Half or Better of the Accountable Act Call Center Jobs Will Be Part Time With No Benefits in Contra Costa County, California

<p>This pertains to one of the call centers and ironically these people get no benefits and might just have to fork out and pay for insurance themselves through the exchange.   In reading this article, there seems to be some confusion, mismanagement or both of the above in how many of the jobs were to be full time and how many were to be part time.<img align="right" alt="image" border="0" height="196" src="http://lh5.ggpht.com/-OIzLec_Go6g/UfNLsJ9hiII/AAAAAAABHVw/e-92BoKa-n4/image%25255B3%25255D.png?imgmax=800" style="background-image: none; border-bottom: 0px; border-left: 0px; padding-left: 0px; padding-right: 0px; display: inline; float: right; border-top: 0px; border-right: 0px; padding-top: 0px" title="image" width="218" />  It sounds like everyone thought they had a full time job until decisions were made.  The full time employees work the day shift and the part time fill in after regular hours it sounds like.  </p> <p>They had over 7000 applications for just over 200 jobs and one person said they quit another job to take this job and found out later it was only going to be part time.  Part time pay will range from $15.33 to $18.63 and the part time are given the option of purchasing their own insurance but it runs from $600 a month all the way up to $2900 a month, typical of what we see in many places today so the part timers might really have to depend on getting a break by purchasing their own insurance through exchanges.  You can see where the union has become involved too with asking the county to pick up 80% of the cost of the premiums since the employees will be Contra Costa County workers.   </p> <p>I guess things could be worse if they were outsourced to the Philippines, India or elsewhere but I think due to the complexities of the project and the constant changes it will be challenging enough to stay on top of it here without adding that element..  BD</p> <p> <hr /></p> <p>CONCORD -- Earlier this year, Contra Costa County won the right to run a health care call center, where workers will answer questions to help implement the president's Affordable Care Act. Area politicians called the 200-plus jobs it would bring to the region an economic coup.</p> <p>Now, with two months to go before the Concord operation opens to serve the public, information has surfaced that about half the jobs are part-time, with no health benefits -- a stinging disappointment to workers and local politicians who believed the positions would be full-time.</p> <p>The worker said no clear reasons for the change were given.</p> <p>Those who became part-time were told they would have to pay full freight on their health plans, ranging from $600 to $1,200 a month for a single worker and between $1,400 to $2,900 a month for an employee with a family. That is a steep bill for employees with part-time jobs paying from $15.33 to $18.63 an hour. </p> <p>Another applicant said he ditched another job offer after getting a congratulatory hiring letter from call center operators in June, only to be given the runaround in the months since.</p> <p>During negotiations months ago, Service Employees International Union Local 1021, which represents the customer service agents, demanded 80 percent of health insurance premiums be paid by the county, and 20 percent be paid by the employee. SEIU did not return a call for comment. </p> <p><a href="http://www.contracostatimes.com/news/ci_23733819/concord-half-call-center-jobs-will-be-part">http://www.contracostatimes.com/news/ci_23733819/concord-half-call-center-jobs-will-be-part</a></p>

Half or Better of the Accountable Act Call Center Jobs Will Be Part Time With No Benefits in Contra Costa County, California

This pertains to one of the call centers and ironically these people get no benefits and might just have to fork out and pay for insurance t...

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UnitedHealthcare Expands Their Cheap Hearings Aids Subsidiary With Marketing To Add More Profits To the Corporate Bottom Line and Sell More Devices And Policies –Subsidiary Watch

<p>If you read here often enough then you know United has more subsidiaries than Carter has pills as the old saying goes.  I do these posts so people are aware when they spend their money today so they have <img align="right" border="0" src="http://lh5.ggpht.com/_v3zjJigoAPE/TXCfvYCDCBI/AAAAAAAAsv0/8biVjC7dBI0/image_thumb%5B1%5D.png?imgmax=800" style="background-image: none; border-bottom: 0px; border-left: 0px; padding-left: 0px; padding-right: 0px; display: inline; float: right; border-top: 0px; border-right: 0px; padding-top: 0px" />an idea as to what big conglomerate benefits with profits to their bottom line.  The article states provided via Optum, which is a “tiered” subsidiary of United.  Back in October of 2011 we had this with seniors by way of claims/billings/contracts basically getting a free hearing aid if they signed up for a certain United Healthcare policy.</p> <h5><a href="http://ducknetweb.blogspot.com/2011/10/unitedhealthcare-throws-in-free-hearing.html">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</a></h5> <p>The company distributing the hearing aids is a subsidiary United created to market and sell them, tiered subsidiaries again.  So if you sign up for a policy and buy a hearing aid they win twice if you will with getting more money from you.  </p> <h5><a href="http://ducknetweb.blogspot.com/2011/10/united-healthcare-gets-in-medical.html">United HealthCare Gets In the Medical Device Business–Distributing Cheap Hearing Aides Sold Via Hi HealthInnovations Division –Subsidiary Watch</a></h5> <p>The devices come from China and by the way here’s another <img align="right" border="0" src="http://lh4.ggpht.com/_v3zjJigoAPE/S_Tii4WcdQI/AAAAAAAAeJ4/bTymG0SSet4/image%5B5%5D.png?imgmax=800" style="background-image: none; border-bottom: 0px; border-left: 0px; padding-left: 0px; padding-right: 0px; display: inline; float: right; border-top: 0px; border-right: 0px; padding-top: 0px" />United subsidiary, a company in China working to promote Chinese drugs and devices worldwide to include the US.  <strong>I3 is a company owned by Minnetonka-based UnitedHealth's technology division and is located in Shanghai.  <a href="http://ducknetweb.blogspot.com/2011/01/ingenix-subsidiary-of-united-health.html">In 2011 i3 sold part of their clinical trials business</a> (yes they were in that too) but kept ChinaGate.  </strong></p> <h5><a href="http://ducknetweb.blogspot.com/2010/05/unitedhealth-subsidiary-ingenix.html">UnitedHealth subsidiary (Ingenix Subsidiary I3) Acquires ChinaGate – Working to Sell Chinese Products Globally</a></h5> <p>Many employer plans with United already offer the Chinese manufactured hearing aids as well.  Again especially today it’s interesting to know where your bottom line dollars go and to where shareholders benefit based on your purchases.  In other <a href="http://ducknetweb.blogspot.com/2013/07/united-healthcare-files-lawsuit-against.html">United news they are suing the city of Birmingham</a> over a contract award and as we all know they sued DOD to get a chunk of the Tri-Care contract.  You know if those folks are not under contract with United, they can’t get access to the “cheap hearing aids” (grin).  </p> <p><strong>Who knows if this will be the next marketing push to get more folks to buy policies or will the company sign contracts with all the other major insurers to sell their hearing aids?</strong>  I’m sure they will run their business analytics to see which path will generate more money and profits before making such decisions.  If you go back to the out of network data base that Ingenix( now OptumInsights) had to short pay doctors and hospitals that went on for 15 years and ended in lawsuits, all the other insurers paid United to license it to increase their profits, so who knows. If the other insurers complain about a marketing edge here, well they cut them in right? An <a href="http://ducknetweb.blogspot.com/2013/07/one-pioneer-aco-saved-money-using.html">AMA subsidiary makes money selling software analytics developed by a United subsidiary</a> too and the <a href="http://ducknetweb.blogspot.com/2009/12/ama-announced-settlement-of-class.html">AMA were the ones who filed the class action suit against Ingenix</a> so strange bed fellows at time and it all goes back to money. </p> <p>We also have a subsidiary of United building t<img align="right" border="0" height="290" src="http://lh5.ggpht.com/-AiPngFSVfCk/UcDpraNTYvI/AAAAAAABG_8/VmtyC7Q1TUk/image3.png?imgmax=800" style="background-image: none; border-bottom: 0px; border-left: 0px; padding-left: 0px; padding-right: 0px; display: inline; float: right; border-top: 0px; border-right: 0px; padding-top: 0px" width="319" />he new federal data hub, as United bought the company two weeks after HHS awarded the contract so there’s a lot of buying up government contractors going on here too.  All of the tiered subsidiaries allows big conglomerate to “hide under the public radar today”.  </p> <h5><a href="http://ducknetweb.blogspot.com/2013/06/qssi-subsidiary-of-united-healthcare.html">QSSI, Subsidiary of United Healthcare Building Federal Data Hub Gets Busted by the Inspector General Regarding USB Security And Compliance With Federal Requirements</a></h5> <p>So many think that all the health insurers are just focused on selling polices and that is not the case today as with subsidiaries there’s a lot more strategic mergers and acquisitions going on than you may be aware of.  We also do wonder <a href="http://ducknetweb.blogspot.com/2012/06/us-health-insurance-regulator-leaving.html">about former HHS regulator, Steve Larsen leaving last year who was responsible for writing a big portion of the Healthcare</a> law and he now has a big VP job at the Optum division of United.  Years ago this didn’t make a ton of difference but it does today with tiered subsidiaries as that’s where a lot of the action is taking place.  </p> <p>Anyway, if you want to read more on subsidiaries just search for “subsidiary watch” here and here’s a group of United subsidiaries linked on a post I made recently.  They are everywhere and even <a href="http://ducknetweb.blogspot.com/2013/06/blackstone-is-not-only-corporation.html">some day might be one collecting your rent check as an example with their investments in middle and low income housing in New Mexico.</a>  In addition, there’s the ever growing <a href="http://ducknetweb.blogspot.com/2013/07/unitedhealthcare-making-bigger-aco.html">purchase or acquisition of physicians and surgical groups across the US, latest being Beach Surgical Holdings,</a> another new subsidiary that has been created under the umbrella of the non profit Memorial Care Foundation which is a physicians group they purchased a while back.  BD  </p> <h5><a href="http://ducknetweb.blogspot.com/2013/07/health-insurance-business-under-radar.html">Health Insurance Business Under the Radar With Tiered Subsidiaries–Where All the Action Takes Place With Mergers, Acquisitions and Profit Centers-Subsidiary Watch</a></h5> <p> <hr />High-tech, custom-programmed hearing aids are now available at affordable prices – starting at just $649 each – to people enrolled in UnitedHealthcare vision benefit plans, including employer-sponsored and individual policies. </p> <p>Hearing aids can often cost thousands of dollars, but UnitedHealthcare’s new discount program enables its vision plan participants to save hundreds of dollars on hearing aids by purchasing them for as low as $649 each*. The discount program already has been available to people enrolled in many UnitedHealthcare medical plans, including employer-sponsored, individual and Medicare Advantage plans, as well as Medicare Part D plans. Some UnitedHealthcare Medicare plan customers pay no out-of-pocket costs for the hearing aids. </p> <p><a href="http://finance.yahoo.com/news/affordable-hearing-aids-now-available-123000046.html">http://finance.yahoo.com/news/affordable-hearing-aids-now-available-123000046.html</a></p>

UnitedHealthcare Expands Their Cheap Hearings Aids Subsidiary With Marketing To Add More Profits To the Corporate Bottom Line and Sell More Devices And Policies –Subsidiary Watch

If you read here often enough then you know United has more subsidiaries than Carter has pills as the old saying goes.  I do these posts so ...

