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Hospitals and Insurance Company Competing for Patients In Pittsburgh–Contracts In Question

3/29/2012 01:02:00 AM  ,  

In this case it’s Highmark and UPMC in the Pittsburg area.  It’s interesting to listen to the comments in the video and the “deals” are discussed here.  They bring up United Healthcare buying up physician’s groups and we have that big in the OC.  image

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

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…

This is really getting tough for patients and again being here in the OC I am hearing a few issues and Blue Shield is suing the part of United that is part of the two big doctor groups.  It was just a couple months ago that Blue Cross and Highmark bought NaviNet which is used by several insurance companies so the insurers here have a joint effort.  Highmark also handles a lot of Medicare through contracts from CMS. 

Blue Cross/Blue Shield Insurers and Highmark Acquire NaviNet Transactional Portal And Medical Records Vendor–Subsidiary Watch

Blue Cross and Highmark back in 2009 tried to merge with each other which I believe was not allowed as they are both obviously different companies still.  I’m glad this is starting to get some national attention as again I see it here in the OC and it’s doing nothing for patients here either.  BD 

 

WSJ's Anna Mathews examines a battle being waged between Pittsburgh's UPMC hospital and insurer Highmark over patients and how consolidation in the health-care industry is spurring similar tensions.

 

http://online.wsj.com/video/a-supercomputer-to-rival-watson-from-jeopardy/C18EA6E2-E536-48E8-8A43-8774D80306A7.html

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Orange County Oncology Doctor Who Couldn’t Stop Defrauding Medicare Will Get His License Back After He Serves Time & House Sold for Just Under $10 Million

3/29/2012 12:22:00 AM  ,  

This was the oncologist that couldn’t help himself and made millions and on top of this the government seems to have messed up with the auctioning of his big house.  The sale of his house was supposed to pay off damages and give the government some money back but the government liens were not filed against the Justices as individuals so the trustee says they will get zero.

The house by the way sold for just under $10 million so the defrauding business was good while it lasted and this was his second go around as he was slapped on the hands basically the firs time.  If there were big payments due on that house, no wonder he couldn’t help himself maybe?  BD

 

Orange County Oncologist Gets Sentenced to 18 months Prison – Diagnosed With “Co-Dependency”- Couldn’t Stop Fraudulently Billing Medicare

A technical glitch overlooked by federal prosecutors may impede the U.S. government from collecting nearly $7.6 million owed by an Orange County physician convicted of Medicare fraud.

The sale of Dr. Glen Justice’s beachfront Corona del Mar house was supposed to pay off damages and restitution he owes the government.

But a court-appointed trustee maintains that the government should get nothing from a sale now in the works because government liens were filed against the Justices as individuals and not against the trusts named on the deed.

Justice pleaded guilty in 2010 to five counts of fraud for billing the government and private insurers for expensive cancer drugs that were never given to patients.

http://lansner.ocregister.com/2012/03/23/did-feds-goof-in-convicted-doctor-case/160064/

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The Wrath of Dr. Khan–ER Versus Medicine Video (Humor)

3/29/2012 12:06:00 AM  , ,  

This is just too funny…only an ER doctor…and glad he has a sense of humor too.

 

Wrath of Dr. Khan

 

 

We certainly need a break now and then.  BD

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BATS Stock Exchange IPO Rogue Algos–Attack of the Killer Algorithms Chapter 34–See How Other Killer Algorithms Occur in Every Day Life With Healthcare & Credit

3/26/2012 10:15:00 AM  , ,  

If you haven’t figured this one out yet, it’s about computer code and “rogue” algorithms and this can happen at any time, any place and so forth.  Most all in tech know that even the best engineers cannot predict when and where but they do imagehappen and you can reflect back on the big Amazon cloud disruption that took place last year.  We don’t like it of course but it’s something we have to live with and the folks at BATS were smart in shutting it down immediately and not seeing a a self heal function would take place.  In addition, the circuit breaking “code” algorithms kicked in, which is a good thing.  Smart engineers made the right decisions at BATS and they will have to regroup and make their come back.

