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California Physician Assistant Awarded $168M - Sexual Harassment Suit In Sacramento Against Dignity Healthcare–Formerly Catholic Healthcare West

3/03/2012 08:24:00 PM  , ,  

This is one huge award which the hospital says they are going to appeal and as the LA Times stated it could be the largest harassment award on record.  When you look at the allegations, the one that stands out that is actually a bit scary is the accusation against a surgeon who broke the ribs of a patient during during a surgical procedure in a fit of rage.  image

In addition the case said 4 others came forward to testify as well.  The PA was fired from Mercy Hospital after 2 years and stated and I assume had on record numerous complaints that were never dealt with.  The settlement may be reduced but still this is a very large case held against what was called “hostilities” at Mercy Hospital.  She stated that cardiology brings in the most money too for the hospital as it does pretty much everywhere so a lot was over looked she said as not to disturb the cash cow.  Commenters stated that even with an appeal the juries findings would probably not be changed, but only the award amount.  right now with the focus on re-admissions, hospitals are in fact looking for ways to market and bring in “new” admissions although it may not be cardiology in essence but rather more testing that could lead to new admissions if problems are found.

At A Time When Medicare is Looking to Cut Down on Re-Admissions Hospitals are Marketing to Find New Admissions As A Source of Revenue

Not too long ago a hospital group used a 3rd party to help them improve their financial position and through a notebook being stolen, it was uncovered that actual patient records were viewed by Wall Street investors with how the company planned to reduce costs at the hospitals.  They are now being sued by the state of Minnesota.

Accretive Health Debt Collector Employee Has Laptop Stolen With Non Encrypted Patient Data from 2 Hospitals And Had Access to All the Data Via Revenue Cycling - Patient Information Was Shared With Wall Street Investors – Algorithms For Profit Again?

So back on track we have bad behavior coupled with a hospital system trying to keep money coming in the door and the balance was lost along the way with patient care that seemed to take the back seat along with having a good working environment.  It was just in January of this year that Catholic Healthcare West announced their name change and their affiliation with the Catholic Church of which Mercy Hospital was part of .  Well I guess there was no “dignity” at Mercy Hospital  with this case ruling.  BD    image

Catholic Healthcare West Ending It’s Affiliation With the Catholic Church–Changing It’s Name

Ani Chopourian told of sexually inappropriate conduct, bullying and retaliation at a Sacramento hospital. The award is believed to be the largest for a single victim of workplace harassment in U.S. history.

Ani Chopourian lost track of how many complaints she filed during the two years she worked as a physician assistant at Sacramento's Mercy General Hospital.
There were at least 18, she recalled, many having to do with the bullying surgeon who once stabbed her with a needle and broke the ribs of an anesthetized heart patient in a fit of rage. Another surgeon, she said, would greet her each morning with "I'm horny" and slap her bottom. Yet another called her "stupid chick" in the operating room and made disparaging remarks about her Armenian heritage, asking if she had joined Al Qaeda.

"Cardiac surgery brings in the most money for any hospital facility, which is why they are willing to turn a blind eye to illegal and inappropriate behavior," Chopourian said. "We had four very strong witnesses who were frightened to speak out but did so because they felt it was important that someone put a stop to this."

http://www.latimes.com/news/local/la-me-harassment-award-20120302,0,1798285.story

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Senator Introduces Bill to Prohibit Companies From Using Medical Debt With Assessing Consumer Credit Scores–Attack of the Killer Algorithms Chapter 21 With Flawed Data

3/03/2012 12:13:00 PM  , , ,  

This is yet one more band aid attempt here, and not a bad thing by any means but it is what it is as this only encompasses one arm of the entire problem.  Credit agencies that are licensed through states are mining data at a rate and with volume higher than we have ever seen.  In one state, North Carolina, one agency, CoreLogic had their license removed for their behavior in both not applying and paying for updates and other areas the state felt they were not in compliance.

This is a huge mess for the average consumer too as state servers are beginning to slow down to a crawl with all the data mining bots taking over, to the point to where you and I as citizens have a hard time getting in and we are the reasons this access was put in place.  That does not make sense does it?  In addition, some states have had to go so far as to buy and install software now to keep the data mining bots out!  So what are we doing here?  The money made licensing the data mining companies is a mere pittance to say the least for their efforts.  I have covered this before with questioning credit agencies and their areas of operation.

In many cases, such as with FICO and CoreLogic some new algorithms have been defined whereby now they have found an area to where they can sell more analytics called somewhat of a “super credit” report that goes above and beyond normal items included.  It is sold as an opportunity for consumers to build a credit record but in essence all we have here is aggregation of your cell phone bill, utilities and more detailed information that really is none of anyone’s business when it comes down to it all and is just one more way for credit agencies to sell data and make millions.  Take Walgreens who on their 2010 SEC statement declared just under $800 million from selling data.  That statement alone should give you a very clear idea as to the billions that are being made by corporations selling data.  In Chapter 8 I go into some details on how this works. 

Consumers Lose More Privacy With New CoreLogic Credit Reporting–”Score” Marketed For Insurers and Employers To Gain Information-California Prohibits Potential Employers – From Using As Jan 1 - Killer Algorithms Part 8

In Chapter 6 I explain how the middle class is becoming nothing but data chasers to fix what has been entered and there are tons of flaws, and again it’s corporate USA wanting to make a profit once again. 