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Doctor Gets Prison Sentence For His Medical CPT Coding Interpretations, Even Though Jury Found Him Innocent–Under Charged Himself

<p>This is an interesting story and probably won’t be the last and you can read all of it from the link at the bottom here.  It’s a bit complex with what the doctor was doing with his coding and the irony here is the fact that it cost the government “less”  not over billing at all.  As new procedures come up that have potential life saving abilities we might see more like this.  He was not attempting to cheat but was rather addressing the billing the procedure as it related to the available codes that were the closest match. </p> <h5><a href="http://ducknetweb.blogspot.com/2013/01/is-medicare-saving-money-and-cutting.html">Is Medicare Saving Money And Cutting Costs? It Depends on the Day of the Week and What Article You Happen to Read…</a></h5> <p> The doctor even tried to justify the fact that perhaps a new code was needed to accurately bill and he ran into issues with both the FDA and CMS.  As the image here indicates documentation can be complicated and many primary MDs have “under coded” for years with the 99213 so they would not have to submit additional complex information if it was a routine simple health issue.  Electronic medical records have helped doctors with methodologies to bill today and make it simpler to substantiate so we have more 99214 codes billed.  With paper billing the submission <img align="right" alt="image" border="0" height="177" src="http://lh3.ggpht.com/-6oFCozWqE3g/Ue_t0l3FSyI/AAAAAAABHVI/AuG4JKz37mM/image%25255B3%25255D.png?imgmax=800" style="background-image: none; border-bottom: 0px; border-left: 0px; padding-left: 0px; padding-right: 0px; display: inline; float: right; border-top: 0px; border-right: 0px; padding-top: 0px" title="image" width="184" />of the documentation can stall a claim for up to 120 days or more and MDs need cash flow so again the under coding with getting paid fast versus the delay would win.  It even seems that HHS got confused on such items last year when they sent letters out accusing doctor and hospitals of all being cheaters and sure are some but to tell all they were cheaters just pretty much showed the lack of education in how all of this works in my opinion.  It made a lot of medical societies and vendors mad as they all saw it the same way and to have Holder from the DOJ sign on too well it gave a damsel in distress type of perception, adding insult to injury.  </p> <h5><a href="http://ducknetweb.blogspot.com/2012/09/hhs-and-doj-send-letters-to-hospital.html">HHS and DOJ Send Letters to Hospital Trade Associations Warning of Gaming Billing System Via Use of Electronic Medical Records–Hospitals Just Learned How to Bill Better & Hired Consultants–Case of Being Algo Duped With Numbers?</a></h5> <p>This sounds more political and the fact that perhaps both CMS and the FDA didn’t have the time and resources to explore further?  The doctor claims his procedure saved lives as had less risk than what the current approved procedures do and allow for.  How can a jury claim he is innocent and he still ends up with a jail sentence?  I can see where this is a complex procedure that an average jury may not understand each detail but the process of no code being available it pretty straight forward on that portion.  </p> <p>The doctor also demonstrated that his procedure was also the approved methodology in Korea.  The government wasted 7 years on this case.  The doctor is a nuclear cardiologist and in the past had lead a campaign with isotope generators were pulled and additional warnings were provided, a good thing.  His procedures cut the time down to one fifth of the time, uses less radiation and is cost effective.  This is what CMS and the FDA ignored and yet we see new procedures and changes all the time.  This indeed sounds very political like someone had it out for the doctor and it’s more than just CPT codes but that’s what it could all be hung on.  BD </p> <p> <hr />The Association of American Physicians and Surgeons (AAPS) recently published several articles telling the story of cardiovascular surgeon John Natale, M.D., who is in prison after being accused of attempting to defraud Medicare. On November 1, 2012, Natale began a 10-month prison sentence, though at trial a jury found him innocent on all charges of fraud.</p> <p>Here’s his story: Between August 2002 and October 2004, Dr. Natale operated on five seriously ill elderly patients, averaging 78 years old. All the patients lived through the surgery, “despite an expected mortality of 90 percent.” The 63-year-old Natale, who “routinely worked from 5:30 a.m. until late at night,” was “habitually … behind in dictating his operative reports” and <img align="right" border="0" src="http://lh5.ggpht.com/-RWnVRRxyy-k/UGN1LxrKj2I/AAAAAAAA-IE/v6-pkvUYR9k/image%25255B5%25255D.png?imgmax=800" style="background-image: none; border-bottom: 0px; border-left: 0px; padding-left: 0px; padding-right: 0px; display: inline; float: right; border-top: 0px; border-right: 0px; padding-top: 0px" />when he filled out the reports weeks after the surgeries, he incorrectly stated that he repaired an aortic aneurysm instead of the type of aneurysm he actually repaired. He was accused of using an incorrect American Medical Association code — a code the government requires doctors use for billing — to bill the government for the procedure he performed, though there is no precise AMA code for the procedure he did.</p> <p>The charges against Natale were the result of a seven-year government investigation into his records, wherein the government reviewed 2,400 operative reports. Natale’s defense rested upon his claims that he simply made some reporting errors and that there was no fraud because <strong>if he had billed the government properly, he actually would have received more money for his services than he actually received.</strong> <strong>The jury agreed and found him not guilty on all fraud charges. But Natale was imprisoned anyway for making “false statements” in his operative reports, though under the law, according to AAPS, “a false statement is a crime only if made in a deliberate attempt to commit fraud —</strong> and, as the jury determined, <em>there was no fraud</em>.” (Emphasis in original.) He was literally imprisoned for making minor errors — if politicians, judges, prosecutors, and Medicare workers were held to the same standard, it would be safe to say that nearly every one of them would be in prison.</p> <p>The harsh sentence meted out to Natale was evidently meant to intimidate doctors. Prosecutor Amarjeet Singh Bhachu flatly stated: “A message needs to be sent out to doctors.” Yet it could have been worse. Because Natale had the gall to actually defend himself at trial and testify in his own defense, the prosecutor asked for a sentence enhancement for “obstruction of justice,” which “could have resulted in 5 years in prison.” No kidding.</p> <p><a href="http://www.thenewamerican.com/usnews/health-care/item/15911-government-healthcare-codes-that-kill#startOfPageId15911">http://www.thenewamerican.com/usnews/health-care/item/15911-government-healthcare-codes-that-kill#startOfPageId15911</a></p>

Doctor Gets Prison Sentence For His Medical CPT Coding Interpretations, Even Though Jury Found Him Innocent–Under Charged Himself

This is an interesting story and probably won’t be the last and you can read all of it from the link at the bottom here.  It’s a bit complex...

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UnitedHealthcare Making Bigger ACO Payments in the Future? Guess They Would Be When Either Attaining Ownership or 51% Controlling Interest in 130 Surgical Center Physicians With Beach Surgical Holdings, Another Subsidiary

<p> <br /><strong>When I look at the news of late of course payments would grow and represent a larger dollar amount as United and their “Tiered” subsidiaries gain either ownership for 51% controlling interest.</strong>  Here’s a couple paragraphs from a <a href="http://finance.optimum.net/optonline/news/read?GUID=23901770&ChannelID=3197">recent press release</a> and in the reference here when it says MemorialCare it means the Memorial Care Foundation, which is owned by United. <img align="right" src="http://lh5.ggpht.com/_v3zjJigoAPE/TXCfvYCDCBI/AAAAAAAAsv0/8biVjC7dBI0/image_thumb%5B1%5D.png?imgmax=800" style="display: inline; float: right" /> They formed yet another subsidiary with another doctor’s group, Surgical Care Affiliates with around 130 surgical centers in the US and now they have controlling interest here at 51%.  Now read on further to the second paragraph…;the remaining 49% is owned by the MDs AND Monarch Healthcare, well United owns them too, so really how much controlling interest do we see here?  It looks like more than 51% even when you put it together right?  And what “little” percent do the doctors have?  You can almost bet they don’t have as much interest as Monarch.  <hr /></p> <p><em>“In February, MemorialCare announced it had joined with Surgical Care Affiliates to form Beach Surgical Holdings, LLC with the goal to develop, acquire and manage ambulatory surgery centers in Orange and Los Angeles counties. The first ventures announced involved partnerships with MemorialCare Surgical Center in Laguna Hills and Saddleback Valley Outpatient Surgery Center in Laguna Woods.”</em></p> <p><em><strong>“Beach Surgical Holdings, a joint venture between MemorialCare Medical Foundation and the national Surgical Care Affiliates (SCA) acquired a 51% interest in Digestive Disease Center,</strong> where SCA will provide strategic and day-to-day management services. Digestive Disease Center, located in Laguna Hills adjacent to Saddleback Memorial Medical Center, has been providing care to the community since 1988, and the new ownership interest furthers MemorialCare's integrated delivery system throughout the Southland.<strong> The remaining 49% interest is owned by the center's gastroenterology physician partners and Monarch HealthCare (owned by United too).” <hr /></strong></em></p> <p>So let’s get back to context here, is this big news <img align="right" border="0" src="http://lh5.ggpht.com/-nyFsMPDDLgk/UDEQa31432I/AAAAAAAA86o/sscFDo2n0LE/image%25255B21%25255D.png?imgmax=800" style="background-image: none; border-bottom: 0px; border-left: 0px; padding-left: 0px; padding-right: 0px; display: inline; float: right; border-top: 0px; border-right: 0px; padding-top: 0px" />in the way that it is written to make the company look like they are dishing out tons of money?  When they take over more physicians groups, form more subsidiaries look at the real actions going on here.  About 6 months ago the AAFP confronted United on paying doctors less than what they get from Medicare in several states and this is the result of complex contracts that pretty much only the lawyers can understand today. </p> <h5><a href="http://ducknetweb.blogspot.com/2012/12/the-aafp-confronts-united-healthcare-on.html">The AAFP Confronts United Healthcare On Reimbursements, Some Are Below Medicare Rates In Parts of the US–Payment Algorithms/Formulas Calculated Deep Within IT Infrastructures Do the Job</a></h5> <p>And recently they said this:</p> <h5><a href="http://ducknetweb.blogspot.com/2012/12/unitedhealthcare-looks-at-doctors-pay.html">UnitedHealthCare Looks at Doctor’s Pay for Savings, Nothing New There Been Doing It for Years But Keep In Mind We Have the Annual Medicare Cut Fix on the Floor Again with Congress–Timing?</a></h5> <p>Here’s yet another subsidiary to sell some additional analytics…and the image below gives a quick screenshot of what the Research Institute is all about, data for sale for one.  </p> <h5><a href="http://ducknetweb.blogspot.com/2013/02/united-healthcare-launches-uhc-research.html">United Healthcare Launches UHC Research Institute–More Data, More Analytics to Measure Performance, Improve Performance, Optimize the Supply Chain and Increase Revenue For Academic Medical Centers</a></h5> <p><img border="0" src="http://lh4.ggpht.com/-U-LQ0YdkZto/URIO3NM9gjI/AAAAAAABEbo/4fo4KJGmRVU/image%25255B8%25255D.png?imgmax=800" style="background-image: none; border-bottom: 0px; border-left: 0px; padding-left: 0px; padding-right: 0px; border-top: 0px; border-right: 0px; padding-top: 0px" /></p> <p>A subsidiary of the American Medical Association makes money selling software of yet another United Healthcare subsidiary so we have sub to sub here putting money down to big conglomerate profit lines. </p> <h5><a href="http://ducknetweb.blogspot.com/2013/07/one-pioneer-aco-saved-money-using.html">One Pioneer ACO Saved Money Using Software From AMA Subsidiary Who Provides Software From a United Healthcare Subsidiary</a></h5> <p>Here’s just a few of the United subsidiaries that I have over the years written about… <a href="http://ducknetweb.blogspot.com/2010/02/unitedhealth-buys-another-wellness.html">biometrics</a>, <a href="http://ducknetweb.blogspot.com/2010/01/model-for-healthcare-reform-is-non.html">wellness,</a> <a href="http://ducknetweb.blogspot.com/2010/11/united-healthcare-subsidiary-ppc.html">international benefits</a>, <a href="http://ducknetweb.blogspot.com/2011/03/qualitymetricingenix-united-healthcare.html">survey analytics with patents,</a> <a href="http://ducknetweb.blogspot.com/2011/10/unitedhealthcare-throws-in-free-hearing.html">hearing aids,</a> <a href="http://ducknetweb.blogspot.com/2011/09/united-healthcare-optum-owns-consulting.html">consulting for drug and devices for the FDA and clinical trials</a> , <a href="http://ducknetweb.blogspot.com/2011/11/so-what-part-of-health-it-has-united.html">clearinghouse sub to work with Epic medical records</a>, <a href="http://ducknetweb.blogspot.com/2013/01/united-healthcare-buys-humedica-and.html">data mining medical information and records,</a> <a href="http://ducknetweb.blogspot.com/2013/04/more-data-for-sale-soon-with-shared.html">and here,</a> <a href="http://ducknetweb.blogspot.com/2010/08/ingenix-subsidiary-of-united-health.html">electronic medical records</a>,<a href="http://ducknetweb.blogspot.com/2013/02/emergency-room-physicians-prefer.html">hospital analytics and software even used by the VA,</a>  big <a href="http://ducknetweb.blogspot.com/2012/07/tri-west-wont-challenge-tri-care.html">contract with Tri-Care where DOD was sued to secure</a>, <a href="http://ducknetweb.blogspot.com/2012/02/united-healthcare-buys-two-hmos-in.html">some additional HMOs in Florida, low & middle income housing in New Mexico,</a> <a href="http://ducknetweb.blogspot.com/2010/09/axolotl-subsidiary-of-ingenix-creates.html">HIE technologies and analytics,</a> <a href="http://ducknetweb.blogspot.com/2010/09/clickfreemd-selling-software-ehr.html">some miscellaneous EMR software,</a> <a href="http://ducknetweb.blogspot.com/2010/09/ingenix-wholly-owned-technology.html">coding software,</a> <a href="http://ducknetweb.blogspot.com/2012/02/unitedhealthcare-launching-cloud.html">Optum cloud platform to sell software,</a> <a href="http://ducknetweb.blogspot.com/2011/08/optumhealth-subsidiary-of-united.html">more analytics with software that helps set up insurance exchanges,</a> <a href="http://ducknetweb.blogspot.com/2012/08/united-healthcare-pbm-optum-rx-hiring.html">an in house pharmacy benefit manager,</a> <a href="http://ducknetweb.blogspot.com/2012/12/sas-adds-optum-unitedhealthcare-fraud.html">fraud prevention analytics</a>, and a <a href="http://ducknetweb.blogspot.com/2007/10/evercare-unveils-details-of-nation.html">hospice company</a>.  </p> <p>So really, what is the purpose here of this article…they bought up more companies or portions of so with controlling more of it there will be more ACOs, even if United or a subsidiary decided to “force feed” one. More about how they <a href="http://ducknetweb.blogspot.com/2013/07/health-insurance-business-under-radar.html">stay under the radar here</a>.  BD <hr /></p> <p>UnitedHealthcare said in July that it will broaden its accountable care organization contracts across its employer-sponsored Medicare and Medicaid businesses in the next five years.</p> <p>The insurance company pays $20 billion to hospitals, physicians and ancillary care providers through ACO contracts that account for quality and cost efficiency measures. It expects to increase such pay to $50 billion by 2017.</p> <p>UnitedHealthcare has ACO arrangements with more than 575 hospitals, 1,100 medical groups and 75,000 physicians.</p> <p><a href="http://www.amednews.com/article/20130722/business/130729985/9/">http://www.amednews.com/article/20130722/business/130729985/9/</a></p>

