This is similar to the recent case where in New York the algorithms resulted in underpayments to patients and doctors with healthcare claims with the use of Ingenix (a wholly owned subsidiary of United Healthcare)  payment formulas.   We have the same/similar problem here when it comes to medical reimbursements as a result of a car accident.  Lawyers are now beginning the process of reviewing medical records that pertain to those who filed to participate in the class action suit.  image

Chiropractor Files Class Action Breach of Contract Lawsuit Against Safeco Car Insurance – Use of Ingenix Data Base Claimants Were Paid Less

This is just one more reminder to ask questions and not always assume that what you see on a computer screen is 100% accurate.  There’s a lot of power in algorithms and the decision making information they present on a screen.  You may be seeing accurate data and then again you may be seeing data presented for “desired results”.  As we are learning lately, there’s a big connection between “desired results” and profit.  

This is also exactly why our government needs to accelerate infrastructure and data capabilities ASAP.  The executive branch has made this a priority and is working hard to accomplish this.  Without equivalent capabilities to audit the “algorithms” calculated by private industry, well we are just pretty much stuck in having to believe they are being honest and with all the stories in the new today, this is being questioned right and left, all the way up to Wall Street. 

It’s sad to say but the reality is becoming clearer every day that is has become an intelligence war with risk management algorithms for profit and finding loopholes in the masses of text written in laws today to short change the consumer and this will continue to erode the public trust when it comes to insurance of any kind today as it has become a game for profit when analytics can show how to dodge payment bullets. That side with all the algorithmic formulas is waging war with machines guns and we are still standing around with swords and daggers, so the methods of battle are certainly on the side of the folks with all the algorithms and analytics, whether they are showing “desired” or accurate results with transparency today is the big question and we are finding “desired=profit” becoming more apparent every day. 

When do the analytics cross the line between actually detecting fraud and creating “desired” results for profit?  It’s a thin line sometimes. 

When lives are at stake and need healthcare and people die without treatment, is this fair and a good business model with “ethics”?  BD

Lawyers will get to read private medical and financial records of strangers as they decide who joins a multi-state class action against insurer Safeco.
On April 14, two LakinChapman lawyers and two for Safeco asked Madison County Circuit Judge Barbara Crowder to protect patient records from everyone but them.
"If disclosed and made available to the public in the absence of a protective order, such disclosure could violate patient policy rights under federal and state law," they wrote.

The class includes any person Safeco insured in 14 states since 1997, if the person submitted a claim that Safeco reduced through Ingenix software (a wholly owned subsidiary of UnitedHealthcare).
Crowder gathered Arkansas, Colorado, Connecticut, Illinois, Indiana, Iowa, Mississippi, New Hampshire, New Mexico, Ohio, South Dakota, Texas, Wisconsin and West Virginia into the action.

Lawyers to seek medical, financial records in class action against Safeco | Madison/St. Clair Record


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