Attack of the Killer Algorithms Part 6–Discrimination With Consumer Credit-Same As Health Insurance Wanting Consumers to Reconstruct Records From Many Years Past As Middle Class Turns Into Data Chasers-Days of Taking Risks to Get Ahead Will Be Limited For Most…Occupy Algorithms

Why should a company set up a factory and make a product or a retail store in the same area of profits when they can buy up a few servers and start mining data with very little overhead and sell it to the public as a “huge” benefit for all the information you could ever want.  Granted there are real reasons for exchanging data and research is one of them but you don’t usually find big “profit” dollars hanging on the data either so there’s a difference between a healthy exchange to improve man kind and those that are just created imagefor corporations to make billions of dollars using “free taxpayer data” they mine. 

This is exactly why corporations are getting richer and have embraced the data selling model as there’s almost no overhead and we are their product every which way you turn.  I

f you take a minute to read the article at this next link I have my raw solution here on how to stop and slow this down as it should be disclosed on a federal level on who sells what to who as well as being licenses and taxed.  It’s a technological war out there with humans being stuffed into analytical equations every where we turn and the flawed data mounting and turning us into “bad guys” is growing.  Most employees at corporate USA companies are not trained on how to use data or to ask questions when it is “flawed” and thus so we remain under the attack of the Killer Algorithms when this occurs.  Corporate USA though knows one thing and that’s the fact that it allows them to make billions doing this though.  Banks, Hedge Funds, Facebook you name it, they are in there taking the cash. 

Start Licensing and Taxing the Data Sellers of the Internet Making Billions of Profit Dollars Mining “Free Taxpayer Data”–Attack of the Killer Algorithms Chapter 17 - “Occupy Algorithms”– Help Stop Inequality in the US

So again, as this continues on no pity from big conglomerates that you or I were unexpectedly sick and were hit with phenomenal medical bills to pay….we are the bad guys because we got sick.  Pretty crappy world and bunch of analytics if you ask me with few and small areas of forgiveness here as it seems the profits and bottom lines come first with share holder liabilities.  image

Granted there are credit scoring issues all over the world and we know with banks but again the poor US consumers get hit and the big banks and other conglomerates just keep on moving with maybe a tiny slap on the wrist, and this keeps inequality moving and shaking sadly. We have the most digital illiterate bunch of law makers that think they are doing something to create solutions when instead all they seem to do is carry around a box of bandaids that don’t stick very well or stop any real bleeding.

This is just yet one more example of those who have the technology to use it to judge and make decisions are doing it and as consumers we continue to be attacked by the Killer Algorithms until someone finally comes to their senses and sees the reality of what is happening and how flawed the data has become that they rely on. 

In the meantime, corporate USA, banks, and so on make billions off our backs right off the web and nobody has enough sense to see this or do anything about it.  The state of California passed another band aid law recently to where credit scores cannot be used as a decision making process when hiring someone for a job. 

All the OMG stories in the news today take precedence of the real mechanics that are shaping our entire economy here as many have long ago decided to take the data selling route rather than create factories with jobs as there’s no effort here and nobody is held accountable for flawed consumer data that attacks us daily.  BD 

Attack of the Killer Algorithms–Digest & Links for All Chapters–See How the Math and Crafty Formulas Today Running on Servers 24/7 Make Life Impacting Decisions About You

WASHINGTON -- Sen. Jeff Merkley, D-Ore., reintroduced legislation Thursday that would prohibit companies from using paid-off or settled medical debt in assessing consumer credit scores.

The Medical Debt Responsibility Act would assist about 72 million Americans affected by medical bill problems and medical debt.

“Medical debt is not a great predictor of a person’s credit-worthiness, and folks should not be shackled from getting loans to start businesses or buy their dream home because they got very sick,” Merkley said in a news release. “We can’t see the future to plan ahead for medical emergencies, but we can stop them from damaging our working families’ credit scores for years in the future.”

"After a sudden illness or medical emergency and the skyrocketing cost of critical treatment, the last thing families should have to deal with is a plummeting credit score. Our legislation will help put a stop to this unfair practice.”

Currently, even medical debt collections that have been completely paid off or settled can still significantly damage a consumer’s credit score for years. As a result, consumers can be denied credit or pay higher interest rates when buying a home or obtaining a credit card.

Merkley said the Medical Debt Responsibility Act would fix this inequity by prohibiting consumer credit agencies from using paid off or settled medical debt collections in assessing a consumer’s credit worthiness. In addition, the bill will require the creditor or credit rating agency to expunge the medical debt from the consumer’s record within 45 days from the day it is paid off or settled.

http://www.ktvz.com/news/30599684/detail.html

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United Healthcare Subsidiary MemorialCare Medical Foundation Acquires Nautilus Healthcare Management Who Manages Greater Newport Physicians-MDs Become Part of MemorialCare System–Subsidiary Watch

3/03/2012 01:29:00 AM  , ,  

You have to really read this press release very carefully as we all know that United Healthcare bought the Memorial Care IPA last year and now it appears Memorial Care Foundation IPA has purchased the management company that runs Greater Newport Physicians.  When it came out in the news, the subsidiary of United, Optum was the name of where it fit in the organization. 

