Ice Bucket Water Heart Rhythm Conversion for Atrial Tachycardias-A New Treatment for Rapid Heart Arrhythmias That Works!

<p><strong>We found therapeutic value with the “Ice Bucket”.</strong>  This is good and they also kept straight faces through all of<img align="right" alt="image" border="0" height="214" src="http://lh6.ggpht.com/-MzGDBDGAA24/VANNTUqBN4I/AAAAAAABLO0/0zg22jGUEqc/image%25255B3%25255D.png?imgmax=800" style="border-left-width: 0px; border-right-width: 0px; background-image: none; border-bottom-width: 0px; float: right; padding-top: 0px; padding-left: 0px; display: inline; padding-right: 0px; border-top-width: 0px" title="image" width="167" /> this, but in fact it works!  Dr.  Mike starts out talking about how a person could help themselves when experiencing a racing heartbeat, or palpitations.  </p> <p>The most common he states is <a href="http://medical-dictionary.thefreedictionary.com/paroxysmal+atrial+tachycardia">“PAT”</a> to where the heartbeat is racing.  It is not considered life threatening and can be triggered by a number of things and can include annoying symptoms.  Dr. Mike goes through and demonstrates things we can do to stop the racing heart and bring the heart back to a normal rhythm. </p> <p><strong>Now we have a new solution demonstrated here which is the “Ice Bucket” methodology that can be used as another alternative. </strong></p> <p>The man’s heartbeat is racing and the staff comes forward to apply the new treatment:)</p> <p>He feels much better after the “Ice Bucket” treatment and the results are confirmed both by a human and the Alive-Cor cell phone app, so we have double the proof that the “Ice Bucket” methodology can work.  I just wrote about the recent FDA approval of the cell phone app as well, links below.  Before it was FDA approved, I told a veterinarian in the OC  about the app and device as well when I had taken my dog in for a visit over a year ago.  You can see the readings in the video below.  </p> <h5><a href="http://ducknetweb.blogspot.com/2014/08/alivecor-receives-fda-approval-for.html">AliveCor Receives FDA Approval For Patients To Use the Heart Monitor Smart Phone App and Device To Detect Atrial Fibrillation (AFib) And Alert Their Doctors</a></h5> <h5><a href="http://ducknetweb.blogspot.com/2012/12/fda-finally-approves-alivecor-iphone.html">FDA Finally Approves AliveCor Iphone Enabled Heart Monitor, Now and the Cat and Dogs Have to Share the Technology With Us</a></h5> <h5><a href="http://ducknetweb.blogspot.com/2012/08/while-waiting-for-fda-approval-for.html">While Waiting for FDA Approval for an IPhone ECG Company Launches Popular Veterinary Version–Cats and Dogs Get Heart Attacks Diagnosed</a></h5> <p>This method may not always be the most convenient for relief though and you need someone to “man” the bucket:)  Good show.  </p> <p><iframe style="height: 282px; width: 514px" height="315" src="//www.youtube.com/embed/QnrYqxoXzkw" frameborder="0" width="560" allowfullscreen="allowfullscreen"></iframe></p> <p>You may remember <a href="http://ducknetweb.blogspot.com/2013/02/southern-california-cardiologist.html">Dr. Mike from last year when he worked for years in his spare time to produce a “Grammy” winner</a> with Omar Akram for best New Age Album of the year and guess what music you hear in his waiting room.  Here’s a short clip from his acceptance speech as I think it it something we all need to think about again today as we live in a world with <a href="http://ducknetweb.blogspot.com/2014/03/virtual-worlds-real-world-we-have.html">too many folks confusing “virtual” and “real” world</a> values at times.  </p> <p><em>“Sixteen years ago, a friend of mine came up to me and asked, ‘How are your investments doing?’”</em><em> <br />“<strong>He then said, ‘Have you ever thought<img align="right" alt="Omar3" border="0" height="142" src="http://lh3.ggpht.com/-CfiU8PwHRt0/USaruedrB2I/AAAAAAABFlQ/1TZI6b6zlf4/Omar3%25255B6%25255D.png?imgmax=800" title="Omar3" width="123" /> of investing in a human being?’”</strong><strong>.</strong> <br />“He subsequently introduced me to Omar; I was moved by his music and we have worked together ever since. I can go on and on but suffice it to say, <strong>if anyone is able to, I would encourage them to invest in a human being. </strong>What you will find is when you help someone else achieve their dreams, in some miraculous way you achieve your own dreams as well.”</em></p> <p>I might add it might make a nice addition to tune in after using the new “Ice Bucket” methodologies shown above to chill the mind down as well.  BD  </p> <p><iframe style="height: 315px; width: 533px" height="315" src="//www.youtube.com/embed/v5yrhCjgPwk" frameborder="0" width="560" allowfullscreen="allowfullscreen"></iframe></p> <p><a href="https://www.youtube.com/watch?v=QnrYqxoXzkw">https://www.youtube.com/watch?v=QnrYqxoXzkw</a></p>

Ice Bucket Water Heart Rhythm Conversion for Atrial Tachycardias-A New Treatment for Rapid Heart Arrhythmias That Works!

We found therapeutic value with the “Ice Bucket”.   This is good and they also kept straight faces through all of this, but in fact it work...

Read more »

Feds Decide to Intervene, File Their Own Lawsuit Against Optum (United Healthcare) Hospice Services Relative to Whistleblower Fraud Cases Already Submitted- Pay for Performance Issues With Hospice Performance and Medicare Fraud At the Core