UnitedHealthcare Making Bigger ACO Payments in the Future? Guess They Would Be When Either Attaining Ownership or 51% Controlling Interest in 130 Surgical Center Physicians With Beach Surgical Holdings, Another Subsidiary

When I look at the news of late of course payments would grow and represent a larger dollar amount as United and their “Tiered” subsidiar...

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TSA Joins the MoneyBall Scene, Collecting Your Personal Data For a Price With Express Scanning Services, But They Can Continue to Smell My Stinking Feet…Guess NSA Won’t Share

<p>Oh is everyone not trying to figure out how to make a buck!  It’s not bad enough that we have a data selling epidemic in place with raising the levels of flawed data every day, but now<strong> TSA wants to express check <img align="right" alt="image" border="0" height="122" src="http://lh5.ggpht.com/-SfQjRD7MRVI/Ue2tLM0rRzI/AAAAAAABHUw/gvNiPLu5iaI/image%25255B8%25255D.png?imgmax=800" style="background-image: none; border-bottom: 0px; border-left: 0px; padding-left: 0px; padding-right: 0px; display: inline; float: right; border-top: 0px; border-right: 0px; padding-top: 0px" title="image" width="168" />you through the airports and if you pay them $85 they won’t check your feet anymore</strong>.  Well you know what, they can still check my feet.  <strong>How far is all of this going to go.  Do you mean these folks are not part of PRISM (grin).</strong>  </p> <p><strong>Gets worse than that as private for hire folks are going to be doing the scanning.</strong>  Government can’t even hire folks do that…where’s the NSA when you need them?  </p> <p>Now all U.S. citizens can apply to speed through airport screening -- if they don't mind contractors potentially mining their social media posts for signs of threatening behavior. TSA Pre✓ is the name of the program.  Now what do these 3rd parties get, more data to sell?  I hate to see the privacy policy written on this one as it has to be at least 3-10 pages long written <img align="right" alt="image" border="0" height="177" src="http://lh5.ggpht.com/-dEEpTxCWMOs/Ue2tL5m8d0I/AAAAAAABHU4/SJiB-LNmOZo/image%25255B4%25255D.png?imgmax=800" style="background-image: none; border-bottom: 0px; border-left: 0px; padding-left: 0px; padding-right: 0px; display: inline; float: right; border-top: 0px; border-right: 0px; padding-top: 0px" title="image" width="269" />by lawyers who are the absolute worst at running government agencies today, even the DOJ is stuck with digital dud Holder right now.  Just watch <a href="http://ducknetweb.blogspot.com/2013/01/the-untouchables-too-big-to-jail.html">Too Big to Jail from PBS and listen to DOJ Manny whine</a>…no confidence at all on the documentary for him with technology.  </p> <p>This scan includes all your social network activity too so yes one more good reason to really limit what you put out there and consider dropping ones like Facebook that are just rich with what you put out there.  Twitter is ok it seems and sure that gets mined but you have to say it in 141 characters or less so less chance of detailed profiles per se.  The vendor gets to choose the method of scanning too so again <img align="right" border="0" height="201" src="http://lh5.ggpht.com/-mtdDy9u8k2U/Ud4kTrJgNyI/AAAAAAABHMw/yUkzusEoDug/image%25255B14%25255D.png?imgmax=800" style="background-image: none; border-bottom: 0px; border-left: 0px; padding-left: 0px; padding-right: 0px; display: inline; float: right; border-top: 0px; border-right: 0px; padding-top: 0px" width="234" />watch out as the data sellers battle each other here.  </p> <p>The pilot program is slated to start this fall, so pay or keep the show search alive.  I wonder if they consulted Snowden on this and will be using SharePoint with the NSA to relay all the information?  If you are a novice at how this works and how private industry makes billions selling your data or want to learn how it works, there’s a game now called Data Dealer…</p> <h5><a href="http://ducknetweb.blogspot.com/2013/07/data-selling-game-now-exploits-non.html">Data Selling Game Now Exploits the Non Regulated Billion Dollar Epidemic–”Data Dealer” The Attack of the Killer Algorithms Gamified</a></h5> <p><iframe style="width: 452px; height: 267px" height="315" src="//www.youtube.com/embed/x2eCAgQ1DTo" frameborder="0" width="560" allowfullscreen="allowfullscreen"></iframe></p> <p>Maybe this is why the FTC is full of digital duds who won’t do anything about the data selling epidemic, you think?  </p> <h5><a href="http://ducknetweb.blogspot.com/2013/06/ftc-reclaim-your-name-campaign-not-good.html">FTC “Reclaim Your Name Campaign” Not Good Enough–No Path for Regulation Identified–All Data Sellers Including Banks, Insurers, Etc. Should Be Required to Buy a License</a></h5> <p><a href="http://www.ducknet.net/attack-of-the-killer-algorithms/">Visit the Algo Duping page</a> for more videos that explain more of how this works from getting duped on studies to the story of how banks duped you with the Sub Prime software models used for the mortgage scams, couldn't’ have happened without it.  I have been at this blog beating everyone over the head for the last 2 years about this and the epidemic keeps getting worse. </p> <p>So now the TSA appears to have joined the “MoneyBall” game.  e are really screwed if this is what the administration is <img align="right" src="http://lh4.ggpht.com/-EDZingdu5LU/Ud4kY6fyEyI/AAAAAAABHNI/JIzGVDTsxdg/image%25255B23%25255D.png?imgmax=800" style="display: inline; float: right" />promoting as yet one more example of reactive solutions for a White House and Congress who can’t model and seem to be afraid of math which is what the other side uses.   John Kerry said a few months ago that it was ok to be stupid and 84 Senators who do all their work on paper took him up on it…and that’s what is responsible for making laws today?  This program is going to make a lot of money for some companies, <a href="http://ducknetweb.blogspot.com/2013/07/health-insurance-business-under-radar.html">just like United Healthcare is rolling in the contract from the government from DOD, HHS, the VA and more.</a>  Heck get rejected for your mortgage loan right at the airport right?  BD    </p> <p> <hr /></p> <p>On Friday, the Transportation Security Administration opened up to the entire American public a voluntary program once reserved for frequent fliers that lets travelers walk, with their shoes and belts on, to express checkpoint lines. Laptops and TSA-size compliant liquids and gels can stay in place too. Body scans are still required. </p> <p><a href="http://www.tsa.gov/tsa-precheck">"Pre✓”</a> enrollment is expected to cost $85 -- and the loss of privacy. TSA is weighing a contract that would hire private screeners to parse an applicant’s consumer data, such Web browsing histories, for signs of danger before admission into express inspection programs.</p> <p>Currently Pre✓ fast lanes are available at about 40 airports. Interested fliers can apply for the program, starting this fall, by completing an online form and submitting identification and fingerprints in person at Washington Dulles International Airport or Indianapolis International Airport. Additional enrollment sites will be announced in a few months. The fee covers priority screening privileges for five years. </p> <p><a href="http://www.nextgov.com/big-data/2013/07/fliers-can-keep-shoes-exchange-letting-big-brother-inspect-their-big-data/67142/">http://www.nextgov.com/big-data/2013/07/fliers-can-keep-shoes-exchange-letting-big-brother-inspect-their-big-data/67142/</a></p>

TSA Joins the MoneyBall Scene, Collecting Your Personal Data For a Price With Express Scanning Services, But They Can Continue to Smell My Stinking Feet…Guess NSA Won’t Share

Oh is everyone not trying to figure out how to make a buck!  It’s not bad enough that we have a data selling epidemic in place with raising ...

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States Reviewing Selling De-Identified Medical Record Procedures–The Data Selling Epidemic

<p><strong>This is a good article that they are now reviewing what they are selling which does NOT fall under HIPAA</strong>.  Recently data analytics and re-matching has become a lot easier with new methodologies.  In the article below a couple folks say there’s not really anything to fear, but I would guess those are the duds who are not aware of how data queries and re-matching works today with the web as a few years ago we did not have this massive exposure.   We do now though and look and see who’s number two on the list…and United buys and guess what, they have tons of data bases and gosh knows what it gets queried with as they have tons of data bases in house so they but to resell.<strong> Heck just in writing software I used to do it with queries with sample data to make sure everything with the program was working correctly so you pick up that skill as a programmer in just writing software so not hard at all to figure out how those who want to profit do it.  </strong></p> <p>Talk to any Wall Street quant and re-matching is just a matter of fact comment so it goes for other industries.  </p> <h5><a href="http://ducknetweb.blogspot.com/2013/06/re-identifying-medical-records-all.html">Re-Identifying Medical Records All Depends on the Query Master and How Much Money Can Be Saved or Made With Adjusting Risk, Up or Down</a></h5> <p><img align="left" alt="image" border="0" height="337" src="http://lh4.ggpht.com/-yscXR0cgQUA/UezI4skNUTI/AAAAAAABHUc/CmXnK8TAJwk/image%25255B3%25255D.png?imgmax=800" style="background-image: none; border-bottom: 0px; border-left: 0px; padding-left: 0px; padding-right: 0px; display: inline; float: left; border-top: 0px; border-right: 0px; padding-top: 0px" title="image" width="464" /></p> <p> </p> <p> </p> <p> </p> <p> </p> <p> </p> <p> </p> <p> </p> <p> </p> <p> </p> <p>Outside of government data you can find Blue Cross and United buying up your Visa and Master Card records too.</p> <h5><a href="http://ducknetweb.blogspot.com/2013/03/insurance-companies-are-buying-up.html">Insurance Companies Are Buying Up Consumer Spending Data-Time is Here to License and Tax the Data Sellers-As Insurers Sell Tons of Data, Gets Flawed Data When Data Buyers Uses Out of Context Too</a></h5> <p>This article goes over some of the new revisions states are taking but this industry really needs a pathway to regulate and that is to buy a license to sell data.  More on that at the link below.  It’s a good idea and we can excise tax those who profit, quarterly like a sales tax.  </p> <h5><a href="http://ducknetweb.blogspot.com/2013/02/time-has-come-to-license-and-tax-data.html">Time Has Come to License and Tax the Data Sellers of the Web, Companies, Banks, Social Networks..Any One Making a Profit-Latest Microsoft/Google Privacy War Helping the Cause –Consumers Deserve to Know What Is Being Sold and To Who in a Searchable Format</a></h5> <p>We have no idea what kind of queries go on behind “closed server doors” especially when you have a few hundred subsidiaries like United as they may not make all their analytic public on what they “really” do.  I do see them advertising for tons of data miners and analysts all the time though.  BD <hr /></p> <p>Some U.S. states are reviewing their policies around the collection and sale of health information to ensure that some patients can't be identified in publicly available databases of hospital records. </p> <p>Washington suspended distribution of the information and developed a confidentiality agreement that all buyers must now sign, according to Donn Moyer, a spokesman for the state’s Department of Health. Bloomberg News, working with Harvard University professor Latanya Sweeney, reported on June 4 that some patients of Washington hospitals could be identified by name and have their conditions and procedures exposed when a <a href="http://www.doh.wa.gov/DataandStatisticalReports/HealthcareinWashington/HospitalandPatientData/HospitalDischargeDataCHARS.aspx">database sold by the state for $50</a> is combined with news articles and other public information. </p> <p>States can legally release such details because the agencies are exempt from the Health Insurance Portability and Accountability Act, the 1996 law that sets <a href="http://www.hhs.gov/ocr/privacy/">federal standards for medical privacy</a>. Organizations that are covered by HIPAA including health care providers, insurers and their business partners are forbidden from disclosing such information. </p> <p><a href="http://www.bloomberg.com/infographics/2013-06-05/whos-buying-your-medical-records.html">Companies that benefit</a> from buying states’ hospital records include IMS Health Inc., the provider of prescription data that was taken private by TPG Capital and Canada Pension Plan Investment Board for $5.06 billion in 2010. Other buyers are OptumInsight, a division of <a href="http://www.bloomberg.com/quote/UNH:US">UnitedHealth Group Inc. (UNH)</a>, the biggest U.S. health insurer, and <a href="http://www.bloomberg.com/quote/WBMD:US">WebMD Health Corp. (WBMD)</a>, which supplements its consumer website with advisory services for companies and insurers. </p> <p><a href="http://www.bloomberg.com/news/2013-07-22/patients-id-d-from-hospital-records-trigger-state-reviews.html?cmpid=yhoo">http://www.bloomberg.com/news/2013-07-22/patients-id-d-from-hospital-records-trigger-state-reviews.html?cmpid=yhoo</a></p>

