are mistakes. According to the IG, these erroneous death entries can also lead to “severe financial hardship and distress to affected individuals.”

Technorati Tags: Social security,dead consumers,clerical errors,SSA,healthcare,data reform,Health IT

Is this going to do it?  Time will tell as not much has enticed most consumers today with getting a personal health record started.  There are closed system, like Kaiser Permanente who automatically provide a PHR for their patients and so far the closed system seems to be working a bit better.  I have around 500 posts up at the top if this blog about personal health records and keep links here for anyone who is interested to get more information.  I keep listings of those that are free of charge, but there are many others out there as well.  The cost is from $8.50 up to $21.00 a month.  It appears you get both a usb drive and have access to your online records as well.  We shall see if this works but again I keep saying that consumers can’t see the value here yet and it’s a little work to put a PHR together and again I go back to getting consumers value in their mobile phones, like being able to find FDA recalls and then the rest will soon fall in place, mobile folks looking for a vehicle, that would be the key.  Read the link below too and see if you agree.  BD 

Healthcare Bar Code Posts

 

BOCA RATON, FL, Sep 06, 2011 (MARKETWIRE via COMTEX) -- MedeFile International, Inc. (otcqb:MDFI) (pinksheets:MDFI), a leader in Internet-enabled Personal Health Record (iPHR) management solutions, today published the official schedule for its nationally televised advertising campaign, which began airing in key U.S. metro markets on ION Television last month and will continue through August 25, 2012.

The ad campaign provides for the airing of 60-second infomercials and four different six-minute interviews with MedeFile's Chairman, President and CEO Kevin Hauser. The ad spots will endeavor to promote mass consumer awareness of MedeFile and the need for and the many benefits of MedeFile's personal health record management solutions.

The televised infomercials and interviews will air a minimum of 1,000 times over the contracted one-year period on ION Television, and may be substituted at FMW's discretion on FOX, ABC, CBS, CNN and MSNBC in the following metro markets: New York, Los Angeles, Chicago, Dallas, Boston, Philadelphia, San Francisco/San Jose, Atlanta, Washington and Houston.

Technorati Tags: PHR,Medefile,medical records,ION,television,infomercial,TV,advertising,healthcare,Health IT

This is good thing and it’s the same process that should and does take place when creating medical records, seeing and understanding both sides of the story.  We also know that the FDA desperately needs engineers just like the rest of businesses in the US as well due to the fact that many more devices have software attached either directly or wireless use.   BD

FDA and Medical Devices-Who Doesn’t Get This, They Are Looking for Engineers Just Like Technology Companies Are Doing- Get Some Congressional Digital Literacy in Place

Press Release:

SILVER SPRING, Md., Sept. 6, 2011 /PRNewswire via COMTEX/ -- Training a key step to improving device review program, strategic priorities

The U.S. Food and Drug Administration today announced two new training programs designed to improve the consistency of medical device reviews by enhancing the skills of those reviewing premarket applications at the Center for Devices and Radiological Health (CDRH).

The Reviewer Certification Program, which began as a pilot in April 2010 with participants from CDRH's Division of Anesthesia, General Hospital, and Infection Control and Dental Devices, will launch this month and is intended to include all new device reviewers.

The program includes up to 18 months of training, aimed at complementing the skills and knowledge that new reviewers bring to CDRH from fields such as biomedical engineering and health care. Reviewers in the program will complete online training modules, instructor-led courses, and obtain practical experience in the medical device review process. Courses include medical devices, food and drug law and regulatory requirements, the CDRH review process, device design, and the impact of human factors.

"We are investing resources so that new device reviewers at CDRH are equipped to handle the range of issues that arise during the premarket device reviews," said CDRH director Jeffrey Shuren, M.D. "This investment will improve the quality of submission review and make the process more consistent and predictable."

CDRH is also developing a pilot Experiential Learning Program for premarket reviewers. The program will include visits to academic institutions, manufacturers, research organizations, and health care facilities and is intended to give reviewers a better understanding of how medical devices are designed, manufactured and used. The program will also help new medical device reviewers understand the challenges of technology development and the impact of medical devices on patient care.