This is just one example on how we as consumers are all at the mercy of the Killer Algorithms at some point in time.  When you have servers running 24/7 making life impacting decisions about you that you can’t see, touch or talk to, it is frustrating for sure.  In healthcare, insurance companies live and die by their algorithms which analyze information and categorize almost everything about us. 

The big problem today is “flawed data” gets in there either by accident or by human error, or by a rogue algorithm.  Below is a digest of links and a great video that debunks a lot of the reports and methodologies used at times and how some of the marketing for profits created “designed” algorithms that specifically move money and you don’t even see it. Context is everything today and when we roll in some big data and we have some flaws in the integrity of what gets rolled in, then sometime we can’t see the bottom or the top.  Ever wonder why it takes so long to get errors fixed?  Some folks don’t update frequently enough too.  You just never know when the algos are going to bite. 

Attack of the Killer Algorithms–Digest & Links for All Chapters–How Math and Crafty Formulas Today Running on Servers 24/7 Make Life Impacting Decisions About You–Updated 3-11-2012

This also looks like a good spot to repeat the TED video from Kevin Slavin who talks about how algorithms shape our world.  If you have not seen this video, take a look now at this mini crash and see how Nanex and other companies study these rogue algorithms to find out how the machines with no input do a lot of this.  It’s machine talking to machine and again when human is in there with potential flaws, time to pay a little attention here.

“It’s a bright future if you are an algorithm” but we can’t say the same for humans right now.

This is a good time for me to repeat a link to a post I made 2 years ago and I think we are almost here in needing a Department of Algorithms or something like it very soon.  Business trumps government every time when it comes to algos for profit sadly.  BD

“Department of Algorithms – Do We Need One of These to Regulate Upcoming Laws?
How Algorithms Shape the World

Not only has BATS CEO Joe Ratterman released a letter to investors and clients, when you visit the Lenexa, Kansas firm's web page, you have the option of downloading a PDF explaining what caused the meltdown. If this self-inflected wound weren't damaging enough, the BATS meltdown also drove down Apple's stock price an estimated 9 percent with it before the circuit breakers kicked in.

The BATS IPO auction system glitch played a role in an issue resulting in the halting of Apple Inc.'s stock for five minutes. Three erroneous prints occurred that triggered a single stock circuit breaker for the AAPL ticker. Normal trading in AAPL resumed after the five minute trading pause and the three erroneous trades were later broken.

While it was unfortunate that our issues impacted another security, the industry's single stock circuit breaker system worked as planned and proved that recent improvements in U.S. equity market structure are working as intended.

http://www.advancedtrading.com/blogs/232700223?cid=twt_AT

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Discussion on Supreme Court Hearing on Healthcare Reform–How Will This Play Out With Current Day Algorithms of Commerce And Unintended Consequences-Video

3/25/2012 10:44:00 PM  , , , ,  

Do we think that they are immune from politics is one of the questions discussed here.  Granted there are changes to be made and amendments but to throw out Healthcare revision totally is not wise. When you stop and think of all the unintended consequences that will arise, it’s scary.  Again I go back to reviewing how it will play out with IT infrastructure as that’s what’s running the country anyway once it is put in place. 

You do have to admit as complicated as things are today you have to do your best to look at each portion and what changes would take place.  The business and banking areas are prepared as they always are to adjust their algorithms to maintain profit levels and THEY WILL RUN THEIR ANALYTICS and probably already have done some work in this area with projecting several different outcomes so they can move quickly in whatever direction they need.  It is what it is today with intelligence and formulas.  One health insurance company United recently hired the former US Assistant Attorney General from Minneapolis as a general counsel so that somewhat signals an area of preparedness on the part of big business here. 

