Pharmacy Benefit Managers Are Not Much More Than “Complex Well-Greased Algorithmic Human Scoring Machines” That Deny or Allow Access To Drugs To Create/Substantiate Big Corporate Profits
10Mar20180So let’s get down to what’s really happening here. Once upon a time the PBM models were a diff...
Optum/United Healthcare Quietly Sold Optum Hospice to Compassus in December of 2016-And Compassus Is Now Contracted Under Optum Services to Manage the Facilities, Services and Provide the OptumCare Doctors
Dec 27, 20170Optum certainly kept this very quiet when they sold their hospice facilities to Compassus and I don’...
Algorithms, Scoring Metrics, Privacy and more in today’s Healthcare business world–The Healthcare Algo Cartel
Nov 19, 20170This is a video of a recent presentation I did at the 74th Annual AAPS (American Association of Phys...
Pharmacy Benefit Managers Invade Medical Records and Electronically Connect Cash Patients to RX Discount Cards-OptimizeRX-to SingleCare to OptumRX
Jun 21, 20171This should not really come as a big surprise as what hasn’t the pharmacy benefit managment business...
“One Trick Algo World” Needs to be Licensed and Indexed–Spurious Correlations “For Profit” Are Out of ControlApr 29, 20170With prediction tools and apps being all the rage today, their reliability and accuracy are not alwa...
DOJ Enters WhistleBlower Law Suit Against United Healthcare–Risk Fiddling for Profit, A Walk Back Down Ingenix Memory Lane AgainFeb 22, 20170Here we go again, back to those Ingenix algorithms and business models, getting a rerun of sorts of ...
Pharmaceutical Wholesalers Inc. File Legal Complaint Against OptumRx “Aligning Its Interests” with the Big Three Drug Distributors in US, Thus Acting as an Agent of the Government With Accreditation ProcessesNov 20, 20160This is a pretty interesting lawsuit and it includes named invidituals at HHS and CMS as well as par...
Cigna & United Healthcare Face Class Action Suits-PBM Over Charging Customers for Prescriptions, OptumRX Pharmacy Benefit Management Software-“Front Running” Consumers With Killer Algorithms at the Drug StoreOct 16, 20161Here we go again. If you haven’t figured this out yet, when you buy a Cigna Health insurance p...
Quants of Optum Carve Out New Outsourced Billing Deal with Quest Labs, Will Also Serve to Enhance The Scoring & Data Selling Business Conducted by Both Companies via Powerful SubsidiariesSep 17, 20160If you don’t know what a Quant is, take time out and watch video #2 in the footer of this blog as th...
“Sully”, The Government’s Flawed Algorithms and Simulations Were Wrong, What Doctors Can Learn From Pilots…Sep 11, 20160I had to include the bit about the comparison here about doctors and pilots as this correlation over...
ICD-10 Conversion Allows Insurance Companies and Pharmacy Benefit Managers the Ability to Push More Drugs and Make Bigger Profits-The Illusion of Better Care Didn’t Happen-Cat Is Out of the BagAug 13, 20160Everyone now has made the big change to convert from ICD9 to ICD10 Coding for medical billing. ...
OptumCare Doctors to Get Allscripts Medical Records EHR–Optum Continues to Buy More Practices and Manage More Doctors Through Independent Physician Associations, Many of Which They OwnAug 07, 20160I’m starting to see more doctors in Orange County selling out their practices to United Healthcare’s...
Hospital Mergers and Acquisitions-Providence and Southern California Based St. Joseph Get Regulator Approval to Begin the ProcessJun 26, 20160Irvine will be the home of a Providence St. Joseph system office once everything gets integrated.&nb...
The Truth About Pharmacy Benefit Managers and Prescription Discount Cards–Created With Automated Algorithmic Processes That Enable Huge Profits-Consumers at Risk!Jun 18, 20160One thing we all hate is the high prices we pay in the US today for our prescriptions. Sure we...
Cigna Launches New Company, CareAllies To Manage Patient Care, Doing Same Things as Does OptumJun 12, 20160By now we should all know the insurers are looking at ways to keep the cost of healthcare down and n...
Cigna Legal Case With Ingenix Flawed Formulas for Out of Network Payments Allowed to Proceed Under ERISA, Can’t Avoid the Claims…May 08, 20160How many companies used the Ingenix Data Base one has to question. While current Acting Direct...