OptumHealth (Subsidiary of United Healthcare) Takes Over Memorial IPA in California-Subsidiary Watch

So if you follow the trail of who owns who, well guess what we come right back to United Healthcare in control of yet another IPA physicians group.  If you read the story below about the ACO with Hoag Hospital and Blue Shield working together with the Greater Newport Physician’s group, we have United Healthcare thrown in here too as they, via MemorialCare IPA run this group of doctors with also having purchased the group Nautilus that manages Greater Newport Physicians.  What a mess. 

Health Insurance Contracts at the OC Corral–Lawsuits, an ACO and A Lot of Mixed Up and Confused Patients As Data Disruption and Patient Care Move Center Stage…

Meanwhile over at the other Newport and Orange County HMO, Monarch, also owned by United Healthcare we have this and a lawsuit filed by Blue Shield.  The legal suit says patients were encouraged to change plans to keep their current doctors.

United Healthcare Acquisition of Monarch Healthcare HMO Already Causing Confusion and Access Problems for Blue Shield Patients in Orange County

You can read below what the Nautilus service that Memorial purchased says and see who else is on the list for clients, Cedars-Sinai Health Group for one and this is right off their website.  Ok so via a subsidiary acquisition here, this puts United subsidiaries in several places to manage, contract and what ever else they come up with for MD reimbursement, procedures, etc.  In addition the quote below also shows an EMR NextGen listed as their “preferred solution”.  This is kind of interesting since Cedar Sinai is mentioned and they are an Epic EHR group and Untied is busy working with Epic to integrate their newly created clearinghouse subsidiary. How close is this division of United getting or is going to move in the direction of more MDs let’s say at Cedars for an example. 

OptumInsight (A Wholly Owned Subsidiary of United HealthCare Optum Division) Creates Medical Clearinghouse Integrated With Epic Practice Management Software-Subsidiary Watch

From the Nautilus website:image

“We employ approximately 350 people in areas including: administration, finance, information services, clinical, customer service, and operations.  Currently, we contract with over 500 physicians in Huntington Beach, Fountain Valley, Newport Beach, Irvine, Costa Mesa, and Aliso Viejo.  Our physician groups are top ranked in California on clinical measures and patient satisfaction.  Our groups are leaders in EMR adoption and our Physician Services Division has a growing client base for the Nautilus/NextGen EMR solution.”

My question is how is this ACO going to work with Hoag Hospital and Blue Shield and what will be the outcome of their lawsuit against Monarch and now that I have read this, again with subsidiary ownership by Untied, how complicated will this get and gee will the Greater Newport Physician’s Group be pulled into the lawsuit in time as well since they are now in the United Healthcare subsidiary daisy chain?

  Remember they bought the company that runs GNP under the Memorial umbrella Foundation IPA which is owned by Untied.  Will patients face the same frustration once this second IPA begins new potential business models?  image

Doctors of course I’m sure will want to know what’s in the next reimbursement talks and who’s standards for the ACO will be in place, Blue Shield or United or both?  Will we have yet even more issues with getting things set up with conflicting or different policies and goals for doctors to meet from each end?  This appears to be a big rats nest and brings about a good question at the link below…how many subsidiaries of one insurance conglomerate can solicit and gain contract without some conflict of interest when so many subsidiaries are involved.  One company is looking to have a bit too much power in my opinion.  BD 

Subsidiary Watch-Corporate Conglomerate Insurers Reduce Compensation Contracts Using One Subsidiary Then Market Same MDs With Another Subsidiary in Health IT
Attack of the Killer Algorithms–Digest & Links for All Chapters–See How the Math and Crafty Formulas Today Running on Servers 24/7 Make Life Impacting Decisions About You

400 Primary & Specialty Physicians Serving 100,000 Reimagesidents Join MemorialCare Medical Foundation, Creating New Division Offering More Physician Alignment Options; Nautilus to Lead MemorialCare IPA, Practice Management Services

Orange County, CA—MemorialCare Health System announced today the affiliation of Greater Newport Physicians with its MemorialCare Medical Foundation and the acquisition of Nautilus Healthcare Management Group, Greater Newport’s affiliated management services organization.

Greater Newport Physicians, created by a group of physicians in 1985 to improve health care for the community, serves more than 100,000 Orange County residents through its 400 physicians, comprised of 140 in primary care and more than 250 representing over 50 specialties. With 400 plus employees, Nautilus Healthcare Management offers services to physician groups, Independent Practice Associations (IPAs) and physician offices.

http://www.memorialcare.org/medical-group/news-press-release.cfm?id=133

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Disney Closes Fat Fighting Exhibit Sponsored by Blue Cross/Blue Shield As It Shamed and Bullied Over Weight Children - Surgeon Defined It as Horrifying on His Blog

3/03/2012 12:22:00 AM  , ,  

Well some of this is finally coming full circle with making villains out of over weight imagechildren.  We have just about villainized just about every type of non perfect behavior we have out there today and when the exhibit and the “on line game” reached a peak on this subject. 

We can shock everyone into making changes as the article describes how this can also hurt self esteem and I think in our society today with some of the anger and mean comments we see, something to think about.  Sometimes today there’s just a little too much of some of this in our face, depending on where you travel and what you do.  Sometimes a little too much negative with sending messages can back fire and that is apparently what happened here.  BD 

"I think they (Disney) likely subscribed to that common misconception that this is something we should just be able to push away from the table and cure," said Ottawa bariatric surgeon Yoni Freedhoff, whose blog post sparked a public outcry over the attraction at Walt Disney Co's world-famous Florida theme park.