"Providing our review staff with opportunities to experience medical device development and use from outside the agency will provide new reviewers with a broader view of the regulatory process for medical devices," Shuren said.

The Experiential Learning Program is in the design stage and scheduled to begin as a pilot program in 2012.

Enhancing staff training is one of the 25 action items listed in the FDA's Plan of Action for Implementation of 510(k) and Science Recommendations announced earlier this year to increase the predictability and transparency of regulatory pathways and to strengthen the 510(k) process. The 510(k) is the most common pathway to market for medical devices.

For more information:

CDRH Plan of Action for 510(k) and Science http://www.fda.gov/AboutFDA/CentersOffices/CDRH/CDRHReports/ucm239448.htm

The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation's food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.

Media Inquiries: Karen Riley, 301-796-4674, karen.riley@fda.hhs.gov Consumer Inquiries: 888-INFO-FDA

http://www.marketwatch.com/story/fda-announces-new-staff-training-for-medical-device-reviewers-2011-09-06

Technorati Tags: FDA,medical devices,healthcare,Health IT,software,training,510k,science,safety,technology

This is a sad story indeed as he went to the ER and was given both pain tablets and antibiotics and he couldn’t afford both.  Gosh you wonder why this happened and someone could have given him the antibiotics and in some areas of the country they are free at certain drug stores for a limited amount.  Needless to say $4.00 at Target or WalMart would have probably done the trick and someone I’m sure would have lent him the few dollars.  Also this comes back around to which medications he chose and if he had a brain infection and was in really bad pain he maybe couldn’t get away from himself, again due to the pain.  A trip to a dentist of course was the first call that could have been made, but again when there’ s no insurance, perhaps people just don’t think clearly.  This is a sad story indeed as it played out.  BD

An unemployed Cincinnati man with no health insurance died after a tooth infection spread to his brain because he couldn't afford treatment, relatives said.

Kyle Willis, 24, came down with a toothache two weeks ago and was told he needed to have one of his wisdom teeth removed.

But Willis - whose uncle is famed bass player Bootsy Collins - decided to tough it out because he was out of work and couldn't afford the treatment.

Soon after, he began getting headaches and his face swelled, so he went to an emergency room. He was told an infection was in danger of spreading to his brain.

"The [doctors] gave him antibiotic and pain medication, but he couldn't afford to pay for the antibiotic, so he chose the pain meds, which was not what he needed," Willis' aunt Patti Collins told WLWT-TV.

While Willis' discomfort subsided, the infection continued to spread, causing lethal swelling in his brain.

Willis died Wednesday, Collins said.

http://www.nydailynews.com/news/national/2011/09/05/2011-09-05_unemployed_man_with_no_health_insurance_dies_after_minor_tooth_infection_spreads.html?r=news

Technorati Tags: infections,tooth ache,antibiotics,unemployed,health insurance,drugs,brain

This makes sense obviously as you protect your eyes and other body parts but I guess the chest area for women here was not something anyone though about much until one paintball shot hit the bulls eye.  Its either that or don’t play Paintball if you have artificial boobs is what common sense tells me here.  Just the thought of an implant covered with paint is not particularly something anyone might want to see. 

Interesting too here in the article too about a doctor working on “adjustable” implants with an implanted port that allows for adding or removing saline, so if you have a hot date and want that “extra” affect, just pump in some saline it appears:)  Back in September of 2009 there was a real popular clinical trial for saline implants and I don’t know what the results are or if this is still ongoing or not, but gee enough about this topic already and if you have implants and play Paintball better use some common sense and protect them.  I guess if the technology advances to where you can adjust, you could just drain them before going to a Paintball match maybe?  BD   

Paintball ruptures British woman’s breast implant: The 190-mph impact of a paintball recently ruptured a British woman’s breast implant. In response, the UK Paintball company began asking female competitors to disclose whether they have implants and to sign a waiver.