Be Aware of Prescription “Claw Backs” as Pharmacy Benefit Management Profit Centers Continue to EvolveMay 07, 20160If you have watched the news of late, drug prices that we pay are a big item as the price of drugs k...
The Rise of the Quants, Again! This Time In US Healthcare- Taming the MACRA Beast of Quantitated Madness For A Lot of Things That Are Probably Just Not TrueMay 07, 20160I’ve been watching this for years with the way healthcare is changing in the US today and we certain...
United Healthcare Reports 1st Quarter-OptumRX (Pharmacy Benefit Manager) Produces More Revenue Than Its Health Insurance GroupsApr 19, 20160You can read the entire press release here as the report is broken down in several entities, but I f...
United Healthcare Hits the Bottom of the Barrel Linking Doctor Information to Healthgrades Flawed DataApr 06, 20160Ok if you have read here long enough, a few years, then you are accustomed to seeing outrageous flaw...
Walgreens Signs Agreement With PBM OptumRX (United Heatlhcare) and Anthem Then Sues Express ScriptsMar 21, 20160The long and short of the OptumRX agreement is to allow patients to be able to pick up and fil...
United Healthcare Puts Their Quants To Work Again-Designs a Subsidiary to Compete Against Them and Sell Insurance With a New Set of Algorithms Named HarkenMar 13, 20160You read the title correctly as United adds yet one more subsidiary to their almost 400 subsidiary c...
United Healthcare Now Offering Employers Wearable Wellness Devices-UnitedHealthcareMotion–More Data To Mine And Sell With Related Risk Assessment Scoring Processes About You-Excess ScoringMar 01, 20160Here we go again, the Big Brother push and of course could all these “motion” scores be combined and...
And So It Starts With Funded Health Insurance Communities to Help the Poor and Obtain A Lot More Behavior Data to Mine and Sell For United Healthcare From the Participants…Feb 23, 20160If you have read here for a while there have been several posts about United Healthcare investments ...
IBM Acquires Truven Analytics–Excess Scoring & Data Selling Of US Consumers Continues to Grow–Unlicensed And the Dangerous Quantitated Hype Progresses To Further Deny AccessFeb 20, 20160Fortune put it right out in their article on why IBM was purchasing Truven Analytics, for the data.&...
Hollywood Presbyterian Medical Center EHR Hacked And Being Held for Ransom..Feb 17, 20160Update: 2-27-2016 It was reported today via the LA Times, the hospital paid $17,000 in ...
Hollywood Presbyterian Medical Center McKesson EHR Hacked And Hospital Data Being Held for Ransom..Feb 12, 20160I’m surprised it took so long to get out as it happened a week ago. It’s been down for 7 days...
St. Joseph Healthcare in Southern California Becoming a “Nurse Next Door” Franchisee-Acquiring 26 Locations With Option for Another 12–Their Current Private Home Care Business To Be Transitioned To This ModelFeb 10, 20161This is interesting and hospitals are under real pressure today to avoid re-admissions as they can b...
- Index and License Data Sellers, Step One Needed for Any Consumer Privacy Efforts to Exist - Spurious Correlations and Flawed Data Risk Assessments Thrive To Erroneously Deny AccessFeb 07, 20160
It’s been a while since I hit this one but since last time, of course, things are getting worse out ...
Hospital CEO and Two Physicians Arrested In Prescription Pain Killer Distribution Ring..Feb 05, 20160Geez this has to be a black eye on the community to have the CEO involved in this, who I imagine wil...
United Files Lawsuit Against HHS/CMS–Doesn’t Want to Pay Their Portion of the Risk Fiddled $70 Billion Said Medicare Advantage Insurer FraudFeb 03, 20160This has been kicking around out there since Whistleblower lawsuits were filed. Initially Humana was...
CMS Medicare Proposing More Data Selling of Both Private and Medicare Patient Claim Data - A New Dignity And Privacy Attack on Both Consumers and DoctorsJan 30, 20160Just when you think it can’t get any worse it does. If you read here often enough then you kno...
United Healthcare Buys Helios Workman’s Comp PBM and Their Other Related BusinessesJan 29, 20160Here’s another purchase, Helios, and the big focus here is the pharmacy benefit management.&nb...
Silicon Valley Is At It Again Confusing the Public With Calling Risk Assessments a Form of A Diagnosis Tool…Jan 27, 20160This should be ruled trickery as that’s what it really is. When you read the snip from the pre...