<p>Optum Hospice used to be known as Evercare until the last year when United Healthcare subsidiary, Optum rebranded the company.  To me a hospice company owned by a health insurance company just doesn’t mix, especially when the same corporation has <a href="http://ducknetweb.blogspot.com/2013/07/health-insurance-business-under-radar.html">truckloads of subsidiary companies</a> that are not always apparent to the consumer.  2/3 of United’s profits come from selling policies and the other 1/3 comes from writing code, selling software, consulting and so on, in other words Health IT.  Optum also wants to be <a href="http://ducknetweb.blogspot.com/2013/11/united-healthcare-optum-insight.html">contracted integrators as well for major medical record systems</a> as they list on their website. </p> <p>I read a little bit of the case and the accusations are amazing as it comes right back to almost slap the<img align="right" height="162" src="http://lh6.ggpht.com/-XnJ6WKypmjw/U8IEjP-TQwI/AAAAAAABKzo/20y0ilhlCIg/image%25255B4%25255D.png?imgmax=800" style="float: right; display: inline" width="278" /> insurer in the face with the allegations of pay for performance measures as it is stated they created an incentive to staff to admit and retain ineligible patients by giving out bonuses and other incentives based up on meeting their targets.  It’s also beginning to sound like the same stat rats at the VA as well, who were so stuck on numbers they could not make a left turn to save a life.  The bonuses (or as sometimes called P4P) were for staff members who admitted, certified and recertified and discharging patients.  </p> <p><strong>Employees were told there would be staff reductions or terminations if the census fell below targets, as well as people could be fired or demoted for discharging ineligible patients</strong>.  Here comes the algorithms as Optum is accused of creating discharge procedures that made it difficult or substantially delayed the discharge of ineligible patients.  Let me guess, it’s all software with input and the algos give you the decision perhaps.</p> <p>The lawsuit also states that contracted physicians were also pressured to improperly certify and recertify ineligible patients.  Here’s all the chronic conditions that were targeted, dementia, Alzheimer's, and pulmonary irregularities and the goal was slated that they could in fact keep patients with such conditions for more than six months.   As a result of such actions, Optum is accused of submitting false claims to Medicare and was overbilled.<strong>  This gets kind of interesting as the new <a href="http://ducknetweb.blogspot.com/2014/06/how-hard-did-united-have-to-lobby-to.html">#2 person at CMS that Burwell appointed, Andy Slavitt</a>  comes from United Healthcare and was the CEO of Ingenix at the time of the <a href="http://ducknetweb.blogspot.com/2012/02/ama-announces-doctors-and-patients-can.html">AMA lawsuit</a> (Killer Algorithms chapter 19)  that used algorithmic automated processes to under pay doctors for 15 years.</strong>  Ingenix algorithms just raised their ugly face again  within the last week with a Blue Cross Company still using them after most everyone else settled in New Jersey.</p> <h5><a href="http://ducknetweb.blogspot.com/2014/08/ingenix-optum-united-healthcare.html">Ingenix (Optum-United Healthcare) Lawsuits Still Bouncing Around Out There–One Recently Settled in New Jersey With Horizon Blue Cross Blue Shield That Was Still Using the Flawed and Corrupt Data Base for Out of Network Payment Calculations</a></h5> <p>Optum Hospice is on the move too and growing with opening new facilities.</p> <h5><a href="http://ducknetweb.blogspot.com/2014/07/optumunited-healthcare-opening-new.html">Optum/United Healthcare Opening New Hospice Care Facilities In Birmingham & Macon, Hospice For Profit-Evercare Subsidiary to Gets Rebranded To Optum Palliative and Hospice Care</a></h5> <p><strong>It goes on further here with employees being given a “scorecard” for each Evercare Office and the offices that were meeting goal would receive positive points if the average daily census met goals.</strong>  This sounds like the ad business here with those offices who converted 85% or better of their referral getting a bonus.  Also the case says that offices were penalized if the discharges of ineligible patients exceeded 10% of the average daily census.  Bonuses could be as high as 20% of their annual salary.  This goes on to talk about a sales force hired called Community<img align="right" alt="image" border="0" height="107" src="http://lh4.ggpht.com/-UETj_C8ScyA/VAKmjbl8iRI/AAAAAAABLOk/Tyr_MkYjJD0/image%25255B3%25255D.png?imgmax=800" style="border-top: 0px; border-right: 0px; background-image: none; border-bottom: 0px; float: right; padding-top: 0px; padding-left: 0px; border-left: 0px; display: inline; padding-right: 0px" title="image" width="281" /> Outreach who’s duty was to troll nursing homes, hospitals and other care facilities to obtain new clients.  Now sales portions take place everywhere and nothing wrong with sales people, and they received commissions on the news of new admissions.  I can’t see a problem there but as long as the sales calls were good will calls and not looking for ineligible patients.  </p> <p>I have seen one thing on their website is that Optum, formerly Evercare is always advertising for people to come volunteer and work for them.  Both the contracted doctors and employees told Evercare they had ineligible patients that needed to be discharged and decisions from higher up mad the decisions.  </p> <p>I know when I had to chose a hospice service for my mother last year, Evercare was not on my list as I just pictured being loaded down with quantitated numbers about my mother while I was trying to see to her care in her last few days.  I report enough on United and their subsidiaries to see all their stats and how they live by them with lacking ethics sometimes and I knew better.  </p> <p><strong><u>It goes on here further to say that salaried physicians who worked there were also coerced and the nature of the contracts provided incentives to the physicians to keep the patients in.</u>  In another area of United Healthcare relative to Medicare Advantage, doctors are being scored and fired across the country and are given no reason or in some cases no communication beyond a letter saying your services are no longer needed</strong>.  </p> <h5><a href="http://ducknetweb.blogspot.com/2014/08/the-secret-scoring-of-americas.html">“The Secret Scoring of America’s Physicians” - Algorithmic Math Models For Insurance Network Contractual Exclusions, Relating to MDs Who See Medicare Advantage Patients..</a></h5> <p>The case further goes on to state that the sales force also knew that targeting the certain types of chronic patients allowed for them to be certified “terminally ill” once they were in house, which allowed them to keep them longer and bill more.  Again we go back to Phoenix, the site of the VA issues where the billing office is for Optum (Evercare).  There are several examples in the court case <a href="http://www.corporatecrimereporter.com/wp-content/uploads/2014/08/evercare.pdf">you can read here</a>.  After I read through it I can see why the Feds stepped in as they are owed money according to the case filing.  <a href="http://en.wikipedia.org/wiki/UnitedHealth_Group">United bought Evercare in 2001</a> so all this took place while under their ownership of the company.</p> <p>The suit also states that another division of Optum, Ovations, a health and wellness company for people 50 years an over in age, worked hand in hand with Optum Hospice.  United owns a few wellness subsidiaries.  Americhoice was also mentioned which has since been absorbed into Untied Healthcare and no longer maintains the separate identity and is called the UnitedHeatlhcare Community Plan.  </p> <p><strong>So again all we hear from United Healthcare day in and day out is pay for performance</strong> so will it come back to bite in their hospice operations?  There’s some pharmacists too out there with Walgreens that get to collect pay for performance from United/Optum in some parts of the country. Are the P4P models beginning to fail?  Could be.   BD</p> <h5><a href="http://ducknetweb.blogspot.com/2011/08/unitedhealth-ymca-expand-diabetes.html">UnitedHealth, YMCA Expand Diabetes Prevention Program with P4P for Walgreens</a></h5> <h5><a href="http://ducknetweb.blogspot.com/2010/04/unitedhealthcare-to-use-data-mining.html">UnitedHealthCare To Use Data Mining Algorithms On Claim Data To Look For Those At “Risk” of Developing Diabetes – Walgreens and the YMCA Benefit With Pay for Performance Dollars to Promote and Supply The Tools</a></h5> <p>We know how United/Optum knows how to model and code with the contracts they have received for fixing not only the US exchange but also some state exchanges as well, so again watch these folks with their algorithms as they know how to hide and do it better than anyone else out there, and it’s all proprietary and it usually takes audit functions years to catch up with them.  Watch video #2 in the footer here to see how quants work and insurers are hiring them by the groves for their profit making math models.  BD  </p> <h5><a href="http://ducknetweb.blogspot.com/2014/05/health-insurer-actuary-jobs-becoming.html">Health Insurer Actuary Jobs Becoming More Difficult In the Era of Killer Algorithms, Can’t Function Like They Used To As Information Changes Take Place Daily And Hourly, More Insurance Companies Are Seeking quants to Create New Math Models, The Next Level Up From Actuary Calculations</a></h5> <p> <hr />Federal officials have intervened against defendants in two whistleblower lawsuits in federal court in Colorado alleging Evercare Hospice and Palliative Care (Evercare) submitted false claims for the Medicare hospice benefit.</p> <p>Evercare is now known as Optum Palliative and Hospice Care, which provides hospice services across the United States.</p> <p>One of the suits names Evercare’s parent companies, including UnitedHealth Group.</p> <p>The complaints include allegations that management pressured employees and physicians to admit and retain patients who were not terminally ill and challenged or disregarded physicians’ decisions that patients should be discharged.</p> <p>According to the lawsuit, the companies “targeted for admission ineligible elderly patients with conditions like debility, dementia, Alzheimer’s and cardiac or pulmonary irregularities that while serious were not likely to lead to the death of the patient within six months, thus allowing the defendants to keep these types of patients on their hospice census for more than six months, if not several years.”</p> <p><a href="http://www.corporatecrimereporter.com/news/200/feds-intervene-false-claims-case-unitedhealth-group/">http://www.corporatecrimereporter.com/news/200/feds-intervene-false-claims-case-unitedhealth-group/</a></p>