Plastic surgeon Dr. Jennifer Walden of New York told ABC News that implants can withstand 20 times the pressure exerted by a mammogram machine, but a speeding paintball can “damage not only implants, but bodily structures such as eyeballs, breasts without implants, cheekbones, etc.” She recommended that women protect that “assets” by wearing protective vests.

Doctor develops adjustable implant: Plastic surgeon Dr. Jeffrey Weinzweig of Chicago has created a saline breast implant that can be enlarged or shrunk from three to six months after it is placed in a woman’s body.

During the original operation, the patient’s implants are connected to medical ports, about the size of a dime, which are placed under her skin.  If a woman wants to expand or reduce the implants’ size, Weinzweig inserts a needle through the ports to add or remove saline from the implants, he says.

The ports are then removed from the patient’s body.

Technorati Tags: breast implants,clinical trials,healthcare,breast surgery,Ideal Implant,Plastic surgery,saline Bags,Paintball

Here we go again, it’s the contracts and the costing algorithms of the insurance companies that are their business models that determine what reimbursement will be.  The article states that now they are “close’ to agreement so maybe this won’t last too long, but in the meantime you can’t go there as of Setember1st and letters went out back in February that this would come around, and it did.  See how long it takes to negotiate insurer contracts today?   This means for right now you can’t go there or visit some of their physicians to get care where Steve Jobs reported went for some of his care.  About a year ago they opened a premier medial school. 

Stanford University Opens State of the Art Medical School

It’s complicated and their algorithmic business models have to allow for the projections they have analyzed and determined with their predictive software. Blue Cross has an entire IT infrastructure for this to calculate and sell to clients too, have had it for a while.  Now Stanford is pretty advanced with everything they do all over and I would expect nothing less here so in essence we may have this with the contract negotiations…as a matter of fact Stanford is probably giving them a real run for their money:)

The battle of algorithms…that’s what contracts pretty much amount to anymore.

The care given relative to Catheterization is very superior and you should read about their advanced MDs and procedures and outpatient procedures.  Sounds like Blue Cross though says we don’t want to pay that much for it maybe? 

At Stanford Hospital Coronary Stent Processes Are Done On As an Outpatient Procedure–Using the Radial Artery in the Wrist

Stanford Hospital Gives Ipads To Patients in the Catheterization and Angiography Labs

And they have the very much anticipated clinical trials for stem cell treatment of the spinal cord.

Stanford Joins Geron Spinal Cord Clinical Trials Program as the 3rd Location in the US

Anthem filed a letter of transition with the State Department of Managed Care and as I read here access to the doctors will be extended until September 16th.  One nice plus though here is that transplant patients don’t have to make a change, thank goodness and the ER rooms don’t require pre-authorization so maybe Stanford ER rooms might be a little busier.  They have been going at this since before February on a new contract.  It further states that Blue Cross HMO has the right to send patients to another doctor.  If one is PPO you might face higher co-pays since I would maybe guess you could be subject to out of network charges.  Just a couple months ago HP committed $25 Million to the Children’s Hospital and Intel has kicked millions to the University as well. 

HP Commits To Invest $25 Million To Stanford’s Lucille Packard Children’s Hospital To Include HP Labs Collaboration

All of this with medical care today just really stands to strengthen the need for a Public Option for sure.  Contracts leave peoples lives, and in the case of the doctors, their livelihoods up in the air. 