Silicon Valley Venture Capitalists Funding Orwellian Software Apps For Medication Compliance-Obnoxious Pill Selfies–Time To Think About Boycotting Some VC Portfolio Companies Right Now…Jan 24, 20160I’ve complained about this here and there but this takes the hat. When you dump out $12 millio...
CMS Sanctions Cigna-No More Selling Any New Medicare Advantage Policies Until Algo Problems Denying Medical Coverage and Prescription Denials Are FixedJan 23, 20160As we may all know Cigna is working to be acquired by Anthem, which would be a huge acquisition.&nbs...
AMA Decides to Buddy Up with the Silicon Valley Data Sellers–Investing In A Healthcare Innovation Company, Yeah It’s Just More Flipping Code To Be Blunt…Jan 11, 20160What a difference a President makes. Last president of the AMA seemed much more interested in ...
So What’s the Future With Guns and Healthcare? Will Doctors be Required to Do “Gun Risk Assessments” On Patients Next?Jan 07, 20160Of course we had to ask this question as with complexities, if a doctor should decide to turn inform...
Rite Aid Pharmacies are the Latest to Begin Used Flawed Data Provided by the EQuIPP Platform Relative to “Scoring” Patients for Predictive Medication Adherence–The “Outlier” Patients…Dec 16, 20151I have had some conversations with pharmacists who are on a pay for performance metric program based...
OptumRX (United Healthcare) Buys Home Infusion Company AxelaCare-Using Algorithms To Determine Your Care With Being Financed By A “Too Big to Fail” US Health Insurance Company…Nov 27, 20150We all know the home drug infusion business is growing as companies send out technicians and clinica...
HHS Joins Optum Labs as Research Partner–Back Peddles Support of FDA Sentinel Program That Does the Same Thing-More Impact from the Six Degrees of Bob Rubin Running Healthcare in the USNov 18, 20150We know Optum Labs is there to make money, selling slots to drug, device companies and others to hav...
Where to Find Cheap Generic Prescription Drugs Less Than a Lot of Co-Pays-Use Cash-And Leave the Insurance, Reward Card, And Pharmacy Benefit Credentials at Home..Nov 08, 20150I have been asked this question many times and with the war on both cost of drugs and the war on cas...
Catholic Hospital Takes Horizon Blue Cross Insurance Company to Court-Tiered Hospitals With Additional Policy Discounts Unfair to Hospitals of Faith–Killer Algorithms At Work..Nov 08, 20150Well what’s not to say we’ll see more of this. Yes indeed it’s getting complicated to get heal...
CVS Laying Off 150 Employees at Headquarters, Meanwhile at the CareMark Florida Ranch A New 500 Personnel Facility to Add Support for Mail Order Drugs In the Works..Nov 07, 20150You can’t make this stuff up and of course this is a big push to save money and get more folks on ma...
- If You Are Insured by Cigna, Guess What You Have a New Pharmacy Benefit Manager Named United HealthcareOct 26, 20150
First question out of the barrel might be “how can that be”. It’s really not too difficult to ...
The End of “Consumer Common Sense” in the US-Fueled by Excess Scoring for Profit, Sustained By Media Publications Serving To Further The Inability For Simple Every Day Life Decisions…Oct 24, 20150This is topic that maybe does not get enough attention, simply due to the fact that today, consumers...
CMS Medicare Part D Program With Medication Therapy Management–Here Comes the Flawed Medication Adherence Prediction Scores, Make Sure Jane Doe Gets the “Cheap Meds”..Oct 22, 20150You know they are going to use these flawed medication adherence scores to determine who gets what w...
“Citizen Score” in China, A Huge Warning For America About the Loss of Privacy, Lifestyle and Personal Worth As Noted by the ACLU With This Orwellian NightmareOct 10, 20150You may or may not be aware of what’s going on with Big Data here but in China this is the deal, a C...
Excess Scoring of US Consumers, US Citizens-Scored into Oblivion By Proprietary Algorithms and Formulas, Never Duplicated or Tested for Accuracy-Profits of Big Business And A White House Executive Command To Continue the Abuse..Sep 20, 20151If you read here often enough then you know I address this topic from time to time as companies and ...
Another United Healthcare (Ingenix) Lawsuit Settling Over 9 Million-Short Paying Ambulatory Surgery Centers-Current CMS Director and One Time Goldman Sachs Banker, Andy Slavitt was CEO of Ingenix for Years…Sep 12, 20150This settlement was a long time coming and it appears now it’s on the way for over $9 million. ...
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