Feds Decide to Intervene, File Their Own Lawsuit Against Optum (United Healthcare) Hospice Services Relative to Whistleblower Fraud Cases Already Submitted- Pay for Performance Issues With Hospice Performance and Medicare Fraud At the Core

Optum Hospice used to be known as Evercare until the last year when United Healthcare subsidiary, Optum rebranded the company.  To me a hosp...

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Sears Holdings Yanks the $37.00 Health Insurance Subsidiary for Retirees

<p>Sears Holdings will be notifying thousands of retirees that their $37.00 a month subsidy towards health insurance <img align="right" alt="image" border="0" height="155" src="http://lh6.ggpht.com/-kQ-vBc3QRho/VAJZ3coeyvI/AAAAAAABLOE/g4P_uPV6vs0/image%25255B2%25255D.png?imgmax=800" style="border-top: 0px; border-right: 0px; background-image: none; border-bottom: 0px; float: right; padding-top: 0px; padding-left: 0px; margin: 0px; border-left: 0px; display: inline; padding-right: 0px" title="image" width="187" />at the beginning of 2015 will be a thing of the past.  It may not sound like a big deal but for those who are on fixed income, it is a big deal that helps.  Again this applies towards those who retired before 2000 as those who retired later already had their subsidiary ripped.  BD  </p> <p> <hr />CHICAGO - About 14,000 Sears retirees will lose a monthly health insurance subsidy as the languishing department store titan looks for ways to shave costs.</p> <p>Sears Holdings planned to send letters Friday to the 14,000 Sears, Roebuck & Co. retirees and dependent spouses who have been receiving the $37 monthly health care subsidy, informing them that the subsidy will be eliminated in 2015.</p> <p>Only employees who retired before 2000 were eligible to receive the subsidy, which was reduced in 2006 and is applied to the monthly cost of health care coverage through Sears-sponsored group benefit plans. Anyone who retired after 2000 had their subsidy eliminated in 2006.</p> <p><a href="http://www.leadertelegram.com/business/from_the_wire/article_e08170f8-bb0c-5abf-ad69-f35659971873.html">http://www.leadertelegram.com/business/from_the_wire/article_e08170f8-bb0c-5abf-ad69-f35659971873.html</a></p>

Sears Holdings Yanks the $37.00 Health Insurance Subsidiary for Retirees

Sears Holdings will be notifying thousands of retirees that their $37.00 a month subsidy towards health insurance at the beginning of 2015 w...

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Cleveland, Texas Hospital Abruptly Closes–Note On Door Says We Hope to Re-Open Soon, Meanwhile Back at the Ranch CMS Is Working Hard to Create A Ridiculous 5 Star Rating System for Hospitals…

<p>One older article seemed to reflect something about a “boiler room” remodel but those are usually scheduled<img align="right" alt="image" border="0" height="183" src="http://lh6.ggpht.com/-RRnJiVcMED4/VAIqK41AkHI/AAAAAAABLN0/2u76_GjFJ7g/image7.png?imgmax=800" style="border-left-width: 0px; border-right-width: 0px; background-image: none; border-bottom-width: 0px; float: right; padding-top: 0px; padding-left: 0px; display: inline; padding-right: 0px; border-top-width: 0px" title="image" width="255" /> and maybe something unexpected popped up in that area as the note does reference the hospital wants to be a “safe” facility.  In addition the hospital has also had financial issues in struggling to pay both employees and vendors in the last 3-4 years.  Who knows, maybe they need a loan to fix the boiler?  RKM Management is the owner of the hospital.  The ER room is closed and the next closest facility is 24 miles away which concerns residents. </p> <p>Back in 2013 the former CEO has some issues too and was on the loose for a while with assault charges against him with a confrontation with the chief nursing officer.  There’s been quite a bit of history written about this hospital struggling to stay in business.  <strong>Nobody wants to talk about this but we have a big case of “hospital inequality” in the US.</strong>  </p> <h5><a href="http://ducknetweb.blogspot.com/2014/03/hospital-inequality-yet-one-more.html">“Hospital inequality” - Yet One More Growing Issue With Healthcare In the US..</a></h5> <p>We keep seeing more and more stories like this<strong> but in the meantime we have good old CMS with a response and answer for all of this “a new 5-star hospital rating system” and don’t you have to about fall off your chair reading this in today’s economic times?</strong>  They haven’t caught on yet that we really don’t need this today and ratings are so “yesterday” as now we want to know what facilities “will be available and open” when we need them.  </p> <h5><a href="http://ducknetweb.blogspot.com/2014/04/cms-plans-to-begin-five-star-hospital.html">CMS Plans To Begin Five Star Hospital Rating System - Add A Column For “Hospital Mortality Projections” Or Stop the Ratings All Together As Lack of Money Today Is More of a Determining Factor With US Hospital inequality That Keeps Growing..</a></h5> <p><object allowfullscreen="true" allownetworking="all" allowscriptaccess="always" data="http://www.kaltura.com/index.php/kwidget/wid/0_kur2lgsx/uiconf_id/12411302" height="245" id="kaltura_player_1409426556" name="kaltura_player_1409426556" type="application/x-shockwave-flash" width="460"><param name="allowScriptAccess" value="always" /><param name="allowNetworking" value="all" /><param name="allowFullScreen" value="true" /><param name="bgcolor" value="#000000" /><param name="movie" value="http://www.kaltura.com/index.php/kwidget/wid/0_kur2lgsx/uiconf_id/12411302" /><param name="flashVars" value="" /><a href="http://corp.kaltura.com">video platform</a><a href="http://corp.kaltura.com/video_platform/video_management">video management</a><a href="http://corp.kaltura.com/solutions/video_solution">video solutions</a><a href="http://corp.kaltura.com/video_platform/video_publishing">video player</a></object></p> <p>CMS like many others are <a href="http://ducknetweb.blogspot.com/2014/03/virtual-worlds-real-world-we-have.html">busy living in the quantitated world of virtual numbers</a> and sure there is valuable information when done right but they don’t know when to stop and succumb to every little bit of data having value on care, whether it does or does not.  There’s plenty of Health IT vendors out there as well to sell you any kind of analytics you want too, so again you have to be smart about it today.  The boneheads at this hospital at the link below are really addicted to the virtual worlds and don’t know when to stop as all the patient credit card and Acxiom data is not going to give better care and they got soaked as it’s not relative to giving immediate good care.  I do have to laugh at how “Algo Duped” the hospital is here.  <strong>There’s Quants working everywhere and like Felix Salmon said, a sharp journalist in this area “quants don’t know when to stop and mess up every industry they infiltrate”.</strong>  </p> <h5><a href="http://ducknetweb.blogspot.com/2014/06/oh-crap-now-hospitals-are-now-buying.html">Oh crap, Now Hospitals Are Now Buying Data From Acxiom - Data Selling Epidemic Continues to Evade on Personal Privacy As “Algo Duped-Stat Rat” People Try to Implement Virtual Models That Won’t Work…</a></h5> <p>No amount of credit card data or Acxiom data is going to help this hospital in Texas here and there’s budget for the nonsense either as they are just trying to stay in business.  CMS is kind of in a tizzy right now as many of their quantitated methodologies are starting to fail them and they don’t have a back up for the models used that were pretty much in line with what one big insurer has guided them to use for the last number of years, and they too have failing models.  We are seeing evidence of such with <a href="http://ducknetweb.blogspot.com/2014/08/the-secret-scoring-of-americas.html">secretive scoring of doctors</a> being turned loose from being network and given no explanation as to why.   BD</p> <h5><a href="http://ducknetweb.blogspot.com/2014/05/people-dont-work-that-way-world-of.html">“People Don’t Work That Way” A World of Broken Software Models That Don’t Align To the Human Side,Too Much Push At Times With Only A Proof of Concept That Fails in the Real World..</a></h5> <hr />Cleveland residents are upset and worried after learning their local hospital has shut its doors. <p>On Thursday night, signs were posted on the front doors of Cleveland Regional Medical Center stating the facility is closed until further notice.</p> <p>"Just got sent up here for a routine chest X-ray from my local doctor, and I can't get in through the doors they are closed as of Aug. 28 and I wasn't aware of that," said resident Fulton Thompson.</p> <p>Posted signs also suggested patients drive to the closest emergency room in Kingwood, which is over 24 miles away.</p> <p>In an emergency, the longer distance could mean the difference between life and death.</p> <p><a href="http://www.click2houston.com/news/cleveland-regional-medical-center-closed-until-further-notice/27791330">http://www.click2houston.com/news/cleveland-regional-medical-center-closed-until-further-notice/27791330</a></p>