"The truth is, if it was that simple to manage weight, I'm pretty confident we wouldn't have a problem," said Freedhoff.

Disney last month unofficially opened the interactive exhibit called "Habit Heroes" at Epcot, one of the sites at the park, and introduced a companion online game. 

Freedhoff blogged on February 23 about what he called the "horrifying" exhibit.

Disney closed the exhibit two days later following complaints and petition drives by other advocates for the overweight and people with eating disorders.

"The attraction and game feature negative stereotypical characters, traditionally used to torment overweight kids, will potentially reinforce and strengthen a cycle of bullying, depression, disease, eating disorders and even suicidal thoughts," the petition stated.

http://www.reuters.com/article/2012/03/03/us-usa-disney-obesity-idUSTRE82201Q20120303?feedType=RSS&feedName=healthNews&utm_source=dlvr.it&utm_medium=twitter&dlvrit=309303

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Prime Healthcare Buys Roxborough Acute Care Hospital in Philadelphia

3/02/2012 11:59:00 PM  ,  

Prime Healthcare is moving beyond the California borders for their expansion with buying hospitals who are in financial straights or in the line to be there of.  It’s easier to buy a hospital while it is still operating rather than to close everything and then look for a buyer. 

Prime had also tried to buy the 2 financially strapped hospitals in Hawaii that closed at Christmas time in 2011 where all employees received a lay off slip instead of gifts.  In addition there has been the “billing” questions with Prime and I posed the question too of whether it was humans upcoding in this instance or was it the automated input from the software.  One has to start wondering when you keep hearing the same story over and over for years with fines for billing errors.

Prime Healthcare Responds to Billing Practices–Flawed Data and Algorithms Once Again-Who Got Sold a Bill of Goods as Kaiser, Stanford & Other Hospitals Had a Ton of Kwashiorkor Malnutrition Billings

Most of the facilities when purchased by Prime undergo some major changes and many services currently provided end up being dropped.  BD 

ONTARIO, Calif., Feb. 22, 2012 /PRNewswire/ -- Prime Healthcare Services announced today that it has acquired Roxborough Memorial Hospital, located in Philadelphia, Pennsylvania, from Solis Healthcare. Roxborough Memorial is an award-winning 140-bed acute care hospitalimage that serves the healthcare needs of residents in Roxborough, Manayunk, East Falls and the surrounding areas of Northwest Philadelphia and Montgomery County.

"We look forward to improving the already excellent care provided at Roxborough Memorial Hospital and continuing the strong relationships with the local physicians and community," said Prem Reddy, M.D., FACC, FCCP, Chairman of Prime Healthcare Services. "I'm especially pleased to be associated with the residency programs and school of nursing and plan to continue their admirable and important work."

http://www.prnewswire.com/news-releases/prime-healthcare-services-acquires-roxborough-memorial-hospital-from-solis-healthcare-139995163.html

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Internal Fixations Systems–Generic Orthopedic FDA Approved Implants at 40% to 60% Less Cost –Designed And Created by World Class Surgeons in the United States

3/02/2012 12:12:00 PM  , ,  

As you may or may not know I am also a webmaster who does some websites and imagework with my sponsors and this one is again worth looking at as the company creates commonly used devices, in other words the nuts and bolts products used in many orthopedic procedures and with having the FDA approved products designed and made here in the US, that is a plus.  In addition there’s no intellectual property rights to pay for, there’s the price difference as we as patients get a break in not having to pay for big patent expenses. 

Disclaimer here is that I do the website and IT work here for SNNWire and this product fits right in with anything else I would blog about for savings and new developments in healthcare. 

You can see the latest magazine under my sponsor section for Micro-Cap Review under my sponsor and advertising section at any time which is updated quarterly.  Below is the article from the magazine which you can expand and read.  Click on the “expand” button to read the entire article. 

If you want more information and to watch a video interview with the CEO use this link for more information.  Also there’s a back link on the Medical Quack from last year below that has additional information and a video update.  Made in the USA doesn’t bad either to my ears.  BD  

“Generic Medical Devices” FDA Approved Doctor Preferred Orthopedic Implants Made in the USA Costing 50% Less

From the website:

“IFS Is committed to driving down the cost of healthcare by offering a comprehensive line of "Best in Class" implants at generic prices. IFS seeks to imagedisrupt the orthopedic implant market and redefine how implants are purchased.
We focus on commonly used, market proven products that do not have IP protection -- 80% of what orthopedic surgeons, hospitals and surgery centers use every day.

IFS implants are designed by world-class surgeons and priced to address the declining reimbursement for surgical procedures.
Our prices are 40-60% less than our competitors.”

Internal Fixation Systems, Inc. (IFIX.OB: OTCBB) is a medical device company that specializes in products that orthopedic surgeons use every day. The company focuses on commonly used, market proven products that do not have IP protections that are designed by world-class surgeons. SNNLive met with Dr. Stephen Dresnick, CEO of Internal Fixation Systems at the OTC Markets Center in New York City.

http://stocknewsnow.com/?p=3025

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Health Insurance Contracts at the OC Corral–Lawsuits, an ACO and A Lot of Mixed Up and Confused Patients As Data Disruption and Patient Care Move Center Stage…

3/01/2012 12:45:00 PM  , ,  

Well let’s start off with the positive side of this with Hoag Hospital and Blue Shield working together with the IPA, Greater Newport Physicians (the one not owned by imageUnited Healthcare) creating an ACO to better serve patients and save money.  The IPA has a long affiliation with Hoag Hospital in Orange County, CA.