Supreme Court Likely to Rule on Healthcare Law Early Next Year–This Gives The Justices Time to Rent Some Computing Space from the DOE As They Will Need It

With other attempted rulings we have had judges with potential conflicts of interest arise and this was mainly due to the fact that there seemed to be a huge neglect of mergers and acquisitions within the industry, which is pretty much still ignored to a degree and not discussed enough. 

3 Judges in Health-Care Lawsuits Caught Up In Potential Conflict of Interest-It’s Called Subsidiary Watch-Be Aware of Your Investments With Mergers and Acquisitions

Last year too I did raise the question of any judge being capable of a decision as it’s not easy and how will the language be interpreted.  Once the text goes into place, next stop is the IT infrastructure and I know many don’t like to hear this or talk about it much but again it’s the reality of world we live in today. 

Healthcare Reform Law– Is Any Judge Fully Capable of A Decision on a Law That is Challenged By Constantly Changing Algorithms?

If the ruling is not modeled correctly with looking at how each part would change and affect consumers and those in the industry, we are in for a huge roller coaster ride and perhaps more of a return to the Wild West.

The Good and the Killer Algorithms will move forward based on rulings and decisions made so again I hope the court is cognizant of this fact in what ever they choose. 

Attack of the Killer Algorithms–Digest & Links for All Chapters–How Math and Crafty Formulas Today Running on Servers 24/7 Make Life Impacting Decisions About You–Updated 3-11-2012

How many laws come to think of it are “unworkable” today?  Intellectual arguments can be made but the ultimate answer here I think is to embrace a single pay system as the bandaids are not working and again economic times have changed since the law was put in place, so to strike it down completely would also be foolish at this point.  We don’t live in times any longer where laws last forever as passed.  BD 

Does Congress have the power to mandate that everyone in the U.S. have health insurance? The Manhattan Institute's Avik Roy and Columbia University's Gillian Metzger discuss the Supreme Court's hearing of the case with WSJ Legal reporter Ashby Jones.

http://online.wsj.com/video/the-constitutionality-of-health-insurance-mandate/5714E905-AFB2-4F72-91DB-51F40A352358.html

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US Chamber of Commerce Working on Full Scale Mission With Seeking Life Sciences Opportunities in Israel

3/25/2012 09:39:00 PM  , ,  

You can see some of the major companies included in this area and when you think imageof it a lot of the Intel technologies for chips has come from Israel for a long time; however in this instance the focus is Life Sciences.  Biotech conventions in Israel are also very hot and I do website that features interviews with many of the CEOs of Israeli companies and you can view a collection here.  

Another example is the Mayor of Akron who attended the ILSI BioMed Conference last year, getting educated and seeing what biotech interests he could bring back to hospitals in his city.  BD 

video platformvideo managementvideo solutionsvideo player

The U.S. Chamber of Commerce on Sunday embarked on its first full-scale mission to Israel, with the focus on the nation’s burgeoning life-sciences sector.

The U.S. Israel Business Initiative, a special section of the U.S. Chamber of Commerce launched in 2010, is meeting with key Israeli business and political leaders. A dozen high-ranking executives from major U.S. companies, including General Electric [GE 19.78  -0.07 (-0.35%) ], Boston Scientific [BSX 5.97  -0.03 (-0.5%) ], Oracle [ORCL 28.55  -0.08 (-0.28%) ], Merck [MRK 38.005  0.41 (+1.09%) ], and MedImmune, are on the tour. Myron Brilliant, senior vice president of the Chamber of Commerce’s international division, is leading the delegation.

One of the main goals of the trip is to facilitate investment and cooperation between American companies and Israeli leaders in life-sciences industry, including companies that specialize in medical devices, bio-pharmaceutical firms, and genetic research. Over the next few days, executives on the Chamber's mission will meet with leaders in Israel’s life-sciences sector directly.

“There’s a real entrepreneurial spirit in Israel,” said Marc Perlman, global vice president, health care and life sciences, for Oracle. “It’s clear Prime Minister Netanyahu is very excited about Israeli innovation. When it comes to bringing investment into this country he gets it.”

http://www.cnbc.com/id/46850417

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