Cleveland, Texas Hospital Abruptly Closes–Note On Door Says We Hope to Re-Open Soon, Meanwhile Back at the Ranch CMS Is Working Hard to Create A Ridiculous 5 Star Rating System for Hospitals…

One older article seemed to reflect something about a “boiler room” remodel but those are usually scheduled and maybe something unexpected ...

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CMS Overload of Short Term Inpatient Hospital Stays Appeals Process Leads To the Agency Offering New Settlement Proposals

<p>This could be good and get a large number of appeals, which are slated to be around 800,000 out of the way, that is if the hospitals agree to the proposed numbers of around 2/3rds of the dollar amounts.  It could be small amounts for some hospitals and very large amounts for others.  CMS is basically offering to pay a flat amount and be done with it.  These are some of the appeals that were a result of audits conducted by contractors at hospitals all over the US in their pursuit of looking for fraud.  Stuff like this goes on forever when numbers and cases are reconstructed years after the fact.  Many of the RAC auditors are actually subsidiaries of insurance companies as well that provide such audits.  It does make you wonder how good the auditing is when in fact you see insurers with their own internal problems such as this one that emerged in New York earlier this year to where over $170,000 was paid for a hammer toe procedure.  It just makes you ask about how accurate at these auditing algorithms if you will.</p> <h5><a href="http://ducknetweb.blogspot.com/2014/03/17509880-to-fix-hammer-toe-billed-by.html">$175,098.80 To Fix A Hammer Toe Billed by New York Podiatrist And the Insurer Paid It, Well Sort Of As They Sent the Check to the Patient By Accident, A New Investigation For “Out of Network” Charges Has Resulted</a></h5> <p>This is interesting as it was “quietly” posted as the New York Times mentions here.  Again it will be up to the hospitals to decide if the settlement works for them and in so many of these appeals, the hospitals have been winning anyway so it’s a matter of if 2/3rds is enough to wipe it out or are the hospitals going to hang in for the full amounts.  I said a while back that most of the auditing functions with RAC auditors are not really necessary any longer as CMS is now using fraud detecting software that catches a lot of the known patterns up front and in actuality does send auditors where they should be looking rather than just a random audit of billing practices.   Of course the RAC auditors don’t want to lose their jobs either<img align="right" src="http://lh3.ggpht.com/-BeKHawizimc/UnSd5OQaM-I/AAAAAAABIaI/HpXUGZsTOEc/image%25255B10%25255D.png?imgmax=800" style="float: right; display: inline" /> and thus there’s the tug and pull and if it is subsidiary of an insurance company, there’s a lot of a revenue stream with the audits.  </p> <h5><a href="http://ducknetweb.blogspot.com/2014/05/heres-some-folks-that-can-be-replaced.html">Here’s Some Folks That Can Be replaced With Technology-Medicare Recovery Audit Contractors - CMS Yarcdata Urika Appliance Can Do This Job And Is With Finding Fraud Patterns…</a></h5> <p><em>“The YarcData unit is helping the U.S. government detect fraud patterns in Medicare and Medicaid payments. Private sector customers include medical research group Mayo Clinic and several financial services, life sciences and telecommunications firms, which Cray cannot name for contractual reasons.”</em></p> <p>Due to today’s complexities and the old audit methodologies no longer containing high levels of accuracy, we are kind of spinning our wheels here with kind of a “he said she said” scenario that wastes everyone’s time.  </p> <p>A good example of trying to rebuilt an audit situation was the VA and I called “foul” on this one myself as quantitating numbers is not going to change the fact that patients died but when you look at what’s put out there today, there’s a lot of this going on and you can get sucked in easy enough, we all do at times.  People are using quantitated math functionality to change virtual values that impact “what really happens in the real world”, which is very dangerous indeed, and the balance is very skewed at times when there’s money involved.  </p> <h5><a href="http://ducknetweb.blogspot.com/2014/08/va-inspector-general-takes-virtual-low.html">VA Inspector General Takes the “Virtual Low Road” With Report at Phoenix Hospital, Working Some Quantitated Mathematical Justifications But We All Know In the “Real” World People Died…</a></h5> <h5><a href="http://ducknetweb.blogspot.com/2014/07/medicare-penalties-for-hospitals-to.html">Medicare Penalties for Hospitals To Take Effect Later This Year With Patient Safety - Can We Learn From the VA On Not Being “Stat Rats” And Attain The “Desired virtual Numbers” In The “Real World”?</a></h5> <p>So again hospitals, depending on their number of appeals and dollar amounts will have to make their own<img align="right" src="http://lh6.ggpht.com/-PwIEC5PP2qU/U8XeRjva-NI/AAAAAAABK04/DaCxAciMrUQ/image73%25255B3%25255D.png?imgmax=800" style="float: right; display: inline" /> decisions and I would imagine there could be quite a few takers on this as it represents one less headache of bean counters in the virtual/real world confusion we  live in today which I call “The Grays”, a very big problem indeed.    </p> <h5><a href="http://ducknetweb.blogspot.com/2014/03/virtual-worlds-real-world-we-have.html">Virtual Worlds, Real World We Have A Problem And It’s A Big One With A Lot of Gray Areas Finding Where The Defining Lines Exist, Confusing Many With A Lot of Weird Values And Strange Perceptions…</a></h5> <p>100 Bottles of Beer, watch this short video and it pretty much explains what’s going on here with how some of this works and the fact that variables with reconstructing after the fact can leave to false perceptions when trying to go to the extremes with math.  </p> <p><object height="300" width="460"><param name="movie" value="http://swf.tubechop.com/tubechop.swf?vurl=ed2FWNWwE3I&start=149&end=235&cid=2520036"></param><embed src="http://swf.tubechop.com/tubechop.swf?vurl=ed2FWNWwE3I&start=149&end=235&cid=2520036" type="application/x-shockwave-flash" allowfullscreen="true" width="460" height="300"></embed></object></p> <p>If you liked this video clip, the scroll down and watch the full presentation in the footer, video #2 of the 4 essentials below.  BD  </p> <hr />Sharply criticized by Congress and others, <a href="http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/medicare/index.html?inline=nyt-classifier">Medicare</a> quietly announced on Friday that it would settle hundreds of thousands of hospital appeals over bills for short-term care, by offering deals that could add up to several hundred million dollars. <p>The decision is an effort by the government agency to end a protracted battle with thousands of hospitals over the amount they should receive for treating patients who stay just a day or two. So many hospitals have filed appeals with Medicare that a backlog now stretches for 18 months or more before the disputes are being resolved.</p> <p>The proposed <a href="http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Medical-Review/InpatientHospitalReviews.html">settlement</a>, which was quietly posted on the agency’s website late Friday afternoon before the holiday weekend, represents a considerable concession by Medicare. The financial payout that it is offering to individual hospitals would be a little more than two-thirds of the amounts they have insisted they are owed.</p> <p>Medicare “is offering an administrative agreement to eligible hospitals willing to resolve their pending appeals in exchange for timely partial payment,” said Aaron Albright, a Medicare spokesman. Mr. Albright described the offer as an opportunity for the hospitals “to alleviate the administrative burden of current appeals on both the hospital and Medicare system.”</p> <p>Medicare and its contractors say many hospitals have overbilled the government for treating patients who underwent simple operations or were in the emergency room for a lengthy evaluation. They say that under Medicare rules, a hospital should receive a lower outpatient rate for that type of care rather than the much higher reimbursement for a full hospital stay, a difference that can add up to thousands of dollars for each patient.</p> <p><a href="http://www.nytimes.com/2014/08/30/business/medicare-will-settle-appeals-of-short-term-care-bills.html?smid=tw-nytimeshealth&seid=auto&_r=0">http://www.nytimes.com/2014/08/30/business/medicare-will-settle-appeals-of-short-term-care-bills.html?smid=tw-nytimeshealth&seid=auto&_r=0</a></p>