States Reviewing Selling De-Identified Medical Record Procedures–The Data Selling Epidemic

This is a good article that they are now reviewing what they are selling which does NOT fall under HIPAA .  Recently data analytics and re-m...

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Who’s Going To Verify Income With Insurance Exchanges, HHS Gives Contract to Equifax To Do So and CMS Says the IRS Will Do It Via the Hub, But When..Contingencies Maybe?

<p>I have tweeted this a couple of times but when you read news about both it does make one wonder…who’s going to do the verification work.  I blogged the Equifax news at the link below that says this will be done in real time.  </p> <h5><a href="http://ducknetweb.blogspot.com/2013/07/government-gives-contract-to-equifax-to.html">Government Gives Contract to Equifax to Verify Incomes of Those Who Apply for Health Insurance Via Exchanges That Qualify For Subsidies–There Goes the Honor System</a></h5> <p><strong><a href="http://www.bloomberg.com/news/2013-07-17/obamacare-privacy-fears-loom-as-computer-links-agencies.html">Quote from the New York Times Below…</a></strong></p> <p><em>“Federal officials said they would rely on Equifax —<img align="right" alt="image" border="0" height="154" src="http://lh3.ggpht.com/-Hm1XF4lZR0E/UexGyKJar5I/AAAAAAABHT8/-TUgXk3TO4w/image%25255B3%25255D.png?imgmax=800" style="background-image: none; border-right-width: 0px; padding-left: 0px; padding-right: 0px; display: inline; float: right; border-top-width: 0px; border-bottom-width: 0px; border-left-width: 0px; padding-top: 0px" title="image" width="241" /> a company widely used by mortgage lenders, social service agencies and others — to verify income and employment and could extend the initial 12-month contract, bringing its potential value to $329.4 million over five years.</em> “</p> <p><strong><a href="http://www.bloomberg.com/news/2013-07-17/obamacare-privacy-fears-loom-as-computer-links-agencies.html">Now over at Bloomberg we have this:</a></strong> </p> <p><em>Applicants will be asked to attest to their current income. For people who report income 10 percent more or less than the most recent </em><a href="http://topics.bloomberg.com/tax-return/"><em>tax return</em></a><em>, or if there is no recent tax return and the hub can’t access data verifying income, a random sample of applicants will be asked to provide additional documentation.</em></p> <p>So when the exchanges open, which process will it be?  Maybe even the IT folks and the folks over at the United Healthcare subsidiary building the federal hub don't know yet.  We have heard many times that he hub is a device to aggregate data and not build another data base but hey we don’t know if anyone out there is caching this either, they could be. </p> <p>Navigators are going to have access, so again access to what portions one might ask.  I can see Equifax being a back up or contingency effort for sure as we all don’t know if the legacy Federal COBOL servers are going to be able to scale.  Smaller efforts where the demands are not as big such as working with a few hospitals with social security exchanges have been around for a short while.  One think to keep in mind though is this is yet another resource connecting to the service and adds to the number of records being accessed and what the demand and actually time served will be.  </p> <h5><a href="http://ducknetweb.blogspot.com/2010/06/health-exchange-in-michigan-gets-3.html">Health exchange in Michigan Gets $3 million Social Security Contract – Electronic Medical Records For Disability Claims and Recipients</a></h5> <p>Social Security already has their own debit card IT infrastructure too, so again the additional information strain that will be put on the system may not really be know until it’s turned loose in the real world.  </p> <h5><a href="http://ducknetweb.blogspot.com/2008/03/social-security-disability-new-debit.html">Social Security Disability - New Debit Card, Going Paperless</a></h5> <p>Ok so back to the IRS COBOL system, does it scale?  COBOL eventually runs out of room when it can’t scale any further too.  I’m sure all the federal agencies have this on their radar as they might start turning to private clouds in time, again with the proper security built in.  All of this takes a lot of time the money though.</p> <p><strong>When it comes down to set a time limit for testing, well if you work in tech one will say there’s never enough time and even when it goes live, you are still testing.</strong>  In California, the exchanges have a new issue, find another small business insurer as WellPoint said goodbye so 49 states as I understand it now still have that option but our insurance commissioner wanted them banned so maybe they just left on their own?</p> <h5><a href="http://ducknetweb.blogspot.com/2013/07/small-business-california-insurance.html">Small Business California Insurance Exchange Option Went From a Choice of One to a Choice of Zero as WellPoint Pulls Out–Stay Tuned As More Develops</a></h5> <p>Ok so coming back around here the answer may not be available yet as the IT infrastructure is work in progress all over the place. <strong>I really do get a kick out of the non tech “cheerleaders” like Nancy DE Parle and a few others walking around saying “the IT infrastructure is complete and ready to go”..it makes tech folks hold their sides with laughter. </strong>Why say that when it’s not true and keep the public updated as it really is…don’t lie…but people running agencies who don’t have some inkling of tech in their background go off, like so many politicians do and make these statements, again it’s better to tell the public the real story and not fabricate.</p> <p>It’s an age old story of tech folks lying to no tech folks and has gone on forever as when the knowledge levels are not equal the tech folks can tell any old story.  <strong>Here’s what I said about HHS back in 2009…where I hinted at academia may not always be the best answer and that Health IT would eat these folks up, and it has, especially the insurance industry</strong>.  </p> <p><strong><u>Where’s the business intelligence other than being a cheerleader?</u></strong>  We need those too buy their stay is not always long term, look at Aneesh Chopra as he was a good cheerleader but when it came time for the “real smart folks” to come in, he left which was a good decision and he couldn’t even get elected in DC at folks preferred the doctor running against him.  </p> <h5><a href="http://ducknetweb.blogspot.com/2009/03/nancy-ann-deparle-and-kathleen-sebelius.html">Nancy-Ann DeParle and Kathleen Sebelius – Business Intelligence?</a><a href="http://www.ducknet.net/attack-of-the-killer-algorithms/"><img align="right" alt="image" border="0" height="147" src="http://lh4.ggpht.com/-KKODajJ3-dw/UexG2LNTKyI/AAAAAAABHUE/3AnOmeBFMVw/image%25255B14%25255D.png?imgmax=800" style="background-image: none; border-right-width: 0px; padding-left: 0px; padding-right: 0px; display: inline; float: right; border-top-width: 0px; border-bottom-width: 0px; border-left-width: 0px; padding-top: 0px" title="image" width="252" /></a></a></h5> <p>It will be interesting to see how this rolls out and<strong> the over confidence of the politicians is staggeringly humorous in the meantime, just give the pubic “real” updates.</strong></p> <p><strong><u>Is it the IRS or Equifax?  It’s only our data and inquiring minds want to know.</u></strong>  Visit the <a href="http://www.ducknet.net/attack-of-the-killer-algorithms/">Algo Duping page</a> for some really great videos done by people smarter than me to learn how IT infrastructures and how math works with it in creating our complex systems.  </p> <p>Also watch the video about “context” from Charles Siefe (presented by Google)as this is very relative right now to the Snowden event…how you get sucked in on stats and reports that have models to make money <img align="right" alt="image" border="0" height="253" src="http://lh5.ggpht.com/-fxB3EneRYcQ/UexG6xUJ_3I/AAAAAAABHUM/DI3GtKcAFVM/image%25255B15%25255D.png?imgmax=800" style="background-image: none; border-right-width: 0px; padding-left: 0px; padding-right: 0px; display: inline; float: right; border-top-width: 0px; border-bottom-width: 0px; border-left-width: 0px; padding-top: 0px" title="image" width="328" />only with little or no balance with ethics and the real world.  Remember all the complexities here are built around the insurance models created by the health insurance industry though and if you think they are just about insurance anymore <a href="http://ducknetweb.blogspot.com/2013/07/health-insurance-business-under-radar.html">look at the hundred of subsidiary companies one of them,</a> the one creating the federal hub and frankly the insurers are going the same way as the banks with too big to fail and again the exchange projects sadly show how bad the government needs to learn more about banking and corporate math as right now we have money and contingencies that give an appearance of a bit of a panic attack per se.  BD</p>

Who’s Going To Verify Income With Insurance Exchanges, HHS Gives Contract to Equifax To Do So and CMS Says the IRS Will Do It Via the Hub, But When..Contingencies Maybe?

I have tweeted this a couple of times but when you read news about both it does make one wonder…who’s going to do the verification work.  I ...

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Small Business California Insurance Exchange Option Went From a Choice of One to a Choice of Zero as WellPoint Pulls Out–Stay Tuned As More Develops