To elaborate a little further here Blue Shield has already over the last couple of years worked with their technologies to benefit doctors and patients.  One contract which was awarded to a company, Office Ally is a step in that direction.  I know the company being here in southern California where they have been located for years and their primary business has been to offer “free clearinghouse services” to doctors to where the insurance companies pay.  That makes sense as the insurers are the ones who benefit with scrubbed claims.  You might remember the contract that was announced back in 2009 and as I understand this relationship has grown.  Office Ally has to create more value in addition to clearinghouse services and thus expanded to offer software as a service for billing, medical records and a PHR, which you can always find a link to here at this site.  A real life situation for e-visits was created to where doctors can get reimbursed. 

Office Ally and Blue Shield of California Collaborate to Provide Online Secure Communications Between Patients and Physicians

So when it comes to keeping something of value and not moving and changing data and patients, Blue Shield already had a working program in place and all patients who were covered under Relay Health from McKesson were transferred.  So now after this amount of time, move files again and disrupt what has been working?  The reason I say this is due to the law suit Blue Shield has filed against Monarch Healthcare IPA (the one that is owned by United Healthcare).  As you can see there are remote monitoring partnerships set up here too.  image

Office Ally Partners With Ideal Life for Remote Patient Monitoring

The AMA a while back wrote about the ability for physicians to get paid for online consults with Office Ally as well, so again with working with various areas of technology the GPS IPA sounds like they can use the technologies to work on the ACO as much is already there. 

American Medical Association Talks About Getting Paid for Online Consults – Patient Ally A Featured Solution

From the website:

“Today, Patient Ally was discussed by the American Medical Association as a physician’s solution imagefor getting paid for e-visits or online consults.   In addition to working with Blue Shield, the service is free for physicians to sign up and become part of the network.  When a doctor becomes part of the network, they are also searchable by patients and other doctors within the network. “

Patient Ally is working with Blue Shield in California to supply this service for those patients insured under the program.  If you have seen or worked with Relay Health, this is very similar and the same concept. 

Patient Ally Expanding Services to Blue Shield Customers in California

Now for what is happening at the other end of the stick, the lawsuit from Blue Shield and after reading this you might say hmmmm….as if this is in fact true to where patients are being coerced to change doctors, well we have a lot more going on here than just a visit, it’s called data and moving and shifting all of that around, not as easy as it sounds.  If the MDs are already getting paid for online consults with Blue Shield, then a change will not affect both payments and the doctor patient relationship. 

The legal suit says patients were encouraged to change plans to keep their current doctors.  United also bought another big IPA, Memorial Services up in Long Beach and from folks I speak with I heard some similar mutterings and concerns.  United does have hearings aids for seniors they make available too for almost little or no cost.  image

United Healthcare Acquisition of Monarch Healthcare HMO Already Causing Confusion and Access Problems for Blue Shield Patients in Orange County

This brings me around to Chapter 6 of my “Attack of the Killer Algorithms” series as when people and records are constantly shuffled around and data errors occur, is there anyone to fix it for you?  No you have to do it yourself and chase data so big corporations can profit huge by selling data.

Attack of the Killer Algorithms Part 6–Discrimination With Consumer Credit-Same As Health Insurance Wanting Consumers to Reconstruct Records From Many Years Past As Middle Class Turns Into Data Chasers-Days of Taking Risks to Get Ahead Will Be Limited For Most…Occupy Algorithms

Welcome to the world of discrimination by the algorithm….

The United conglomerate is getting so big and diversified that they have an entity or subsidiary to serve almost anyone’s needs in healthcare and it all goes to their one big profit center for shareholders.  If sales leads are interchanged, which I don’t’ know if they are not not, but it could one heck of a system for each entity to share information with the others and send in what ever subsidiary was needed for a sale?

Subsidiary Watch-Corporate Conglomerate Insurers Reduce Compensation Contracts Using One Subsidiary Then Market Same MDs With Another Subsidiary in Health IT

Again it’s all the call of the contract it seems today and nobody is giving a lot of thought to how the patients need time to review and consider all their moves but rather in some areas it’s a push and shove routine as you can see here we have systems in place and you just can’t keep uprooting people by the minute.   Contracts require more algorithms to run then so we truly are under the “Attack of the Killer Algorithms” today as patients and consumers.  I have about 20 chapters on this with links below.  The video at the link below is well worth watching as it will help educate you on how some of the “for profit” algorithms are created more for desired than accurate results and sadly the 2 are not always the same, as they should be, great presentation done at Google’s New York office by NYU professor Siefe, one of my favorite mathematicians.  BD   

Attack of the Killer Algorithms–Digest & Links for All Chapters–See How the Math and Crafty Formulas Today Running on Servers 24/7 Make Life Impacting Decisions About You

Hoag Memorial Hospital Presbyterian in Newport Beach has undertaken a new coordinated care model in partnership with Blue Shield of California and Greater Newport Physicians. The three-year accountable care initiative aims to provide approximately 11,000 Blue Shield HMO policy members in Orange County with integrated, cost-efficient healthcare.