CMS Overload of Short Term Inpatient Hospital Stays Appeals Process Leads To the Agency Offering New Settlement Proposals

This could be good and get a large number of appeals, which are slated to be around 800,000 out of the way, that is if the hospitals agree t...

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VA Beginning to Use Wearables That Are Not Data Poachers …

<p>This is a good article here and goes to show that wearables that keep a patient’s dignity in place can be used successfully. <img align="right" alt="image" border="0" height="187" src="http://lh4.ggpht.com/-yTdQs3OQzEI/VAAgPHYTuiI/AAAAAAABLNg/CmmT5oqV6Vk/image%25255B2%25255D.png?imgmax=800" style="border-top: 0px; border-right: 0px; background-image: none; border-bottom: 0px; float: right; padding-top: 0px; padding-left: 0px; margin: 0px; border-left: 0px; display: inline; padding-right: 0px" title="image" width="182" /> This is a new project that is measuring the use of orthopedic or prosthetic devices and the patient owns the device and the data, very cool.  The <a href="http://modushealth.com/">Modus step watch</a> was developed more than 10 years ago.  </p> <p>It appears to be an accelerated pedometer to measure patient progress.  BD </p> <p> <hr />The VA won’t be reimbursing for Fitbits and Jawbone UP devices, however. The contract template specifies that the devices be able to measure a number of highly specific metrics such as stance and swing time, gait symmetry, dynamic function, cadence and cadence variability, step count, numbers of steps per time interval, peak performance, and functional level assessment. And they have to record continuously and accurately as well. One such device is <a href="http://mobihealthnews.com/34726/modus-health-wants-to-build-a-more-clinical-activity-tracker/"><strong>modus health’s StepWatch</strong></a>.</p> <p><strong>“The device becomes [owned by] the veteran, and they own that information,” he said. “If we want to see it, it’s the veteran who allows us access to that.”</strong></p> <p>The change was motivated by an Inspector General audit of the VA’s practices around procurement of prosthetics. The VA needed to show it was being responsible as new technological advances cause the price of prosthetics to rise in recent years.</p> <p><a href="http://mobihealthnews.com/36158/va-to-reimburse-for-certain-clinical-activity-trackers/">http://mobihealthnews.com/36158/va-to-reimburse-for-certain-clinical-activity-trackers/</a></p>

VA Beginning to Use Wearables That Are Not Data Poachers …

This is a good article here and goes to show that wearables that keep a patient’s dignity in place can be used successfully. This is a new ...

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Apple Updates HealthKit Privacy Policies–Could Be A Good Time to Also Embrace Support For the Government to License All Data Sellers, Apple Will Be Conducting “Due Diligence” With Those Writing Apps For the Platform As Part of Their Business