<p><strong>Nationally Blue Cross/Blue Shield was the one national choice that was to be available on all exchanges</strong> but it seems we have a change of plans, but California is still at work with finalizing the list so we might guess another carrier might come in to this space.  <strong>Small business<img align="right" alt="image" border="0" height="90" src="http://lh5.ggpht.com/-lDD1S1fP14I/Uen3IDPXxYI/AAAAAAABHTs/8O7inBggZjs/image%25255B3%25255D.png?imgmax=800" style="background-image: none; border-bottom: 0px; border-left: 0px; padding-left: 0px; padding-right: 0px; display: inline; float: right; border-top: 0px; border-right: 0px; padding-top: 0px" title="image" width="227" /> insurance will still be sold in California by Anthem just not via an exchange</strong>.  Anthem also operates their own private exchange called <a href="https://www.calchoice.com/">California Choice,</a> so here we go with private exchange competition.  Individual policies will still be sold via the exchange, so the small business portion is the only area affected. </p> <h5><a href="http://ducknetweb.blogspot.com/2013/05/california-insurance-exchange-starting.html">California Insurance Exchange Starting to Look Pretty Blue as Aetna, Cigna and United Have Announced They are Not Participating</a></h5> <p>The California Insurance Commissioner recently was hammering on WellPoint for their rate increases so one might wonder if this had anything to do with their decision as he demanded they be barred from the small group market, so maybe they just decided to leave on their own.  It only takes 3 employees to start a private exchange as you can read in this <a href="http://ducknetweb.blogspot.com/2013/03/one-more-insurance-exchange-started-by.html">back link.</a>   There are over 100 private exchanges in the US.  <a href="http://ducknetweb.blogspot.com/2012/11/blue-cross-in-california-automatically.html">Doctors in California</a> who see patients with Blue Cross exchange insurance will be reimbursed at about 30% less than those buying a policy elsewhere.  </p> <p>We already know that Aetna and United Healthcare pulled out of California completely with the exception of employer provided insurance at the end of this year.  </p> <p>In the meantime, if you want to dive into even more <img align="right" border="0" src="http://lh5.ggpht.com/-O5Y7n4tBsXQ/Ucueq6cmtBI/AAAAAAABHGE/A9dOTY-kK2c/image%25255B8%25255D.png?imgmax=800" style="background-image: none; border-bottom: 0px; border-left: 0px; padding-left: 0px; padding-right: 0px; display: inline; float: right; border-top: 0px; border-right: 0px; padding-top: 0px" />software here’s yet one more offering from WellPoint if you are a business with 100 employees or more, <strong>as a company <u>you can stick employees with one more website to use for analytics</u> so they can just get a simple office visit and know every last penny of what the cost will be and the company can cap what they want to spend on many procedures and treatment.</strong>.  Wonder why insurance is so costly with all this software,<strong> oh those 3rd party business consultants and associates that figure more ways to put the consumer in front of a computer screen to just get their healthcare taken care of.  </strong></p> <h5><a href="http://ducknetweb.blogspot.com/2013/06/wellpoint-initiates-new-employer-health.html">WellPoint Initiates New Employer Health Cost Tool With Capping Services–3rd Party Castlight To See Additional Revenues as They Will Train The Insured On How To Use the Their Software</a></h5> <p>By the time all different sectors of business piles on another site and holds employee responsible for a choice it takes up a lot of time.  Those in DC and with wealth don’t have to mess with this and thus we end up with 84 senators who can’t even use the electronic filing system available to them at the Senate.  John Kerry though a few months ago did say it was ok to be stupid so they took him up on it:)</p> <h5><a href="http://ducknetweb.blogspot.com/2013/07/senate-finance-committee-hearings-on.html">Senate Finance Committee Hearings on EHR Incentives Make a “Huge” Case for Restoring the Office of Technology Assessment for Congress–They Need a Bigger Brain</a></h5> <p>So stay tuned and see what the state of California announces on the next round and I’ll try to make sure I keep the news rolling.  BD  </p> <p> <hr />Health insurance giant Anthem Blue Cross is spurning California's new insurance market for small businesses, a potential setback in the state's rollout of the federal healthcare law.</p> <p>Anthem, a unit of WellPoint Inc., is California's largest insurer for small employers. The company's surprising move raised concerns about the state's ability to offer competitive rates and attract businesses to its new Covered California exchange that opens Jan. 1.</p> <p>Friday's disclosure made Anthem the first big insurer in California to publicly pass on the small-business pool. Some other big names, such as <a href="http://www.latimes.com/topic/economy-business-finance/unitedhealth-group-inc.-ORCRP015915.topic">UnitedHealth</a> Group Inc. and <a href="http://www.latimes.com/topic/economy-business-finance/aetna-inc.-ORCRP000343.topic">Aetna Inc.</a>, have already opted out of California's larger exchange for individual consumers.</p> <p>Anthem's decision in California underscored that the small-business exchanges are the most susceptible to a lack of interest among insurers.</p> <p>Anthem also said it will remain part of a private exchange for small firms called California Choice.</p> <p>One concern for health insurers selling in exchanges is that too many customers with big medical bills pick a certain company and it absorbs a higher share of the medical costs among that population.</p> <p><a href="http://www.latimes.com/business/la-fi-anthem-small-business-20130720,0,4631280.story?track=rss&cid=dlvr.it&dlvrit=52116">http://www.latimes.com/business/la-fi-anthem-small-business-20130720,0,4631280.story?track=rss&cid=dlvr.it&dlvrit=52116</a></p>

Small Business California Insurance Exchange Option Went From a Choice of One to a Choice of Zero as WellPoint Pulls Out–Stay Tuned As More Develops

Nationally Blue Cross/Blue Shield was the one national choice that was to be available on all exchanges but it seems we have a change of pl...

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Health Insurance Company, Medical Mutual of Ohio Pulls Out of South Carolina, United Healthcare Picks Up the Insured Policy Holders

<p>Well United scores once again with more business and they won’t have to go to court and sue anyone this time.  In 2007 the Medical<img align="right" alt="image" border="0" height="65" src="http://lh3.ggpht.com/-I7iYIhhAeUw/Ueng1qxDTnI/AAAAAAABHTc/f-oDU5rr0uo/image%25255B3%25255D.png?imgmax=800" style="background-image: none; border-bottom: 0px; border-left: 0px; padding-left: 0px; padding-right: 0px; display: inline; float: right; border-top: 0px; border-right: 0px; padding-top: 0px" title="image" width="229" /> Mutual purchased Carolina Care Plan and I am assuming this is the big portion of the policy holders that will be moved over to United.  </p> <h5><a href="http://ducknetweb.blogspot.com/2013/07/united-healthcare-files-lawsuit-against.html">United Healthcare Files Lawsuit Against the City of Birmingham Disputing Contract Award To Blue Cross</a></h5> <p> <hr />After 6 years in the business in South Carolina it appears it must not be profitable enough to sustain the current policy holders.  GD  </p> <p>COLUMBIA, S.C. -- An insurance company says it's leaving South Carolina because of regulations related to health care reform.</p> <p>Medical Mutual of Ohio is the parent company of the Carolina Care health plan, which covers 28,000 policyholders in South Carolina.</p> <p>Byers says changes under the federal health care act that go into effect this year and next year played into the company's decision to leave South Carolina.</p> <p>He says policyholders covered under Carolina Care are being transitioned to UnitedHealthcare. </p> <p><a href="http://www.sacbee.com/2013/07/19/5579977/health-insurance-company-pulling.html">http://www.sacbee.com/2013/07/19/5579977/health-insurance-company-pulling.html</a></p>

Health Insurance Company, Medical Mutual of Ohio Pulls Out of South Carolina, United Healthcare Picks Up the Insured Policy Holders

Well United scores once again with more business and they won’t have to go to court and sue anyone this time.  In 2007 the Medical Mutual p...

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Community Health Systems Gets Hit With Another DOJ Subpoena Amidst 57% Drop in Income–Still A Suitor For HMA?

<p>Just a few days ago it was out in the news at Bloomberg that <strong>Community Health System was a potential suitor for buying up <img align="right" border="0" src="http://lh3.ggpht.com/_v3zjJigoAPE/TQFijwnOAzI/AAAAAAAAk9U/WkRjkjB2UqY/image%5B4%5D.png?imgmax=800" style="background-image: none; border-bottom: 0px; border-left: 0px; padding-left: 0px; padding-right: 0px; display: inline; float: right; border-top: 0px; border-right: 0px; padding-top: 0px" />Community Health Systems..only problem is HMA has their own problems with subpoenas from July of 2011 too</strong>, see link below.   A couple months ago the HMA CEO got out of Dodge with a hedge fund chasing him down the road.  </p> <h5><a href="http://ducknetweb.blogspot.com/2013/05/hma-hospital-ceo-to-retire-amid.html">HMA Hospital CEO To Retire Amid Pressure From Hedge Fund Glenview Capital While Investigation Over Admission Procedures Continues With 3rd Party Software Vendor</a></h5> <p><strong><u>From 2011 – Community Subpoenas</u></strong> </p> <h5><a href="http://ducknetweb.blogspot.com/2011/04/community-health-systems-receives.html">Community Health Systems Receives Subpoena–Bring in Your Algorithms Used By Pro-MED 3rd Party Software for the ER</a></h5> <h5><a href="http://ducknetweb.blogspot.com/2011/05/sec-issues-community-health-subpoena.html">SEC Issues Community Health A Subpoena Related to Emergency Room Practices-The Gang’s All Here With Tenet, HHS and So On</a></h5> <p>In December of 2012 <a href="http://ducknetweb.blogspot.com/2013/05/hma-hospital-ceo-to-retire-amid.html">60 Minutes did a story on HMA with their admissions policies</a> and if you have not seen it, watch it, especially if you are in Health IT for sure as we know the mechanics of how this stuff gets put together.  I have heard it too with admission quotas here in California from doctors who are either hospitalists or work in the ER about being pushed to get more people admitted when the filled bed counts get low.  It does happen and doctors just absolutely get infuriated and I don’t blame them when they hear such language.  You can go back and <a href="http://ducknetweb.blogspot.com/2009/04/hospital-admissions-are-down-er-doctors.html">visit a classic from about 3 years ago from the TMA on their story and</a> video on that topic to where they fired the ER doctors as they wouldn’t play.  </p> <p>Back in 2010 <a href="http://ducknetweb.blogspot.com/2011/01/tenet-tells-community-health-thanks-but.html">Community Health tried to buy Tenet in</a> a somewhat bullish type of take over to even suggest who should on their board.  <a href="http://ducknetweb.blogspot.com/2013/06/tenet-healthcare-buys-vanguard-health.html">Tenet as you know just ended up buying Vanguard,</a> recently filed <a href="http://ducknetweb.blogspot.com/2011/04/tenet-files-suit-accusing-community.html">lawsuits against Community Health</a> and went about their business.  Well they may not have as much cash now as they did when they tried to do a hostile take over of Tenet.  </p> <p>Another big hospital chain <a href="http://ducknetweb.blogspot.com/2011/03/hca-hospital-corporation-of-america.html">HCA about a year ago said we are billing better now and that’s the reason for our increased profits</a> and pulled off a huge IPO, this was where Rick Scott, governor of Florida was kind of forced to retire from due to their past legal issues with their huge Medicare fraud settlement..  Last year profits at the health care industry giant <a href="http://topics.nytimes.com/top/news/business/companies/hca-holdings-inc/index.html?inline=nyt-org">HCA</a>, which controls 163 hospitals from New Hampshire to California, soared, far outpacing those of most of its competitors. Nobody seems to but them of late with questions though and you wonder why that is with CMS talking about catching fraud all the time.  Instead <a href="http://ducknetweb.blogspot.com/2012/09/hhs-and-doj-send-letters-to-hospital.html">hospitals and doctors and their associations got a letter that said we think all of you cheat from Sebelius and Holder at the DOJ.</a>  </p> <p>Oh gosh all this big business going on, hospitals battling to merge and stay in business and make money, well folks this seems to be our future and the priorities as Wall Street algorithms for profit keep pushing and who knows what they will leave us when they are done.  BD</p> <p> <hr />The U.S. Justice Department hit Community Health Systems with an additional subpoena and a request to interview two high-ranking executives, escalating a two-year Justice Department investigation into the company's admissions practices from its emergency departments. <br />The Franklin, Tenn.-based chain disclosed the revelations in an earnings preview that also showed a sharp <strong>57.2% decline in net income, which it attributed to weak patient volume, higher-than-expected bad debt and an adverse payer mix.</strong> </p> <p>On July 9, shortly after its second meeting, it received the subpoena, which expanded on an earlier April 2011 subpoena to request “documents that support the factual refutations and defenses that the company has articulated during its discussions with the government.” <br />The documents include, for example, its criteria for observation status and its financial relationships with physicians who have admitting privileges, the company said.</p> <p>Health Management Associates, Naples, Fla., is also under investigation into its short-stay admissions, and received <a href="http://www.modernhealthcare.com/article/20110804/NEWS/308049978/hma-subpoenaed-about-doc-referrals-pro-med">similar subpoenas in May and July 2011</a>. The company used the same emergency department management software as Community. </p> <p>It also said it expects to report a 5.7% drop in same-facility admissions and a 2.6% decline in adjusted same-facility admissions, a measure that also accounts for outpatient activity. </p> <p><a href="http://www.modernhealthcare.com/article/20130718/NEWS/307179891?AllowView=VW8xUmo5Q21TcWJOb1gzb0tNN3RLZ0h0MWg5SVgra3NZRzROR3l0WWRMWGJVL3dKRWxiNUtpQzMyWmVzNW5zWUpMV2c=&utm_source=link-20130718-NEWS-307179891&utm_medium=email&utm_campaign=mh-alert">http://www.modernhealthcare.com/article/20130718/NEWS/307179891?AllowView=VW8xUmo5Q21TcWJOb1gzb0tNN3RLZ0h0MWg5SVgra3NZRzROR3l0WWRMWGJVL3dKRWxiNUtpQzMyWmVzNW5zWUpMV2c=&utm_source=link-20130718-NEWS-307179891&utm_medium=email&utm_campaign=mh-alert</a></p>

Community Health Systems Gets Hit With Another DOJ Subpoena Amidst 57% Drop in Income–Still A Suitor For HMA?

Just a few days ago it was out in the news at Bloomberg that Community Health System was a potential suitor for buying up Community Health S...