Again Stanford is world known for their technology with healthcare, but we are like I said, back to those costing algorithms and with Blue Cross figuring out how to maximize share holder dividends.  Insurers can’t negotiate a contract in a years' time so its time for inconveniencing patients and consumers off in other directions as deadlines today seem to mean zero as far as getting that part of the job done.  BD 

Patients with Anthem Blue Cross health insurance stopped having coverage at Stanford Hospitals and Clinics on Thursday (Sept. 1) after contract negotiations were not resolved, according to an Anthem document Palo Alto Online received yesterday.
The contract termination means that Stanford University Hospital, Lucile Salter Packard Children's Hospital (LPCH) and Stanford Medical Group might not be in the Anthem insurance-plan network. Authorizations and copay amounts could change for patients with the HMO and PPO plans, Lucile Packard spokesman Robert Dicks said.
The hospitals sent Anthem a letter on Feb. 25 informing the insurance giant of the termination on the contract's Sept. 1 expiration date.

http://www.paloaltoonline.com/news/show_story.php?id=22374

Technorati Tags: Stanford,Blue Cross,Health Insurance,hospitals,healthcare,Heatlh IT,doctors,patients,in network,disruptions,co-pay,contracts

It’s always interesting to occasionally look at what is being done outside the US and SAP has developed an EMR that connects to Siemens and other middleware use in Europe.  In addition SAP also has their Collaborative E-Care solutions to connect patients and doctors as well for remote monitoring and communication.  SAP is a big software manufacturer world wide and I was not aware of their mobile medical records business until of late, and they do have all types of other healthcare and other industry software they sell. .  The next release is to be fully two way as right now it’s pretty much just read only.  I think the US has so many EHR vendors here that in this industry perhaps they do a bigger market over seas, but don’t quote me on it as this could be a stepping stone into more business here. 

Patients will be able to enter information for their end with the PHR.  The format looks nice and easy to read and somewhat reminds me of the screens on a EMR demo from Microsoft from a few years back.  From what I am reading and seeing this looks like a mobile user interface that works with several back end data bases, with Siemens being at the top with already having connectivity.  BD 

Jan Korten, a solutions manager at SAP, and Thilo Berndt, the product development manager for SAP’s mobile healthcare apps, debuted the EMR app during an August 31 Webinar. You can watch the 1-hour presentation and slides here. But in the meantime, here’s an illustrated summary of what they covered.

Ten SAP developers in Europe have been working on the EMR app for the past 3 months. Just finished, the app - iPad today, Android tablets like the Samsung Galaxy Tab tomorrow - is about to be piloted by a trio of European hospitals and then released at the end of October, says Korten.

 

There’s a lot of talk about how a smooth, slick user interface is an important competitive advantage. In healthcare, however, an easy-to-use, powerful UI is mission-critical. While doctors are often very gadget-y, they are also impatient and too busy to deal with a lot of training. An intuitive UI that easily delivers the right information can actually “save lives,” says Korten, a former doctor himself.

The next version will use the Sybase Unwired Platform (SUP) middleware to store more data locally for offline access, handy when doctors are in network “dead spots” within a hospital. It will also be able to download data via 3G.

Here’s the high-level technical architecture: app running on multiple devices (some now, some later), multiple applications and data sources on the back-end, and the SAP Mobility Platform in the middle. This lets the devices access servers via one of three ways: SUP, SAP Gateway, and Netweaver. SAP today ties into Siemens’ i.s.h. medical records platform. According to Korten, the roadmap includes the ability to tie into Picture Archiving and Communications Systems (PACS) and Lab results databases built by 3rd parties.

With Collaborative eCare app, patients can upload data on their symptoms and medicines taken to their doctors while at home. Doctors can adjust dosages and change prescriptions and set reminders for patients to take their medicines via the app. Alerts can even be sent via text message to the patients.

http://www.zdnet.com/blog/sybase/how-two-sap-mobile-health-apps-can-improve-patient-care-mhealth/1484

Technorati Tags: SAP,medical records,software as a service,healthcare,Heatlh IT,PHR,eCare,Ipad

I can’t help but think back with covering Health IT to once again go back to what I said in August of 2009…but who in the heck am I, just someone who wrote code for a while and knows how this takes place and works against the digital illiterate or those in denial, not fair.  If you visit the link below you can go back and hear Harry Markopolos and his testimony in front of Congress, kind of timely right now.

“Department of Algorithms – Do We Need One of These to Regulate Upcoming Laws?