<p>I said a while back that Apple has the money so if any tech company could kick the data sellers out, they could and it sounds like that’s the plan.  I did read to where they had talked with insurance companies if that’s the case then folks will start heading for the exits. <img align="right" alt="image" border="0" height="210" src="http://lh6.ggpht.com/-ihcvyDFMOCY/VAAcinTPJ-I/AAAAAAABLNU/CDdOO6udmFA/image%25255B3%25255D.png?imgmax=800" style="border-top: 0px; border-right: 0px; background-image: none; border-bottom: 0px; float: right; padding-top: 0px; padding-left: 0px; border-left: 0px; display: inline; padding-right: 0px" title="image" width="250" /> Why?  We all know insurers make a ton of money selling our data and they buy a lot of our data as well.  Here’s an example of a company that buys your credit card data, analyzes it and “scores” your behavior before selling it as then they can charge the insurers more and of course this comes out down the tubes in higher premiums at some point as all of this is not cheap as companies are making millions doing this.  So staying away from data selling entities like this are a sure win for consumers here.  </p> <h5><a href="http://ducknetweb.blogspot.com/2014/08/argus-analytics-produces-share-of.html">Argus Analytics Produces “Share of Credit Card” Data On Consumers - Digs Up The Dirt on Your Credit Card Behavior Patterns-US Consumer Protection Agency Is A Client-We Are Paying for Richard Cordray’s Slow Education Process</a></h5> <p>In addition, I made a perky post as well stating we didn’t want Apple sitting down with United Healthcare writing code together either.  As you may or may not know 1/3 of United’s profits comes from writing software, code and analytics and 2/3s comes from policies.  They know <a href="http://ducknetweb.blogspot.com/2014/08/ingenix-optum-united-healthcare.html">how to rip with math models</a> for profit and have done it for years with their huge portfolio of subsidiaries and subsidiaries of those subs, so again the trust would not be there with consumers.  We also know that insurers record and analyze your voice at their call centers and probably score and sell that data too.  </p> <h5><a href="http://ducknetweb.blogspot.com/2014/08/apple-in-talks-with-insurers-now.html">Apple In Talks With Insurers Now Relative to Healthkit? If So We’re Going The Other Way As Consumers Are Waking Up to the US Data Selling Epidemic Along With Profit Making Algorithms That Generate “Secret Consumer Scores” That Benefit Corporations - A Big Factor With Inequality Acceleration</a></h5> <p>We also have this nice report done from the World Privacy Forum here that discussed “The Secret Scoring of America” that tells you more about the lack of privacy and the data selling epidemic in the US.  Any bank, company that has data hanging around today it seems to be burning a hole in their pocket and we get “data flipped” out there today as well, re-queried and resold right and left.  </p> <h5><a href="http://ducknetweb.blogspot.com/2014/04/world-privacy-forum-report-scoring-of.html">World Privacy Forum Report - The Scoring of America: How Secret Consumer Scores Threaten Your Privacy and Your Future - One Big Element that Fuels the Continued Attack of Killer Algorithms & Demise of the Middle Class Creating Profiteering And/Or Denial of Access</a></h5> <p>So again if Apple chooses to stay out of the epidemic, which would be nice, they too would need some form of index that in reality could also help lawmakers too with privacy efforts.  We absolutely have no index of who’d distributing data and we need that with consumer data so we know who they are.  Just think if you were Apple and were approached by a developer and Apple needed to verify what you do, don’t you think they would appreciate a listing of data sellers to see what kind of data they sell (profiles or all personal data, HIPAA, etc.) before they waste their time?  Sure it would help them and it would help us consumers at the same time.  Right now when I talk to folks in the “real world” they’re running for the exits to stay out of the radar as there’s no trust.  </p> <h5><a href="http://ducknetweb.blogspot.com/2014/08/wearables-again-consumers-are-going.html">Wearables Again, Consumers Are Not Going There Until We Get Some Transparency and Privacy Efforts As We Know There’s Data Being Collected But We Don’t Know Where It Goes…</a></h5> <p>It’s a matter of transparency with know who the data distributors are and what kind of data they sell.<img align="right" src="http://lh5.ggpht.com/-FXEGyEhRSk8/U614j51gJoI/AAAAAAABKr0/oFC4pIILflo/image%25255B13%25255D.png?imgmax=800" style="float: right; display: inline" /><strong>  We license people for things with far less risk, like a license to catch a fish for one example,</strong> sell real estate, sell stock, do hair and nails and the list goes on and there’s nowhere near the big risk is with selling data as the consumers get hurt.  Licensing would not stop data selling but it would rather make companies accountable and transparent, as the levels of flawed data are on the rise out there too.  </p> <h5><a href="http://ducknetweb.blogspot.com/2014/06/the-quiet-and-unspoken-consumer.html">The Quiet and Unspoken Consumer Movement to Stay Off the Radar - Contrary To All You Read About Sensors, Apps and Wearables, More Folks Are Running for the Exit Doors…</a></h5> <p>Senator Schumer was right as the FTC found 7 apps that were selling data, so again there you go, one more reason to get a law on the books for licensing and disclosure of what kind of data is sold and who they sell to.  MasterCard is doing smash bang up marketing ploy out there right now with selling data and looking for new clients to buy our data.  If you read the link below I even pulled Acxiom out of their safe nest as they approached me on Twitter.  Time to <a href="http://ducknetweb.blogspot.com/2014/08/somebody-needs-to-start-calling-foul-on.html">call foul</a> on some of this stuff as it’s become <a href="http://ducknetweb.blogspot.com/2013/04/modeling-for-inequality-with.html">modeling for  inequality with segmentation</a>, which is a good video by the way.  </p> <h5><a href="http://ducknetweb.blogspot.com/2014/08/senator-schumer-of-new-york-calling-for.html">Senator Schumer of New York Calling for Privacy Protections With Sharing Data From Wearable Devices, As FTC Found Some Are Sending Data To 3rd Parties, Once Again Need To License the Data Sellers & Distributors</a></h5> <p>Other than the watch we don’t know what devices will be incorporated but here’s one device, Angel Health, that is of interest to where you can choose your own apps to work with the device and again we really don’t know where Apple is with the devices and sensors outside again of the watch.  <a href="http://ducknetweb.blogspot.com/2013/12/open-sensor-company-angel-raises-over.html">Here’s an open source device</a> that is in the works as well.  The whole idea here is to put what apps you want on it and maybe this is similar to what Apple’s doing or heck they could probably buy it if they wanted.  </p> <p><iframe height="281" src="//player.vimeo.com/video/74271995" width="500" allowfullscreen="allowfullscreen" mozallowfullscreen="mozallowfullscreen" webkitallowfullscreen="webkitallowfullscreen"></iframe></p> <p>It would be nice not to wonder if your butt was being chased by some data mining algorithm when it comes to your healthcare data.  So again it would be great if Apple would get behind the campaign to get the data sellers licensed as it would help them as well with developers writing for the HealthKit platform.  If developers are going to provide privacy policies, we want it simple as consumers and if the developer is not sharing or selling data, it’s a pretty easy privacy policy to write.  <strong>Let’s also say that a developer who want to write an app doesn’t want to sell data here, but maybe has other products that do, that needs to be spelled out too as that WILL occur.</strong>  </p> <p>Don’t give us reams of legal privacy pages to read and try to understand too:)   We run for the exits there too when it’s too complex for us to understand as we have been mined and sold so many times, a level of trust needs to be there.  BD </p> <p> <hr />Ahead of Apple's expected iOS 8 launch in September, the company has restricted developers from selling or otherwise distributing sensitive data collected by the <a href="http://appleinsider.com/articles/14/06/02/apple-announces-healthkit-for-holistic-health">HealthKit</a> application programming interface, which is set to debut as part of the new mobile operating system. The terms, buried in the latest iOS 8 beta's licensing agreement, were highlighted by the <em>Financial Times</em> <a href="http://www.ft.com/intl/cms/s/0/d510afec-2ecd-11e4-a054-00144feabdc0.html">on Thursday</a>.</p> <p>According to text pulled from the license, developers may "not sell an end-user's health information collected through the HealthKit API to advertising platforms, data brokers or information resellers," and are barred from using gathered data "for any purpose other than providing health and/or fitness services." <br />In addition to the imposed data sharing restrictions, apps using the HealthKit API must provide privacy policies to end users. </p> <p>Apple, however, is already looking ahead to skirt possible privacy issues. Senior executives <a href="http://appleinsider.com/articles/14/06/09/fda-says-apple-feels-a-moral-obligation-to-improve-health-tracking-data-collection">have met</a> with the U.S. Food and Drug Administration to discuss regulatory issues and the company is reportedly <a href="http://appleinsider.com/articles/14/08/12/apple-reportedly-in-talks-with-major-healthcare-providers-over-healthkit-partnerships">in talks</a> with major medical records systems firms, <a href="http://appleinsider.com/articles/14/08/21/apple-spoke-with-unitedhealth-humana-regarding-healthkit-tie-up-report">insurers</a> and healthcare providers eager to integrate with HealthKit. </p> <p><a href="http://appleinsider.com/articles/14/08/28/apple-imposes-restrictions-on-healthkit-data-sharing-with-ad-platforms-others">http://appleinsider.com/articles/14/08/28/apple-imposes-restrictions-on-healthkit-data-sharing-with-ad-platforms-others</a></p>