The program will launch on July 1 and lasts for an initial 36 months, with the partnership agencies intending to extend the duration in order to provide a more tangible and beneficial impact on employers’ and members’ healthcare costs and expenses

.http://www.ocmetro.com/t-Hoag-joint-initiative-affordable-care-02-27-2012.aspx

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Epocrates EHR Too Late For the Show and Looking to Sell Their Mobile Medical Records System

2/29/2012 11:25:00 PM  ,  

This is kind of too sad as I have used Epocrates for years on my cell phone andimage PDA before that to look up formularies.  Even on this blog I put a courtesy search box for their web services to make it easy to look up a drug. The problem here is that they have way too much competition and the late start didn’t help them out a bit.

Epocrates Entering the Mobile EHR Market

This is just yet one more merging or selling of software as it’s happening all over and I can’t even keep up with it, especially on the insurer side of payor software.  BD 

The San Mateo, Calif.-based company acknowledged that building the EHR has hindered its ability to pursue other ways to expand its portfolio. “As a result, we are exploring strategic alternatives for our EHR offering,” according to a statement. The company noted it needed to focus more “on the natural extension of our core business.”

The company had high hopes for the EHR, as it counts 340,000 physicians on its network. But the product, which is mobile-device friendly, was coming late into a saturated market. A first-phase version of the software was not available until August 2011 and the product did not receive Complete EHR meaningful use certification until February 2012.

http://www.healthdatamanagement.com/news/epocrates-stock-ehr-electronic-health-records-44090-1.html?ET=healthdatamanagement:e2388:120588a:&st=email&utm_source=editorial&utm_medium=email&utm_campaign=HDM_Daily_022912

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Judge Says No to Cardinal–Suspension Remains on Shipping Drugs from Florida Facility–Where Were The Algorithms/Analytics To Find This?

2/29/2012 11:09:00 PM  ,  

As you read on here and with the way we use business intelligence for everything and even abuse it today in some areas, here’s a case to where the CVS pharmacy would have stuck out like a sore thumb if the average store dispenses 69,000 a year and this store dispenses 1.8 million pills.  I know any intelligence report of course would have caught that in a heartbeat but the problem is, someone has to look at it as well and bring it to the forefront.  I think the judge making this ruling is being tough as the numbers are so very far out of whack here with normal and customary numbers.   image

DEA Raids 2 CVS Stores in Florida and Suspends License of Drug Distributor Cardinal Health–Lots of Oxycodone

Then you have the other side of the coin with making sales numbers too so perhaps in the name of sales and marketing this little observation here was perhaps not that important?  BD 

WASHINGTON – Cardinal Health, a Fortune 500 drug distribution company accused by the Drug Enforcement Administration of selling excessive amounts of prescription painkillers to Florida pharmacies, must stop shipping drugs from its Lakeland, Fla., distribution center, U.S. District Judge Reggie Walton ruled Wednesday.

The DEA says the Lakeland distribution center posed a danger to public health. A DEA investigation found Cardinal shipped 50 times as much oxycodone to its four top pharmacies in Florida as to its other retail customers. In 2011, a CVS pharmacy in Sanford, Fla., purchased 1.8 million pills from Cardinal, DEA records show.

An average U.S. pharmacy dispenses 69,000 a year, the DEA said.

http://www.usatoday.com/news/nation/story/2012-02-29/cardinal-health-painkillers-florida/53307498/1

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FDA Approves First 4 in 1 FluMist Vaccine For Ages 2 to 49

2/29/2012 10:53:00 PM  ,  

We get some extra vaccine power in this FluMist vaccine it appears so I guess might as well get all you can at once and you inhale it.  Strains of two types of both strains A and B are included.  BD

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WASHINGTON (AP) — Federal health officials have approved the first vaccine that protects against four strains of the common flu, offering one additional layer of protection against the influenza virus that affects millions each year.

The FluMist Quadrivalent vaccine from AstraZeneca's MedImmune unit protects against two strains of influenza A and two strains of influenza B. The Food and Drug Administration approved the spray-based vaccine for people ages 2 to 49.

Previously all vaccines contained two strains of influenza A and one strain of influenza B, chosen annually by medical experts based on their potential to spread the virus. Having an extra strain of influenza B increases the likelihood that the vaccine will protect against illness, the FDA said in a statement.

http://www.google.com/hostednews/ap/article/ALeqM5ibXE85rONseljFyN9twquE_-qoSw?docId=0f1bacee0d3d4d109f2cde74ead44952

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Feds Bust Doctor in Dallas, Texas Area for Medicare Fraud–No Yacht and No Escape from the US Now… Biggest MD Fraud Case in History

2/29/2012 10:40:00 PM  ,  

When you read through this he had it all pretty well planned out so this was not an “accidental” case of errors with medical billing by any means.  Getting busted one and then going around to create another company to keep functioning is like really asking to be caught and there’s greed in fraud for sure.  What is also kind of funny is the book that they found that evidently was his business plan to make all the money and run, "Hide Your A$$ET$ and Disappear."image

Also too using folks from shelters and giving them grocery money and so forth was not a good idea either and if the folks were hungry well they maybe got some food out of the deal and probably had no idea as to the big over all scheme that was taking place.  Stories like this are just amazing as honest doctors fight, dig and scratch at times to get what’s owed and then you have this one who figured out how to work the system for $360 million.  Everyone got certified for care and a boiler room the article stated was in place to handle the paper work.  BD 

Federal officials say they have taken down the largest Medicare fraud scheme investigators have ever discovered: a $375 million dollar home healthcare scam operating in the Dallas, Texas area.