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Senate Finance Committee Hearings on EHR Incentives Make a “Huge” Case for Restoring the Office of Technology Assessment for Congress–They Need a Bigger Brain

<p>I had a little time to listen in and watch the video and again all I can say is we go way back to square one again, same questions<img align="right" border="0" src="http://lh5.ggpht.com/_v3zjJigoAPE/TWIVynbAGVI/AAAAAAAAr9E/zewiugyQmSI/image_thumb%5B4%5D.png?imgmax=800" style="background-image: none; border-right-width: 0px; padding-left: 0px; padding-right: 0px; display: inline; float: right; border-top-width: 0px; border-bottom-width: 0px; border-left-width: 0px; padding-top: 0px" />, same everything and those testifying we doing a good job trying to explain.  Baucus appeared to want a simple answer to all of this and believe me if there was one, it would have been there but he doesn’t get it with complexities of IT Infrastructure today. </p> <p>“<strong>The short order code kitchen burned down years ago and there was no fire sale, period’</strong>…this is what they don’t seem to get, the time, money, labor of intelligent programmers, developers, networkers and so on.  This is really sad.  Here’s an image of what I tweeted yesterday.</p> <p><img border="0" height="279" src="http://d3j5vwomefv46c.cloudfront.net/photos/large/791676913.png?1374167222" style="background-image: none; border-right-width: 0px; padding-left: 0px; padding-right: 0px; border-top-width: 0px; border-bottom-width: 0px; border-left-width: 0px; padding-top: 0px" width="452" /></p> <p>Now here’s that great Sunlight Foundation campaign to restore the Office of Technology Assessment…this is a tool and great suggestion to help them and not attack..but can they see the forest for the trees one might ask?</p> <h5><a href="http://ducknetweb.blogspot.com/2013/02/congress-needs-bigger-brainrestore_18.html">Congress Needs a Bigger Brain–Restore the Office of Technology Assessment And Truly Assess What is Useful And Remove The Algo Duping Permeating In Government–Fantasy Perceptions That Are Not Real Can Be A Dangerous Thing</a></h5> <p><iframe style="width: 447px; height: 276px" height="315" src="//www.youtube.com/embed/cs6jg2zPQKw" frameborder="0" width="560" allowfullscreen="allowfullscreen"></iframe></p> <p>Instead we get long and lengthy discussions on who can filibuster and when..geez..I’m sorry but this is beginning to sound juvenile if you will…and I know we are all tired of it, or the default topic that comes up with women's health as that’s a safe place to go hang out when laws requiring technology knowledge are discussed. </p> <p>I had also way back thought the use of IBM Watson would be good to help Congress but no luck there either as all appeared to think it was good for Jeopardy game shows only, sad but Citibank put it to use on modeling and is using models that might be hiding risk to get more of our money, think about that one.  </p> <h5><a href="http://ducknetweb.blogspot.com/2012/03/ibm-watson-going-to-work-at-citigroup.html">IBM Watson Going to Work At Citigroup on Wall Street–Congress Didn’t See Big Data As A Tool (Hadoop Framework) When They Had Their Chance…For Consumers The Attack of the Killer Algorithms–Chapter 22</a></h5> <p>I mean what is it with this group that appears to “refuse” to learn or use knowledge?  I read yesterday where 84 of the senators still file their reports on paper instead of digitally.  Where does Tom Coburn fit in here as a doctor, is he a “paper doc” too?  I never hear any input from him on this area and he claims to still see a few patients when he’s not in DC.  </p> <p>Again I listened in yesterday and in my opinion it sounded like a bunch of lawmakers that were out of touch with reality and how technology is impacting our lives.  Even on the financial end of things too we are getting a “low tech” bill proposed for a problem that needs “high tech”.  I like Elizabeth Warren too and the bill will help, but it’s not enough.  Cordray gets confirmed so what’ the progress here, <a href="http://ducknetweb.blogspot.com/2013/04/richard-cordray-fail-with-understanding.html">continue to build a data base so he can learn about what we go through, does he not participate himself to see this?</a> </p> <h5><a href="http://ducknetweb.blogspot.com/2013/07/glass-steagall-revival-presents-low.html">Glass-Steagall Revival Presents a “Low Tech” Partial Solution for an Industry that Needs “High Tech” Regulation-Consumers Get 5 More Years of Bank Modeling For Inequality With Segmentation - No Real Regulation In Sight</a></h5> <p>As far as privacy bills too, nothing<img align="right" border="0" src="http://lh3.ggpht.com/-Egtq6OJ0O_g/TfaWpBYw97I/AAAAAAAAzRk/a445GNw2Cx4/image_thumb%25255B1%25255D.png?imgmax=800" style="background-image: none; border-right-width: 0px; padding-left: 0px; padding-right: 0px; display: inline; float: right; border-top-width: 0px; border-bottom-width: 0px; border-left-width: 0px; padding-top: 0px" /> proposed there either that is substantial sadly so I guess it’s good to listen in once in a while and see what levels of discussion are being had?  When the Snowden issue came out and we had Diane Feinstein talking about technology she has never touched, what in the world do you think the technologist out there thought?  </p> <h5><a href="http://ducknetweb.blogspot.com/2013/06/ftc-reclaim-your-name-campaign-not-good.html">FTC “Reclaim Your Name Campaign” Not Good Enough–No Path for Regulation Identified–All Data Sellers Including Banks, Insurers, Etc. Should Be Required to Buy a License</a></h5> <p>Not much as she doesn’t know what she is talking about with any real specifics…sad.  Everyone hates when politicians talk about subjects they know nothing about and profess to be an expert?  Its loses credibility for them in the long run though if not immediately.  </p> <p>Really though a few other things bug me too like hearing a Secretary of State saying it’s ok to be stupid, a former Homeland Security director that won’t use email (luddite excuse as discussed on the web by others), an HHS Department that wants to “<a href="http://ducknetweb.blogspot.com/2013/02/speed-up-rate-of-change-in-health.html">hurry up” Health IT</a> and <a href="http://ducknetweb.blogspot.com/2013/04/senators-letter-to-hhs-regarding-fraud.html">joined in a letter by the DOJ head Holder signing with threatening hospitals and doctors</a>?  I mean what is up with these folks?  Again, same echoes of what the Senate testimonies offered.  <strong>So let’s all get totally distracted and jump for joy over some new Facebook app right?</strong>  Right now with the insurance exchange work some of these folks are finally learning you can’t “hurry up Health IT” short of water boarding developers, engineers and programmers..geez<a href="http://ducknetweb.blogspot.com/2013/07/house-to-investigate-decision-to-delay.html">…”why are those deadlines not being met” we hear over and over and over from lawmakers.</a>  </p> <p>You want to see what I deal with for one example when Google tells me out of the blue that my name is not machine compliant and thought I was a<img align="right" border="0" src="http://lh3.ggpht.com/_v3zjJigoAPE/TKYXI9HNaQI/AAAAAAAAh1M/7da7_nnWx-c/image_thumb%5B7%5D.png?imgmax=800" style="background-image: none; border-right-width: 0px; padding-left: 0px; padding-right: 0px; display: inline; float: right; border-top-width: 0px; border-bottom-width: 0px; border-left-width: 0px; padding-top: 0px" /> real duck?  That’s an example of what real world folks like me deal with when it comes to data and the errors and yet we are stupid?  I’ll put a ton of consumers up against what I heard yesterday (grin).  </p> <h5><a href="http://ducknetweb.blogspot.com/2013/01/im-sorry-your-google-plus-name-does-not.html">“I’m Sorry Your Google Plus Name Does Not Comply With Google “Names Policies”…Barbara “Duck Algorithm” & Was Using My Real Name All Along…Killer Algorithms Chapter 52</a></h5> <p>This is what we all fear as consumers is data being used out of context against us and it is happening and it getting worse with flawed data and marketing of business models that lie.  This is why I created the <a href="http://www.ducknet.net/attack-of-the-killer-algorithms/">AlgoDuping/Killer Algorithm  page</a> to help educate those who want to know about what’s really happening on servers running 24/7 making life impacting decisions about all of us.  </p> <h5><a href="http://ducknetweb.blogspot.com/2012/11/big-dataanalytics-if-used-out-of.html">Big Data/Analytics If Used Out of Context and Without True Values Stand To Be A Huge Discriminatory Practice Against Consumers–More Honest Data Scientists Needed to Formulate Accuracy/Value To Keep Algo Duping For Profit Out of the Game</a></h5> <p>This has been stated many times over the web about digital illiteracy of lawmakers and others in key positions and I guess today I decided to make a case of it as how do lawmakers that don’t participate in today’s technologies that can afford to pay other people to do all of it for them have adequate knowledge<strong>…at least get some resources like the Office of Technology Assessment to help you and think about IBM Watson to create some better law models with smarter queries and data, please! </strong></p> <p>This is called modeling for inequality and it’s all about math<img align="right" border="0" src="http://lh5.ggpht.com/-1Rt-FmjxxOA/UWxD-0exc4I/AAAAAAABGgI/f1z12M3Uj8o/image3.png?imgmax=800" style="background-image: none; border-right-width: 0px; padding-left: 0px; padding-right: 0px; display: inline; float: right; border-top-width: 0px; border-bottom-width: 0px; border-left-width: 0px; padding-top: 0px" /> and formulas running on servers so again when I listened yesterday there was no hint of any of this type of knowledge coming from the Senators..scary.  Here’s a former quant that will lay it out for you and she has a great lecture series called “Weapons of Math Destruction”..good to listen in as she worked for a hedge fund and did the math for Larry Summers..her comments are good and truthful.  I said pretty much the same type of thing with the <a href="http://ducknetweb.blogspot.com/2012/02/attack-of-killer-algorithmsdigest-links.html">Attack of the Killer Algorithms series I started two years ago</a>.  You can catch another one of her videos from PBS in the footer of this blog too, another good one and having like her testify in Washington to wake up the technological dead would be great.  Listen to how Wall Street treats their math talent, “like a mule.” </p> <h5><a href="http://ducknetweb.blogspot.com/2013/04/modeling-for-inequality-with.html">Modeling for Inequality With Segmentation, Insurance Industry Uses Backwards Segmentation As Some Models Stand to Threaten Overall Democracy</a></h5> <p><iframe style="width: 456px; height: 254px" height="315" src="//www.youtube.com/embed/3up4PezpthU" frameborder="0" width="560" allowfullscreen="allowfullscreen"></iframe></p> <p><strong>Well that’s about enough today as I have to go back and empty out my junk mail from the folks in Nigeria that have millions waiting for me (grin). Fix that!</strong>   Anyway after listening yesterday to the hearings it just stirred all this up again and I’m here trying to bring reality into the picture and yesterday the testimonies from the folks were good, informative but sadly not appreciated to the point they should be, and are we all just mules in Health IT and in other areas of life?  The Government is clearly out-modeled today and again that Office of Technology Assessment would really help them understand how business works today.  BD </p>

Senate Finance Committee Hearings on EHR Incentives Make a “Huge” Case for Restoring the Office of Technology Assessment for Congress–They Need a Bigger Brain

I had a little time to listen in and watch the video and again all I can say is we go way back to square one again, same questions , same ev...