Apple Updates HealthKit Privacy Policies–Could Be A Good Time to Also Embrace Support For the Government to License All Data Sellers, Apple Will Be Conducting “Due Diligence” With Those Writing Apps For the Platform As Part of Their Business

I said a while back that Apple has the money so if any tech company could kick the data sellers out, they could and it sounds like that’s th...

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VA Inspector General Takes the “Virtual Low Road” With Report at Phoenix Hospital, Working Some Quantitated Mathematical Justifications But We All Know In the “Real” World People Died…

<p>I can fully understand the efforts of the auditors and recreating what they found with data, but it all comes back once more to context and again we live too heavily in virtual worlds today where flawed data is also on the rise.  Sure the auditors are going to piece together everything as best they can, but there was way too much coverage on the news on this.  I’m there were folks that even took in more than I did.  </p> <p>I just quickly breezed through the report which a long pdf and spent time reading the summary as well.<img align="right" height="230" src="http://lh6.ggpht.com/-3szEXZPRIqQ/U7qv_R169gI/AAAAAAABKxc/evT7Y_hxGEc/image121.png?imgmax=800" style="float: right; display: inline" width="347" />  I also said when this situation first erupted that this was the issue with the administrators at the VA living too much in the virtual world.  If you happened to watch one report from Anderson Cooper, he commented and walked away with the same perception “all they talked about were their numbers”.  So again a report like this is not going to be completely conclusive and maybe it’s the news media tweaking the title here a bit too?  </p> <p>We know there was only one urologist on staff and that patients were having to wait or be sent to other facilities, sometimes hundreds of miles away due to this fact so you can’t sit here and say that the delays didn’t play a role with patient deaths.  Again there was just way too much here.  The software, didn’t have an audit table on the changing of appointments so we have to take their word on the paper and some of the changes as again all of that is not 100% accurate either.</p> <p>What we did have though at the VA in Phoenix were good doctors that had a conscience and felt the need to report what was going on as unlike the OIG at the VA or any other government entity, doctors deal with the “real” world and there’s a name for that and it’s called “patients”.  I used to be a developer and data base person and I know all about users finding shortcuts or something that I missed in my software, it happens and I would have been mad myself if those scheduling errors had not been reported to me for fixing if I were in on the development group, but users don’t always do that.  I’ve seen people just literally fight a program and find their own little short cuts and take 2-3 times the amount of time to do something rather than to tell me so I could do a fix.  They do that.</p> <p>As I said here, this is just the tip of the iceberg with all of this and a big tip it is.  </p> <h5><a href="http://ducknetweb.blogspot.com/2014/05/va-crisis-just-tip-of-iceberg-as-us.html">VA Crisis Just The Tip of the Iceberg As US Needs a Full On Healthcare Culture Change Everywhere To Get Back In Touch With the Real World of Patients…</a></h5> <p>The administrators, like folks in other places were a bunch of stat rats and there’s<img align="right" src="http://lh3.ggpht.com/-kBA-dLfLLGU/UIepz3XA3GI/AAAAAAAA_Kk/8WllR3a7ChM/image%25255B7%25255D.png?imgmax=800" style="float: right; display: inline" /> a lot of that out there and I write about it all the time.  Again being I was a developer and partly due to the way I’m wired I can pick it like a sore thumb.  </p> <h5><a href="http://ducknetweb.blogspot.com/2014/05/va-crisis-should-be-huge-wake-up-call.html">VA Crisis Should Be A Huge Wake Up Call , We Have Turned Into a Nation of “Stat Rats”, Losing Touch With the “Real” World As Virtual Values Confuse, Collide and Wreak Havoc As Models & Formulas Fail</a></h5> <p>Sure we knew there would be numbers but by all means this does not lessen the impact of what happened with the neglect at the Phoenix VA hospital or anywhere else in the system.  </p> <p>I don’t care whether they stated they could not conclusively confirm that patients died, we know they did and what we end up with is quantitated justifications here that are only numbers with a bit of “Algo duping” tossed in.  </p> <h5><a href="http://ducknetweb.blogspot.com/2013/12/quantitated-justification-for-believing.html">Quantitated Justification For Believing Things That Are Not True And Using Mathematical Processes To Fool Ourselves-The Journalistic Bot Functionality Debuts As Media Can’t Resist the Formulas…</a></h5> <p>Scroll down and watch video number one and then think about the VA situation again, and see if your perceptions <a href="http://www.va.gov/oig/pubs/VAOIG-14-02603-267.pdf">reflect what’s in this report</a> and I can almost bet your skepticism will grow.  BD  </p> <p><a href="http://abcnews.go.com/Politics/delays-necessarily-veteran-deaths-va-report-finds/story?id=25134189">http://abcnews.go.com/Politics/delays-necessarily-veteran-deaths-va-report-finds/story?id=25134189</a></p>

VA Inspector General Takes the “Virtual Low Road” With Report at Phoenix Hospital, Working Some Quantitated Mathematical Justifications But We All Know In the “Real” World People Died…

I can fully understand the efforts of the auditors and recreating what they found with data, but it all comes back once more to context and ...

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Todd Park US CTO Leaving His Post-Anyone Noticing a Pattern Here With Technologists Jumping Ship One After Another?