The current administration still has a few executives hanging around that don’t appear to exercise any consumer IT literacy and they kill us and waste a lot of time being non participants, but worse over on the other side we have the Drama Queen antics of the GOP. 

Madoff's Scheme – One Reason To Put the “Smart People” in the Right Places So We Don’t Get Fooled Again

You know people who understand the complicated code process just sit and shake our heads while watching news being reported somethings more for OMG status and ratings, but that’s what we have right now and it’s not all that way, mostly the political news it seems.  Look who was one of the first to break the silence, the IT guy who of course had this long figured out but was paid well. 

Madoff Employee Breaks Silence – The IT Guy Talks about the “Root Kits” of Madoff’s Wall Street

“The three managers who ran parts of the businesses were getting $500,000 to $750,000 a year and they didn’t even know anything about modern computerized trading,” the employee said.  The employee was part of a trading group, which was able to break a security code that he says led them to a site that was supposed to be seen only by the Madoff family. It showed the profits and losses of the legitimate businesses. Even in years when they grossed $25 to $50 million, they calculated in the outlandish costs and thus concluded that the firm barely broke even and some years lost money”

The SEC has had to learn some hard lesson and now is working to correct that image and want coders around to help them too and this was from yesterday, September 1, 2011.  Give the SEC the coders they need as HFT is going to shift again as the hardware war is coming to a close and the next move is to rework the algorithms for the transaction, query and other factors to see if they can optimize with software over the next guy, but never mind the extra exposure to potential corruption and some of these folks over clock their server processors too, and you just thought it was kids that did that with the need for speed with gaming

FINRA and SEC Asking High Frequency Trading Firms To Hand Over the Algorithms of Their Trading Strategies And Code–Time for That Department of Algorithms?

So enough of my long article lead in…here’s the trailer and hopefully it will be a good accounting when the movie is released.  The trailer looks pretty good with actual footing in there. 

Chasing Madoff

Nobody wanted to do the math except Harry Markopolos and nobody listened to him, there are crooked algorithms in this world and healthcare got burned in several areas here too, a couple examples below.  BD

Madoff Scam Hits Harvard Medical School Grants and affiliate Beth Israel Medical Center

Mayo Clinic – Madoff connection with funding Gastrointestinal Research

http://www.thereformedbroker.com/2011/09/02/chasing-madoff-trailer/

Technorati Tags: Madoff,fraud,NASDAQ,healthcare,movie,Greed,Whistle Blower,Healthcare,Fraud,Physicians,Wall Street,Massachusetts,Charity,Donations,Investors,technology,SEC,Cancer Donations,Boston,Foundations,Ponzi,Beth Israel Deaconess of Boston,Harvard Medical School

Occasionally I step over into a bit of the financial side of things and the reason for this post is that back in August of 2009 I made a post about the US needing a Department of Algorithms…hmmmm…not far off now is it, call it what you like but audit functions for code should be upon us about now, we need it.  You can read the post at the link below which I created due to the Madoff situation and the Harry Markopolos testimonies. 

Tuesday, August 25, 2009

“Department of Algorithms – Do We Need One of These to Regulate Upcoming Laws?

“In healthcare we have an agency that every likes to complain about called CCHIT that certified the safety, accuracy, and interoperability of healthcare records, just wonder why this process might not be explored in other areas where transactional data exchanges are taking place.  We want our medical records to be accurate and concise, so why not the same with our investing?  This is just a question I pose.”

---

Also we have tons of algorithms running like crazy in healthcare with insurers and other financial institutions that could also use the same auditing.  We go to great lengths to certify the software and algorithms contained within for medical records, but do we hold any of the accounting algorithms of the insurers accountable…no.  This has gone on a long time and not the first time I have suggested such a process here.   Algorithms should be written to give accurate results and many are written for desired results which are not always on in the same with the word accurate. 