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Hospital Denied Access to Electronic Medical Records Over Billing Dispute With Vendor

<p>Since 2008 the hospital has paid $3,083,607.64 and the system has never been fully functional and the hospital claims it was not HIPAA compliant in all areas.  Business Computer Applications is the vendor who sold the hospital the system and who is demanding payment.  The EHR system, Pearl electronic medical records is CCHIT certified  as well as ONC-ATCB.  </p> <p>The hospital decided to change systems and install an EHR from GE, named Centricity and is the new system as of July 1.  <img align="right" alt="image" border="0" height="92" src="http://lh4.ggpht.com/-36czpEbMBlE/UegIQE9r_mI/AAAAAAABHSo/DMe76HuDULA/image%25255B8%25255D.png?imgmax=800" style="background-image: none; border-bottom: 0px; border-left: 0px; padding-left: 0px; padding-right: 0px; display: inline; float: right; border-top: 0px; border-right: 0px; padding-top: 0px" title="image" width="135" />The vendor and the hospital have done business together for 24 years.    The vendor is demanding $285,097.03 in unpaid services from the hospital and has remotely disconnected the hospital from their servers.  The hospital claims the vendor refused to provide a drive with all the patient records as well.  Milwaukee Health Services, the hospital takes care of much of the under served patients and has not been able to access records since July 1st and has filed a lawsuit.  The hospital could use a little work on their website but maybe this is temporary due to the switch to GE Centricity.  If they are live on the new system, and without the past history, all would have a file as a “new” patient for the time being until this is resolved but no access to past history.  </p> <p>When medical records were in the baby stages, we used to hear more stories like this and the question at that time was whether to host your own records or use web based services.  We all know how that has changed in the last number of years with “cloud” services pretty much being predominant today.  It’s been a while since I have seen a “hostage” medical record story come out, but there were more again in the early days.  BD <hr /></p> <p>MILWAUKEE (CN) - A computer firm is "jeopardizing the health and safety of about 40,000 people" - many of them uninsured or underinsured - by freezing a hospital out of access to its own medical records because of a billing dispute, the hospital claims in court. <br /> Milwaukee Health Services sued Atlanta-based <a href="http://bca.us/products/electronic-medical-record-system-pearl/">Business Computer Applications,</a> in Federal Court.<img align="right" alt="image" border="0" height="71" src="http://lh3.ggpht.com/-GOgr8a-SnkY/UegIReatJKI/AAAAAAABHSw/MMl9LyKnmc8/image%25255B3%25255D.png?imgmax=800" style="background-image: none; border-bottom: 0px; border-left: 0px; padding-left: 0px; padding-right: 0px; display: inline; float: right; border-top: 0px; border-right: 0px; padding-top: 0px" title="image" width="144" /> <br /> Milwaukee Health Services Inc. "specializes in the care of underserved populations," the hospital says in its complaint. It says it "serves everyone regardless of income or third party coverage." <br /> The hospital claims the defendant performed an unauthorized remote disconnection from the hospital's local servers that house its patient data. It says the IT company refuses to restore computer service unless the hospital pays it $285,000.</p> <p> The hospital has paid Business Computer Applications since 1999 to handle service, maintenance and hardware, and to develop a Clinic Management System for the hospital, according to the complaint. The system would take care of appointment scheduling, patient billing, and accounts receivable. <br /> In 2008, the hospital began paying BCA to develop and install an electronic medical record system, known as the Pearl EMR, which was to be integrated with the Clinic Management System.</p> <p><a href="http://www.courthousenews.com/2013/07/17/59431.htm">http://www.courthousenews.com/2013/07/17/59431.htm</a></p>

Hospital Denied Access to Electronic Medical Records Over Billing Dispute With Vendor

Since 2008 the hospital has paid $3,083,607.64 and the system has never been fully functional and the hospital claims it was not HIPAA compl...

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United Healthcare Files Lawsuit Against the City of Birmingham Disputing Contract Award To Blue Cross

<p>This is not the first time the company has filed a lawsuit as the most publicized was the Tri-Care contract in which the company sued the Department of Defense and we have never heard details of exactly <img align="right" border="0" height="102" src="http://lh4.ggpht.com/-GPn1iE76d3k/T5D3QJ8PWFI/AAAAAAAA6jk/kMvDzt1Smc0/image_thumb%25255B3%25255D.png?imgmax=800" style="background-image: none; border-bottom: 0px; border-left: 0px; padding-left: 0px; padding-right: 0px; display: inline; float: right; border-top: 0px; border-right: 0px; padding-top: 0px" width="212" />why that was but they got the contract.  United Healthcare has truckloads of subsidiaries an as in the Tri-Care bidding situation they create yet another new subsidiary for business they want to pursue. </p> <h5><a href="http://ducknetweb.blogspot.com/2011/06/update-unitedhealthcare-sues-department.html">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?</a></h5> <p>This is not the first battle of such as other lawsuits have been filed over contract awards where they are contested.  In the Tri-Care case it literally put the Blue Cross subsidiary out of business and then <a href="http://ducknetweb.blogspot.com/2012/03/united-healthcare-awards-contract-to.html">United awarded some of the subsidiaries of Blue Cross</a> that were set to go away, contracts.  Using tiered subsidiaries is how a lot of insurance companies stay under the radar today.  The link below has a lot of information about subsidiary actions as well as a number of government contractor <a href="http://ducknetweb.blogspot.com/2013/06/qssi-subsidiary-of-united-healthcare.html">businesses the company has bought, even the one who is doing the Federal Data Hub</a>, which they bought 2 weeks after HHS awarded the contract to QSSI.  </p> <h5><a href="http://ducknetweb.blogspot.com/2013/07/health-insurance-business-under-radar.html">Health Insurance Business Under the Radar With Tiered Subsidiaries–Where All the Action Takes Place With Mergers, Acquisitions and Profit Centers-Subsidiary Watch</a></h5> <p>Last year the state of Louisiana rejected United’s Protest over their contract award to Blue Cross/Blue Shield too.</p> <h5><a href="http://ducknetweb.blogspot.com/2012/08/state-of-louisiana-rejects-united.html">State of Louisiana Rejects United Healthcare’s Protest Over Awarding Blue Cross/Blue Shield Contract To Manage State Employee Health Insurance–Battle of the Insurance Algorithms Continues..</a></h5> <p><a href="http://ducknetweb.blogspot.com/2012/06/us-health-insurance-regulator-leaving.html">Steve Larsen who used to work at HHS left</a> and took a Vice President job with the agency last year as well.  In November of 2011 the company hired the US Assistant Attorney General from Minnesota as General Counsel so it appears he is busy and did money talk?  </p> <h5><a href="http://ducknetweb.blogspot.com/2011/11/united-healthcare-opens-retail-employer.html">United Healthcare Opens Retail “Employer Benefits” Store in Queens New York And Hires Former Minnesota US Assistant Attorney General As General Counsel</a></h5> <p>At some point with all the lawsuits that have arisen so<img align="right" border="0" src="http://lh5.ggpht.com/-qiQpiRo-XmQ/TkAWhmzCpnI/AAAAAAAA3F4/tig3AhkQlNM/image_thumb%25255B2%25255D.png?imgmax=800" style="background-image: none; border-bottom: 0px; border-left: 0px; padding-left: 0px; padding-right: 0px; display: inline; float: right; border-top: 0px; border-right: 0px; padding-top: 0px" />me might be thinking twice before inviting them to bid as if they don’t get the contract they’ll take you to court and tell you how to award your contracts.  BD</p> <p> <hr />UnitedHealthcare Services Inc. has filed a lawsuit against the city of Birmingham, claiming a new benefits agreement between the city and <a href="http://www.bizjournals.com/profiles/company/us/al/birmingham/blue_cross_and_blue_shield_of_alabama/3607">Blue Cross and Blue Shield of Alabama</a> violated Alabama's competitive bidding laws.</p> <p>The lawsuit, filed July 1 in Jefferson County Circuit Court, asks a judge for an injunction to prevent the city from carrying out a new health care benefits contract with Blue Cross – <a href="http://www.bizjournals.com/birmingham/blog/2013/03/top-of-the-list-health-and-accident.html">the state's largest health insurer.</a></p> <p>Officials with the city and UnitedHealthcare were not available to comment Monday.</p> <p>The case stems back to January, when the city sought bid proposals for a third-party medical plan administrator. In the lawsuit, UnitedHealthcare claims it was determined to be the low bidder and the winner of the contract.</p> <p>According to the lawsuit: "Later that very day, UnitedHealthcare was advised that its contract award had hit a snag – BCBS had received a termination letter, but was subsequently allowed to revise its proposal."</p> <p>Several days later, the lawsuit claims, a meeting was held to discuss a joint contract between Blue Cross and UnitedHealthcare, the filing said. Each provider was to be awarded components of the contract, but after a review by a city committee, the city awarded the contract to Blue Cross alone, UnitedHealthcare claims in the lawsuit.</p> <p><a href="http://www.bizjournals.com/birmingham/news/2013/07/15/unitedhealthcare-sues-city-of-birmingham.html?page=all">http://www.bizjournals.com/birmingham/news/2013/07/15/unitedhealthcare-sues-city-of-birmingham.html?page=all</a></p>

United Healthcare Files Lawsuit Against the City of Birmingham Disputing Contract Award To Blue Cross

This is not the first time the company has filed a lawsuit as the most publicized was the Tri-Care contract in which the company sued the De...

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One Pioneer ACO Saved Money Using Software From AMA Subsidiary Who Provides Software From a United Healthcare Subsidiary

<p>It’s what I keep saying, the actions takes place with subsidiaries today in healthcare and lot with insurers.  United popped in and bought Humedica in December of last year, 2012 so the processes were ongoing before United purchased them at Beth Israel.  I don’t know if a United clearinghouse subsidiary is used there or not but as you can see here with subsidiary companies United has a vested interest as all subsidiary profits of course like any company go to the bottom line profits.  </p> <h5><a href="http://ducknetweb.blogspot.com/2013/01/united-healthcare-buys-humedica-and.html">United Healthcare Buys Humedica and Gets More Data to Analyze and Sell To Medical Device and Drug Companies–More Big Profits From Health Data</a></h5> <p>The article states that Anceta is a subsidiary of the AMA who uses Humedica, as <a href="http://www.anceta.com/">advertised on the website</a> as well.  So in addition to the ACO being a success profit were there for this subsidiary of United as well since they now own it.  When United bought Humedica it had a nice payout for Bain capital Ventures and a few more and opened it’s doors in 2009 for business.  Success though is still in the implementation and the use of humans as well.  BD <hr /></p> <p>Fisher said his organization has a subsidiary called Anceta, which uses a tool developed by Humedica that gathers data and allows providers to see where they stand on respective benchmarks. “It's one thing to give providers a lot of data, but it's another thing to sit down with the data and re-engineer care processes,” Fisher said.<img align="right" border="0" src="http://lh4.ggpht.com/-DvrGbeEFbMY/UQM-9AFgKnI/AAAAAAABDxw/g5MaSH4vWQc/image%25255B3%25255D.png?imgmax=800" style="background-image: none; border-bottom: 0px; border-left: 0px; padding-left: 0px; padding-right: 0px; display: inline; float: right; border-top: 0px; border-right: 0px; padding-top: 0px" /> <br />Earlier Tuesday, Fisher released a statement that said that “an overwhelming majority” of 25 AMGA members participating in Medicare's Pioneer ACO program will stay in the program, while the remainder will either transition into the Medicare Shared Savings Program or opt out of Medicare accountable care. </p> <p><a href="http://www.modernhealthcare.com/article/20130716/NEWS/307169946?AllowView=VW8xUmo5Q21TcWJOb1gzb0tNN3RLZ0h0MWg5SVgra3NZRzROR3l0WWRMWGJVL3dIRWxiNUtpQzMyWmVzNW5vWUpiaW4">http://www.modernhealthcare.com/article/20130716/NEWS/307169946?AllowView=VW8xUmo5Q21TcWJOb1gzb0tNN3RLZ0h0MWg5SVgra3NZRzROR3l0WWRMWGJVL3dIRWxiNUtpQzMyWmVzNW5vWUpiaW4=</a></p>

One Pioneer ACO Saved Money Using Software From AMA Subsidiary Who Provides Software From a United Healthcare Subsidiary

It’s what I keep saying, the actions takes place with subsidiaries today in healthcare and lot with insurers.  United popped in and bought H...

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The Privacy Report, License Plate Data for Profit–Privacy Exploitations, The Next Frontier?