The alleged "mastermind" of the fraud, Dr. Jacques Roy, is charged with certifying hundreds of fraudulent claims for Medicare reimbursement, and pocketing millions in payments for services not needed, or never delivered. Prosecutors say the 54-year-old Dr. Roy, who was arrested today and could be sentenced to life in prison, operated a "boiler room" to churn out thousands of phony Medicare claims and recruited homeless people as fake patients.

The government charges that Dr. Roy was planning to take the money and run. He allegedly hid much of his Medicare money in an offshore account in the Cayman Islands, and in documents filed in court today, the government charges that Dr. Roy was planning to change his identity and flee the country to avoid prosecution. In a motion opposing bail for Dr. Roy, prosecutors claim that he had created a false Canadian identity under the name Michel Poulin, had a copy of a book called "Hide Your A$$ET$ and Disappear," and a guide to yacht registration in the Caymans.

In some cases, the indictment charges, Medicare patients were recruited by offering cash and groceries in return for signing up for home health care. These fraudulent "patients" were then allegedly certified by Dr. Roy for services. Some of those recruits didn't even have a home to visit, according to sources close to the investigation: they were recruited from homeless shelters.

http://abcnews.go.com/Blotter/biggest-medicare-fraud-history-busted-feds/story?id=15809129#.T08VuHlXWSo

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United Healthcare Buys Two HMOs in Florida–More Cheap or Free Hearing Aids for Seniors Perhaps–Subsidiary Watch

2/29/2012 12:50:00 AM  , ,  

Not too long ago the cheap and free hearing aides were in the news.  These are distributed through yet another United Healthcare subsidiary, of which there are many, more than any other health insurer has.  As you can read below the bonus was a free hearing aid for those in Miami Dade county who enrolled in their plans, to include HMOs and Medicare Advantage. 

UnitedHealthCare Throws in Free Hearing Aids for Those Who Enroll In AARP Medicare Advantage, HMO & POS Plans in Miami-Dade County From Their New Subsidiary

Maybe this is yet one more way to capture more market with United.  If you read the link below you can read up on some of their other subsidiaries and again they have a ton and you might be surprised as this is not the same company it was a few years ago as some investments are outside of healthcare.  With so many subsidiaries they are in every nook and cranny of healthcare today, whether it be owning an IPA, an HMO, their Optum Bank with deposits of over a billions, to all types of Health IT groups and they sell on heck of a lot of data for profit too from some of these divisions.  The more HMOs they buy, the more control they get on paying doctors and contracts for reimbursement. 

United Healthcare Preparing to Roll Out New Contracts To Pay Doctors& Hospitals For Meeting Goals and Keeping Costs Down– Plenty of Subsidiaries to Provide Some of the Technology And/Or Products & Generate Income–Subsidiary Watch

With all these varied subsidiaries, no wonder they hired former US Attorney General in Minnesota for their general counsel as I too sometimes wonder when the “conflicts of interests” or those of a monopoly of business sector questions will arise. They are also duking it out in Kansas and Nebraska for state and employee managed care contracts.  In Kansas, Blue Cross who is the largest in that state decided not to even bid, and again when up against the mighty subsidiary powers Untied has being being  able to bring in profit dollars from so many different areas from introducing a drug to the FDA all the way down to physician reimbursement, I do wonder how they compete not to mention the draw of the crowd for those cheap hearing aides in some areas.  image

Blue Cross and United Healthcare Duking It Out In Nebraska Over State Health Insurance Contract–We Have More Subsidiaries My Cost Algorithms Are Better Than Yours?

If they don’t get a contract then there’s always a lawsuit like the Tri-Care situation which as far as I know has not yet been resolved, so again with all the might legal powers and a new general counsel is maybe why Blue Cross gave up in Kansas?  I guess time will tell.  BD 

Update: UnitedHealthcare Sues Department of Defense Over Tri-Care Contracts–They Said They Would Do This – Is This A Case Of My Algorithms Are Better Than Yours?

UnitedHealthcare, the giant nationwide insurer, is making a major move in South Florida by announcing Tuesday it has agreed to purchase two Miami-Dade based Medicare and Medicaid insurance plans that have more than 100,000 members and eight clinics.

Terms of the two deals were not announced.

Preferred Care Partners has 55,000 Medicare members in its health maintenance organization in South and Central Florida and another 5,000 members in its Medicaid HMO. It has six clinics in Miami-Dade.

Medica Healthcare Plans has 35,000 Medicare HMO members and 7,200 Medicaid beneficiaries in Miami-Dade and Broward. It has two clinics, in Coral Gables and Hialeah.

“This is certainly a bold move by United,” said Joseph Caruncho, founder and chief executive officer of Preferred Care. “It shows their commitment to become involved in South Florida and immediately become a major player.”

http://www.miamiherald.com/2012/02/28/2665453/unitedhealthcare-buys-preferred.html

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Gordon Gekko Comes Back to Help the FBI With A Public Service Announcement to Help Fight Financial Crime On Wall Street

2/28/2012 12:22:00 AM    

This is a little off topic but interesting that Michael Douglas, who played the role, twice, was asked to do a public service video but I guess it gets attention as he played a pretty ruthless character and I watched both movies myself just as like movies.  What’s interesting is when you read his comments below that people used to come up and congratulate him on being the bad guy, he doesn’t even get where that comes from as it was a movie.  BD 

“The movie was fiction, but the problem is real,” Douglas says in the announcement. “Our economy is increasingly dependent on the success and integrity of the financial markets. If a deal looks too good to be true, it probably is. For more information on how you can identify securities fraud, or to report insider trading, contact your local FBI.”