FINRA reports to the SEC and focuses requests on flawed codes to understand how they are constructed.  This has moved up a notch from the original requests as more information is now being requested. FINRA has also beefed up their staff with more individuals WHO UNDERSTAND CODE.  I still think back to the Goldman case and I have often wondered how the entire case went down with having a full understanding of what actually happened. 

The former coder stated that he accidentally moved some code, and I have done that, but again I’m not writing anything as sophisticated as stock market investing software, so that part could have been true and again I wrote my opinion up when all of this was current, and stated you do need to understand the “value” of the code so as not to incriminate someone using a partial open source module for example. We all do that and build additional code on top of perhaps several open source models put together and have them fully function to fit the request of the software.  Also, a couple of other relative posts from the Medical Quack in 2009 below: 

Goldman Stolen Code – Has Algorithmic Fraud Become A Business Model in HealthCare Too?

Are We Ever Going to Get Some Algorithm Centric Laws Passed for Healthcare!

This is really a good time to start asking questions on CODE as more personal data and profile information is sold on the internet and while it may be good for gathering statistics, we have those who narrow some of these queries down to an individual level and you end up with flawed data and algorithms that are sold beyond what they can really deliver in the way of business intelligence.  In healthcare I am always happy to see HP or Microsoft provide their services as they do not have a stake with another subsidiary who can profit with algorithm designs of a subsidiary when it comes to reimbursement or revenue cycling. 

Again, I stand on my suggestion for a Department of Algorithms that I wrote about 2 years ago all the way around for financials and healthcare, as we want accurate and honest code that will not fleece consumers as we have had our fill of that and the economy and the redistribution of the money speaks for itself.  Call it whatever you want but get some auditing done with some REAL CODERS who can dig in and find both the flaws and the accuracies. 

In the healthcare/insurance side of regulation we have actually had one state legislature begin to question the same thing with insurers and ask for their CODE.  Back in October of 2010 I wrote about their inquiry here:

New Jersey Legislature Getting Smart– Bill to Modify Claim Procedures to Include Asking For Insurance Company Algorithms-Bill A3334

If you are lost in the math in this article, pick up a copy of this book, “Proofiness, the Dark Side of Mathematical Deception”…more at the link below and that will explain enough to perhaps bring a basic understanding of how math and algorithms if not done accurately can be far from reality at times. 

“Proofiness–The Dark Side of Mathematical Deception”–Created by Those Algorithms–New Book Coming Out Soon

One other bit of back information, some insurers get sued over their algorithms too.

Insurance Companies Under Attack with Lawsuits – Generated by Their Algorithms

We all remember the AMA legal case against United which was 15 years of paying lower than customary fees for doctors and patients who required out of network services and lawsuits are still going on that one as so many of the insurers subscribed to the data base used by the subsidiary of United.  There are outstanding cases against Blue Shield, Aetna and more who licensed use of that data base.  It was just about a two years ago that HealthNet finally agreed to pay claims at a level of 14% above what the data base called for.  It all comes back around to those algorithms. 

So after reading this far, again it seems fair to link the algorithm audit processes here to both the financial and healthcare sector as they are all transactions where someone gets paid and we want accurate and correct formulas used.  One more mis match that has bothered me of late is the credit agency FICO claiming they can sell analytics with free information from the web combined with a consumer credit score to sell this to insurers and pharmaceutical companies as predictive analytics to determine by a score if a patient will take their meds.  You don’t have be a coder to figure out that while this might make a good report for overall statistics if you want to query the information for relevance, but to take it down to a one on one bases with flawed data, it’s wrong and it’s mis matched false intelligence algos being sold.  Don’t be fleeced on this one, no matter how good the marketing looks.  My write up in FICO was carried over by a reader to the Daily Kos. 

FICO Analytics Press Release Marketing Credit Scoring Algorithms to Predict Medication Adherence–Update (Opinion)

So while FINRA is opening the door to audit code, we could certainly use some of that in healthcare transaction audits as well.  We had the case last year with Blue Cross running the “breast cancer” algorithm that was reported in Reuters that had to be corrected. 