<p>First off, I have no problem with police agencies using monitors in their cars as this is what it was designed for but what we have here is yet another problem with the word “context” and it gets replaced with the<img align="right" alt="image" border="0" height="173" src="http://lh6.ggpht.com/-doWko7So5Q0/UecFvSt1wOI/AAAAAAABHSY/GCvSd4_m1lg/image%25255B4%25255D.png?imgmax=800" style="background-image: none; border-bottom: 0px; border-left: 0px; padding-left: 0px; padding-right: 0px; display: inline; float: right; border-top: 0px; border-right: 0px; padding-top: 0px" title="image" width="266" /> word “profit’.  That’s the problem as now more see it as an opportunity to run some queries and “flip algorithms” for profit.  Again we do need to license and tax these folks, soon. Billions and I mean billions are made with intangible resources, aka data selling and when it’s wrong and contains errors, who fixes it for free..we do, after they have made their profits.  I benefited from the scanner being used and had my stolen purse returned to me by police even before I knew it was missing due to a scanner identifying a stolen care that was drive by the thief, so there is real use for it when done properly.  It was odd as the police by the time they called me had already recovered my purse and I didn’t know it was missing yet as I was not carrying it and it had been a break in to where I lived.  </p> <p>It is so bad there’s a game out that exploits the inability or lack of education of our government to regulate this, license to sell and excise tax will do it, just like a quarterly sales tax.</p> <h5><a href="http://ducknetweb.blogspot.com/2013/07/data-selling-game-now-exploits-non.html">Data Selling Game Now Exploits the Non Regulated Billion Dollar Epidemic–”Data Dealer” The Attack of the Killer Algorithms Gamified</a></h5> <p>This game I feel is important as the message it carries that you have a lot of folks who write code that think they are better than you and will use such technologies to take advantage of you and your money.  Insurance companies do this to disguise their data scraping efforts, it’s a joke and I hope none of you fall victim there as most of their fun games lack any real luster anyway…like Famville for one example.  Guess what they were trying to mimic to collect and scrape data. </p> <p><strong>ABSOLUTE FEEBLE ATTEMPT BY THE FTC, EITEHR THEY DON’T CARE OR THEY ARE UNDER EDUCATED IN THIS AREA, I DON’T KNOW WHICH APPLIES.</strong></p> <h5><a href="http://ducknetweb.blogspot.com/2013/06/ftc-reclaim-your-name-campaign-not-good.html">FTC “Reclaim Your Name Campaign” Not Good Enough–No Path for Regulation Identified–All Data Sellers Including Banks, Insurers, Etc. Should Be Required to Buy a License</a></h5> <p>So, now let’s take your face and match it to a license plate…9the car repo man can do that if he’s smart enough as they use these scanners too) was that really you driving..the facial recognition will validate that and bingo…more data for sale. So here’s old Blue Cross or United hanging out, they are already in this game to see if you are buying clothes a size larger (that’s what Blue Cross said not me) and gee now they can see where you are, and if you bought a size larger, gee did your car ever get near any gyms?  Think about that.</p> <h5><a href="http://ducknetweb.blogspot.com/2013/03/insurance-companies-are-buying-up.html">Insurance Companies Are Buying Up Consumer Spending Data-Time is Here to License and Tax the Data Sellers-As Insurers Sell Tons of Data, Gets Flawed Data When Data Buyers Uses Out of Context Too</a></h5> <p>It’s the same old story with someone wanting to make a buck and sell your data and at the same time risk taking it out of context to make that buck.  It’s easy to do with data.  If you want to see some real nerds on this topic, look up the quantified self guys, they think they can fix everything with data and they are a strange <a href="http://www.ducknet.net/attack-of-the-killer-algorithms/">algo duped</a> bunch that could be a group that would use stats out of context.  <strong>These companies come under NO privacy laws and decide who gets to use the data.  We are back to “trust me”….BD</strong></p> <p><iframe style="width: 453px; height: 249px" height="315" src="//www.youtube.com/embed/x2eCAgQ1DTo" frameborder="0" width="560" allowfullscreen="allowfullscreen"></iframe></p> <p> <hr />The autonomous readers — small cameras affixed to police vehicles, light poles, bridges, street signs, buildings, you name it — chronicle a vehicle’s whereabouts to the second. Only a fraction of photos provide an immediate “hit” matching the vehicle to a crime. At least one town, the affluent San Francisco suburb of Tiburon, has cameras operating on the only road leading into and out of town. Nationwide, the authorities and even private enterprise maintain a trove of locational data on citizens’ movements, according to the report.</p> <p>Data from these cameras, according to the report, “is being placed into databases, and is sometimes pooled into regional sharing systems. As a result, enormous databases of motorists’ location information are being created. All too frequently, these data are retained permanently and shared widely with few or no restrictions on how they can be used.</p> <p>“These huge databases of plate information are not subject to any data security or privacy regulations governing license plate reader data,” the report said. “These companies decide who can access license plate data and for what purposes.”</p> <p><a href="http://www.wired.com/threatlevel/2013/07/license-plate-readers/">http://www.wired.com/threatlevel/2013/07/license-plate-readers/</a></p>

The Privacy Report, License Plate Data for Profit–Privacy Exploitations, The Next Frontier?

First off, I have no problem with police agencies using monitors in their cars as this is what it was designed for but what we have here is ...

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VA Launches CareGiver Pilot Program, Giving 1000 iPads to Families of Veterans–IT Infrastructure Innovation Work In Progress

<p>This looks interesting and is obviously developed to provide better care and of course information.  The big question with using a pilot is to find out “will they use it”.  We see a lot of that with the over loaded medial apps we have out there today.  A group of 4 different software companies were use to create the dashboard and app, <a href="http://www.agelixconsulting.com/businessmodel/offshoredevelopment.html">one from the financial sector</a> contributed which outsources a some of their development to India.  You can also visit the VA site and <a href="https://mobilehealth.va.gov/article/va-mobile-health-begins-family-caregiver-and-veteran-appointment-request-pilots">find out more about it.</a></p> <p><img align="left" alt="image" border="0" height="178" src="http://lh6.ggpht.com/-sc_HaRlYmDs/UebqSEt7IgI/AAAAAAABHSA/ge05Xk8R7sk/image%25255B8%25255D.png?imgmax=800" style="background-image: none; border-bottom: 0px; border-left: 0px; padding-left: 0px; padding-right: 0px; display: inline; float: left; border-top: 0px; border-right: 0px; padding-top: 0px" title="image" width="451" /></p> <p>Soon you will also be able to make online appointments with the VA and this too is in pilot mode with the mobile apps. The CareGiver program is there to help the families of Veterans who have major health issues.  Here’s a video on how the appointments will work.  Video visits and telephone visits are also going to be accessible.  Additional videos on “how to” are located here <a href="https://mobilehealth.va.gov/content/veteran-appointment-request-help-center-videos">at the VA site.</a> </p> <p><iframe style="width: 446px; height: 241px" height="315" src="//www.youtube.com/embed/Z-vqABBOBLY?list=PL3AQ_JVoBEyxRkTEbJX84LFjYeJb-PsSe" frameborder="0" width="560" allowfullscreen="allowfullscreen"></iframe></p> <p>A government contractor, called LHI, which is a <a href="http://www.logisticshealth.com/specialpages/vha-provider-recruitment-how.aspx">subsidiary of United Healthcare actively solicits via the website to find additional doctors</a> also participates in the VA program with <a href="http://www.logisticshealth.com/News/LHI-is-Awarded-Contract-to-Serve-U.S.-Veterans">disability exams for services outside the VA facilities</a><strong></strong>.  When you look at the technologies of the mobile solution one might wonder how this connects to the LHI program as doctors need to learn to use the LHI dashboard to submit medical information.  It is called <a href="http://www.logisticshealth.com/services/in-clinic.aspx">“In Clinic”</a> services.  You can also <a href="http://www.logisticshealth.com/services/in-clinic.aspx">watch the video</a> here describing those services here  A couple years ago before the United purchase, the <a href="http://ducknetweb.blogspot.com/2010/12/va-awards-contract-to-picis-subsidiary.html">VA awarded another big contract to a United subsidiary.</a></p> <p><img align="left" alt="image" border="0" height="412" src="http://lh3.ggpht.com/-BDSzY-U6b0A/UebqUdiji8I/AAAAAAABHSI/K_AjQ2tY3lM/image%25255B9%25255D.png?imgmax=800" style="background-image: none; border-bottom: 0px; border-left: 0px; padding-left: 0px; padding-right: 0px; display: inline; float: left; border-top: 0px; border-right: 0px; padding-top: 0px" title="image" width="453" /></p> <p> </p> <p> </p> <p> </p> <p> </p> <p> </p> <p> </p> <p> </p> <p> </p> <p> </p> <p> </p> <p> </p> <p align="left">The VA information system is huge and recently <a href="http://ducknetweb.blogspot.com/2013/06/united-healthcare-referral-algorithms.html">with the conversion of the Tri-Care contract to United</a> on the west coast there have been some issues, so again being the technology company United is with an abundance of reports and analytics that hit us all the time as well as  <a href="http://ducknetweb.blogspot.com/2013/06/qssi-subsidiary-of-united-healthcare.html">building the new federal data hub via another subsidiary they own,</a> how long before the pilot here goes beyond the VA facilities.  I guess we will have to wait and see on how the pilot works before appointments and other capabilities go to this application when those with disabilities need services outside the VA.  <img align="right" border="0" src="http://lh3.ggpht.com/_v3zjJigoAPE/THsxLR4O03I/AAAAAAAAg5o/dVUkOUzR5Ec/image%5B14%5D.png?imgmax=800" style="background-image: none; border-bottom: 0px; border-left: 0px; padding-left: 0px; padding-right: 0px; display: inline; float: right; border-top: 0px; border-right: 0px; padding-top: 0px" /></p> <p align="left">And don’t forget the Blue Button whereby you can download your medical records if you are a veteran.  <a href="http://ducknetweb.blogspot.com/2012/07/strong-case-for-veterans-affairs-blue.html">Here’s a good back post on how it worked for one military officer</a> when the hospital records were down.</p> <h5><a href="http://ducknetweb.blogspot.com/2010/08/va-can-now-use-blue-button-to-download.html">VA Can Now Use the “Blue Button” to Download Their Data from Their PHR (Personal Health Record)</a></h5> <p><strong>Time will tell if this works and it’s too bad the VA gets beat up all the time with the DOD medical record integration as you do have to take in additional services and computer code of pilots like this into the over all process</strong> and again as mentioned above with the LHI division of United, having to get the records from private doctors under contract with and have them placed in the VA medical records so the VA doctors can see what is done outside their facilities.  </p> <p><strong>It’s not as simple as many of those on the Hill seem to think with demanding deadlines to be met as scheduled “short order code kitchen burned down a few years ago”.</strong>  Here’s a few back links below on that topic and is it any wonder these <a href="http://ducknetweb.blogspot.com/2013/03/va-claims-system-still-has-large-back.html">2 key executives (VA CTO and CIO)</a> earlier this year held up the white flat and left?  They have a lot of IT infrastructure updates and innovation coming from all different directions not to mention the complexities of dealing with commercial health insurers as well.  BD  </p> <h5><a href="http://ducknetweb.blogspot.com/2013/03/va-claims-system-still-has-large-back.html">VA Claims System Still Has a Large Back Log- Software development and Implementation Working to Correct But All Things Take Even More Time Today With Complexities</a></h5> <h5><a href="http://ducknetweb.blogspot.com/2013/02/va-to-integrate-authentidate-telehealth.html">VA To Integrate Authentidate Telehealth Solutions with VistA EHR Medical Records System For Remote Patient Monitoring</a></h5> <h5><a href="http://ducknetweb.blogspot.com/2013/02/speed-up-rate-of-change-in-health.html">Speed Up Rate of Change in Health IT?–“Short Order Code Kitchen Burned Down a Few Years Ago and There Was No Fire Sale”..IT Infrastructure Chance and Revisions Takes a Lot of ”Code”, “Time” and “ Most Importantly Money”</a></h5> <p> <hr />The Department of Veterans Affairs has fully launched its pilot, <a href="http://mobihealthnews.com/17260/va-to-equip-1000-family-caregivers-with-ipads/"><strong>announced last year</strong></a>, in which it’s <a href="https://mobilehealth.va.gov/article/va-mobile-health-begins-family-caregiver-and-veteran-appointment-request-pilots"><strong>distributing 1,000 iPads to family caregivers of veterans</strong></a> loaded with 10 specially-created apps.</p> <p>“There are three things that we’re looking at in the pilot,” said Kathleen Frisbee, Director of Web and Mobile Solutions in the Veterans Health Administration. ”The first is the impact of the iPads on caregivers’ stress and burden. We’re looking at the historical stress and burden scores we collect through our home visits on those that have the iPad versus those that don’t. The second is looking at caregiver preparedness and trying to understand the impact iPads can have on that. And finally we’re looking at the characteristics of caregivers that predict use of the iPad. It’s trying to understand the audience, what made people use it versus why they didn’t use it.”</p> <p><a href="http://mobihealthnews.com/23817/va-launches-caregiver-pilot-with-10-new-apps/">http://mobihealthnews.com/23817/va-launches-caregiver-pilot-with-10-new-apps/</a></p>

VA Launches CareGiver Pilot Program, Giving 1000 iPads to Families of Veterans–IT Infrastructure Innovation Work In Progress

This looks interesting and is obviously developed to provide better care and of course information.  The big question with using a pilot is ...

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