Douglas’s spot is the latest element of “Perfect Hedge,” an initiative begun by the FBI New York’s office to combat insider trading at hedge funds, said FBI Special Agents David Chaves and Richard Jacobs, supervisors in the bureau’s New York’s securities and commodities fraud squads

Douglas told agents that decades after the movie that won him an Oscar for best actor, he’s frequently stopped and greeted as a hero and not a Wall Street villain.

Douglas said he was “startled over the positive response he received as Gordon Gekko,” Chaves said. He quoted Douglas saying, “I don’t know what’s wrong with Wall Street but I would be approached all the time, people would ‘high-five’ me or shake my hand for being this terrible man who stole people’s money. Where are the values? The culture has to change.”

http://bottomline.msnbc.msn.com/_news/2012/02/27/10519206-gordon-gekko-changes-sides-works-for-fbi

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More Birth Control Pill Recalls–Patient Found This Error with Pills in Bubble Pack in Reverse Order–The “Shitty Deal” With No Bar Codes to Make Them Easier to Find…

2/27/2012 08:43:00 PM  ,  

I goes pay to ask questions and look around anymore as you never know what you might find and obviously this woman knew her pills enough to the fact that she was able to recognize that the wrong colors for the wrong weeks were in the wrong places.  This time it’s generic pills on the hook.

No bar bodes yet to make the recalled lots easy enough to find so worth a mention again so I can sound like a 3 years old broken record here as that’s how long my campaign has been going to get the drug, device companies and the FDA to collaborate and get this going.  A few weeks ago Pfizer had their recalls with birth control pills.

Pfizer Recalls 1 Million Birth Control Packs–Where’s the Bar Codes to Help Consumers Identify? Yet One More Big Example of the “Shitty Deal” American Consumers Get

Glenmark Generics is issuing a nationwide recall of seven lots of birth control pills. The pills are labeled "norgestimate and ethinyl estradiol tablets."

Because of a packaging error, some of the pills were placed in the wrong order within the packs, according to a statement from the Food and Drug Administration. The packs contain three types of pills with varying levels of hormones, designed to be taken at different times during a woman's cycle.

Lot numbers of affected packs are as follows: 04110101, 04110106, 04110107, 04110114, 04110124, 04110129 and 04110134. The packs were distributed nationwide between Sept. 21 and Dec. 30, 2011. The complete name of the product is norgestimate and ethinyl estradiol tablets USP, 0.18 mg/0.035 mg, 0.215 mg/0.035 mg, 0.25 mg/0.035 mg (Generic).

The error was discovered when a consumer complained she received a pack in which the tablets were packaged in reverse order, the FDA said.

http://www.foxnews.com/health/2012/02/27/more-birth-control-pills-recalled/?test=latestnews

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Blue Cross and United Healthcare Duking It Out In Nebraska Over State Health Insurance Contract–We Have More Subsidiaries My Cost Algorithms Are Better Than Yours?

2/27/2012 08:24:00 PM  ,  

Ok so the title got your attention but gee if you have followed news about insurers then you do know that United has tons of subsidiary companies and Blue Cross doesn’t even come close in number and as you have read too they are not all insurance companies.  We have all different types to include hearing aids, FDA consultants, Wellness and so on.  They have truckload of data too.image

The person making the decision says it will save around $8 million a year and again you wonder do subsidiary companies figure in here somewhere along the line?  We have the China Gate subsidiary that works to promote more drugs and devices for approval worldwide and in the US for one.  I don’t know if Blue Cross has an equivalent of that type of subsidiary or not but have not read about one.  Here’s the real back breaker is that the state of Nebraska has a contract with Express Scripts and we know what happened there with Blue Cross as of the first of the year so perhaps this enters in here as I’m sure there’s many Walgreen stores throughout the state. 

Anthem Blue Cross Members Will No Longer Be Able to Fill Prescriptions at Walgreens After January 1, 2012

Well we know what happens if a rebid takes place though with government contracts, like this lawsuit they filed against Tri-Care over losingimage the bid, if you remember this, so here we go again, all about contracts. 

Update: UnitedHealthcare Sues Department of Defense Over Tri-Care Contracts–They Said They Would Do This – Is This A Case Of My Algorithms Are Better Than Yours?

They own enough companies to do all the analytics that one could desire I think and even said they would not stop short of legal action.  The Tri-Care contract for the south includes Alabama, Arkansas, Florida, Georgia, part of Kentucky, Louisiana, Mississippi, Oklahoma, South Carolina, Tennessee and most of Texas.”  BD

LINCOLN, NE – Blue Cross Blue Shield of Nebraska is challenging the state's decision to switch insurance companies for state employees to UnitedHealthcare - a decision worth $184 million annually.

On Feb. 15, the state announced that it is awarding UnitedHealthcare with a contract to administer a health plan for state employees, which will take effect July, 1 2012.

"We made this decision because United is going to save us a significant amount of money each year," said Department of Administrative Services Director Carlos Castillo. "It's about five percent, $8 million a year on average. We also looked into comparing some of the programs each company could provide to us to help make a decision to switch."

http://www.healthcarefinancenews.com/news/nebraska-drops-bcbs-state-health-insurance-provider?topic=05,19

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