And one one last closing note here, we have so much of our personal data being sold and million and billions made from all of this, and there’s no way you can stop the algorithms so next step, license those folks and tax them, healthcare could use a bit of this money coming back to help doctors and hospitals on the brink of bankruptcy with reduced contracts signed with insurers created by algorithmic business models.  Big business uses them all the time and laws just can’t keep up.

Privacy Wanted–So Let’s Require Those Who Sell Web Data to Register and Tax the Transactions and Publicly Disclose Who They Sell To With a Federal Registry

There’s nothing wrong with using algorithms and software today for analytics, and we need and depend on them to run so many areas of our lives and business, but if they are not accurate and are only created for “desired” results where monetarily someone has to lose, well it’s time for that Department of Algorithms to certify that they are in fact fair and creating fair game for all. 

Further more we need lawmakers to also make the effort to use technologies that are up to date and allow for better decision making to stop some of the intellectual fleecing that we have seen for the last number of years.  We have lawmakers who want to put data out for public use that has tons of flaws and errors and have no clue on the cost.  HHS and enforcement agencies by all means need access but again with what is proposed here and the ROI on the expense of this is just not there.  We have for profit MD and hospital rating services all over the web with flawed data to include dead doctors and other information thieves can mine for fraud and correcting that information certain supersedes this project by all means.

Digital Illiteracy Is Killing Us With New Bill Wanting MD Medicare Compensation Put Online-No Clue on the Cost, Time and Truckloads of Errors to Audit and Correct

So let’s beef up our IT infrastructure and get lawmakers and the audit enforcement agencies the intelligence they need to investigate and ensure that the “secret sauce” algorithms used today are all on the up and up.  If lawmakers used better technology to study and query, we would also have better laws for the agencies to work with from the beginning, it’s a technology team effort here.  BD   

IBM Watson Capabilities Being Pitched to Financial Industry-Congress Must Not Have Felt They Needed This So Further Behind We Fall With Effective Intelligent Lawmaking

(Reuters) - U.S. securities regulators have taken the unprecedented step of asking high-frequency trading firms to hand over the details of their trading strategies, and in some cases, their secret computer codes.

The requests for proprietary code and algorithm parameters by the Financial Industry Regulatory Authority (FINRA), a Wall Street brokerage regulator, are part of investigations into suspicious market activity, said Tom Gira, executive vice president of FINRA's market regulation unit.

"It's not a fishing expedition or educational exercise. It's because there's something that's troubling us in the marketplace," he said in an interview.

Most of the algo-related requests, he said, have been made to hedge funds that use quantitative trading strategies.

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This is a breath of fresh air as cancer donations have not been in the news as much as they have been in the past due to economic conditions.  The research money will center around genomics at Johns Hopkins relating to finding cures for cancer. 

With opening the Center for Personalized Cancer Medicine at the Johns Hopkins Kimmel Cancer the donation could not have come at a better time.  In addition the Goodwin's have also made other major donations to other centers relative to providing funds for cancer research.  BD

Philanthropists William H. Goodwin Jr. and Alice T. Goodwin, known for their generosity in supporting local causes, have given $30 million for cancer research to Baltimore-based Johns Hopkins University.

The money from the Goodwins' Commonwealth Foundation for Cancer Research is being used to establish a research center focused on gene-based, personalized cancer treatments.Goodwins' Commonwealth Foundation

"We are now entering into a new phase or era of cancer research, and it's going to center around genomics," Goodwin said last week.

Over the years, the Goodwins' foundation, which was established in 2002, has made generous donations to other cancer centers, including Massey Cancer Center at Virginia Commonwealth University, the University of Virginia Cancer Center, Memorial Sloan-Kettering Cancer Center in New York City, and M.D. Anderson Cancer Center in Houston.

"The Commonwealth Foundation of Virginia and the Goodwin family have been very generous to VCU Massey Cancer Center and to Virginia Commonwealth University as a whole," Massey Cancer Center spokeswoman Jenny Owen said. "We're very grateful for their ongoing support.

William Goodwin sold AMF Bowling for $1 billion in the late 1990s.

http://www2.timesdispatch.com/business/2011/aug/28/tdmet01-philanthropists-give-30-million-to-johns-h-ar-1268861/

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I like this video and it has some important messages and boy do we see this today.  Gee I see it all over Twitter every day with judgments and a little less caring than what we used to have.  If someone’s numbers is skewing a study, let’s kick him out, he’s the bad guy making a mess out of our study.  In reality the bad guy maybe just needs help and there within lies this conflict of interest.  I don’t put posts on this blog that tells everyone what to do and repeat “Magpie” news items where everyone feels they need to repeat to reach those “bad” guys, as education is so much better and you just make those folks feel bad or they get mad. 

It’s like if I see one more article on how medical records improve care, I want to scream, that battle has been won a long time ago and we know they do, but people continue to feel this burning need to keep reiterating it all the time.  I’ve even had other folks on Twitter agree with the fact that they are tire of it too, so let’s move on and go to the next level and work on the mechanics, security, implementation and so forth as there’s a lot of work there to be done.  The message in this video kind of tells us to be aware of our own “Conflicts of Interest” and take a different view here and there and that’s not a bad idea.  Check out the video on the black spots on his face and his recovery process here as he was badly burned in an accident.

Conflicts of Interest

In life we encounter all kinds of people, many biased and sometimes we too get blinded with conflicts of interest.  He found he was interfering with his own science with his bias.  Something to give some thought too with trials and studies.  BD 

http://www.youtube.com/watch?v=n8Y8FK8gonc&feature=digest_refresh_thu

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This is different in the fact that a social network is going through a “clinical trial” to see if the extended care and offerings helps reduce re-admission to the hospital.  All security standards and HIPAA compliance entities are in place and the patient’s records would be coordinated with those at the hospital.  The doctor sets up the plan for the patient, and it looks pretty straight forward and is all about communication and records with being able to use both the patient and clinical input. 

Patients would be able to upload their information for review so remote monitoring would be possible.  Messages sent to medical teams would all be encrypted.  With knowing the diagnostic codes the clinicians can build the plan consisting of learning, monitoring and support.  Nurses, caseworkers and health coaches could also be involved with adding support.  This looks a bit different than what I have seen thus far with actually using the patient information.  The difference here from what I have covered about other systems that are out there is the involvement of the physician after leaving the hospital with the patient not feeling they have not been the baton being passed to the next person.  In addition having the ability to communicate with a “peer” patient is a plus too as that has been a missing puzzle piece that has lead patients to the internet and if you have someone in a group with a similar or same issue who is also local, it could be a good thing.  If one is not available though, the internet is still there as well.  BD 

A social network that doctors can prescribe to their patients: that's the idea behind a new San Diego startup called Wellaho. The company creates software to manage and support patients after they leave the hospital by bringing together different parts of a patient's support system. Doctors, family, and friends could all be part of the network, which can be customized for individual patients. The system will begin clinical trials in three large San Diego hospitals next month, with a larger rollout planned for 2012.

Other patient-based networks, including PatientsLikeMe, HealthCentral, Inspire, CureTogether, and CaringBridge, are gaining popularity with the chronically ill. But this one is different, says Wellaho's founder, Naser Partovi. "It's prescribed by a doctor, and it involves clinicians as well as friends and family. It's much more controlled."

Social networking is only one aspect of the system, says Partovi. It also gives each patient access to information about treatment options and clinical trials, and a place to record and monitor ongoing health progress in addition to communicating with doctors or caretakers. "All three of those parts—learning, monitoring, and supporting—are personalized for each patient," says Partovi. "We know their diagnosis and treatment codes, and we can build a special system around each diagnostic code."

http://www.technologyreview.com/biomedicine/38456/?p1=A3

Technorati Tags: Wellaho,San Diego,clinical trials,hospitals,re-admissions,healthcare,doctors,patients,outpatient management,peer patietnts