<p>You can’t blame him as he doesn’t need the money and anguish if you look at that angle, but according to what I have been reading his new mission is to help find smarter folks to work for the government.  I can imagine the frustration he has at times.  We all<img align="right" alt="image" border="0" height="229" src="http://lh4.ggpht.com/-tWV8g5-bAIg/U_6dF5Rm0XI/AAAAAAABLNE/L3QN11Fe0bQ/image%25255B3%25255D.png?imgmax=800" style="border-top: 0px; border-right: 0px; background-image: none; border-bottom: 0px; float: right; padding-top: 0px; padding-left: 0px; border-left: 0px; display: inline; padding-right: 0px" title="image" width="190" /> know in tech that to help those not in tech we have to change our terminology into some form of “Pig Latin” so others can understand what’s going on, what needs to be done, etc.  In other words,<strong> translate from tech world to the layman world and that’s not always easy to do.</strong>  There are some that lie and cheat during this process and they eventually are found out when someone else gets a glimpse of their code or just flat out calls “foul”.  The White House privacy person quit as well and she may have been the wrong person in the wrong job from what I saw from her short term in office too.  </p> <h5><a href="http://ducknetweb.blogspot.com/2014/08/us-first-privacy-technology-officer.html">US First Privacy Technology Officer Resigns After Only One Year - More Proof That Lawyers Fail Running High Tech Government Agencies, Nor Can They Advance Any Consumer Interests</a></h5> <p>The US has been suffering dearly in this area for a long time and right now with the speed of technology moving so fast, it’s easy to get duped and lawyers can be the easiest targets at times.  Why?  They only think about verbiage “while code runs hog ass wild”.  What do we have running government agencies, more lawyers so you can see why we have just been stuck and not been able to move ahead with the likes of Kathleen Sebelius, Mary Jo White, Richard Cordray and a host of others, they just don’t get it and hang on to verbiage to save their lives.   Like it or not, this is what it is coming down to, math and the models used that can hide dirty code and risk and make money while hurting others.  </p> <h5><a href="http://ducknetweb.blogspot.com/2014/01/not-only-is-it-time-to-hold-banks-and.html">Not Only Is It Time to Hold Banks and Corporations Accountable, But Rather Hold Their CEOs, Math Model Creations and Proprietary Computer Code Accountable As Well…</a></h5> <p>I talk about “data mechanics logic” all the time and we have very few in government head positions that even have a “little” bit of this thinking, <img align="right" src="http://lh3.ggpht.com/-a-7jyNBopZE/UFS4-DuKWKI/AAAAAAAA9yk/wyBkwNgpXgE/image%25255B29%25255D.png?imgmax=800" style="float: right; display: inline" />but it it necessary and you don’t have to write code to have it, but it is easier to master if you have written code.  <strong>Just last week every one in technology just laughed our asses off listening to the new White House Cyber Security Head just brag about how he has very little technology background.  Well we all know he’s headed down the delusional perception path and he’s up to be a big “dupee” for sure.</strong>  Just the fact that he made that speech tells you he’s going to to be a dupee.  </p> <p>This is exactly what <a href="http://ducknetweb.blogspot.com/2009/02/kathleen-sebelius-kansas-governor-for.html">I was afraid of in 2009</a> when I made a blog post and got my head bit off about Kathleen Sebelius, as I could it coming and now I call it the <strong><a href="http://ducknetweb.blogspot.com/2014/04/secretary-sebelius-at-hhs-resigns-wrong.html">“Sebelius Syndrome”</a></strong> and it’s all over DC and the White House.  During the Healthcare.Gov folks like myself were almost rolling on the floor listening to what came out of her mouth as data mechanics knowledge tells you up front she’s lost and some of the stuff she said was like impossible and there’s where the rolling comes in.  It would be like me telling my auto mechanic how to fix my car, I couldn’t do that by any means but she, was so off the wall and you could tell she hated technology.  <strong>This was my favorite here, come on folks hurry up and write that code:) <img align="right" src="http://lh3.ggpht.com/-6FaL59_0dLU/UFS49WylLCI/AAAAAAAA9yU/raN7-HSvqhI/image%25255B41%25255D.png?imgmax=800" style="float: right; display: inline" /></strong></p> <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>Here’s Mary Jo White with her somewhat recent spectacle.  </p> <h5><a href="http://ducknetweb.blogspot.com/2014/04/markets-are-not-rigged-spoken-like-true.html">“Markets Are Not Rigged” Spoken Like A True Data Mechanics Novice, It’s Like Sebelius at HHS All Over Again, Looking For Algo Fairies at The SEC, One More Government Agency Wrapped Up in “The Grays”…</a></h5> <p>So hopefully we might end up with some “real” data mechanics logic folks eventually working in DC if this is in fact what Todd Park is going to do, I sure hope so as the “dupees” are sinking the ship with their whacked out perceptions we keep hearing. <img align="right" height="116" src="http://lh6.ggpht.com/-SwJlc6NbZAI/U22CAMO8P2I/AAAAAAABKPU/5MVrMdAoqv0/image%25255B7%25255D.png?imgmax=800" style="float: right; display: inline" width="282" /> What’s even scarier sometimes is to listen to them talk about their own perceptions at times too.  </p> <p>We certainly can’t take too much more of this before we sink even further.  The Office of the Comptroller of the US is getting some help from someone at MIT to help them as well to work with and help verify financial models that banks use…this is a big deal as subprime could have never occurred without all of the models and the fiddling with risk.  So again we see help coming there as well.  This is an important agency as they collect all the fines levied against banks and others out there.<strong>  I am hoping this is the same direction Todd Park might be taking as well.  </strong></p> <h5><a href="http://ducknetweb.blogspot.com/2014/05/government-is-finally-hiring-some-data.html">Government Is Finally Hiring Some Data Sleuth Quants - Office of Comptroller of the Currency To Work In Compliance With Bank Models..</a></h5> <p>If you want to see the <a href="ducknetweb.blogspot.hk/2012/09/quants-alchemists-of-wall-street-video.html">power of math models and quants,</a> watch the video below and you can always find it in my footer along with 3 other videos that help educate you in layman’s terms mostly on “what’s really going on.  If we don’t come out of the math bliss we’ll sink even further.  Having lawyers run important technology heavy agencies is not the answer.</p> <p><iframe style="height: 286px; width: 534px" height="315" src="//www.youtube.com/embed/ed2FWNWwE3I" frameborder="0" width="560" allowfullscreen="allowfullscreen"></iframe></p> <p>If you want to learn more about how far in the toilet we are, visit the <a href="http://www.ducknet.net/attack-of-the-killer-algorithms/">Killer Algorithms</a> page for more.  </p> <p>So again I hope Todd Park is on this path to help and wake up Washington.  BD  </p>

Todd Park US CTO Leaving His Post-Anyone Noticing a Pattern Here With Technologists Jumping Ship One After Another?

You can’t blame him as he doesn’t need the money and anguish if you look at that angle, but according to what I have been reading his new mi...

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Prime Healthcare Files Lawsuit Against Hospital Employee Unions–Wants Them Out of The Way So They Can Be Successful in Buying Daughters of Charity Health System

<p>Well if this doesn’t beat all and really how much can the Union really do other than voice concerns, <img align="right" alt="image" border="0" height="61" src="http://lh4.ggpht.com/-5UbJ1sjKO6E/U_568GbRROI/AAAAAAABLM0/hGs-q3XZnpQ/image%25255B3%25255D.png?imgmax=800" style="border-top: 0px; border-right: 0px; background-image: none; border-bottom: 0px; float: right; padding-top: 0px; padding-left: 0px; border-left: 0px; display: inline; padding-right: 0px" title="image" width="222" />which they are entitled to do by all means.  Sure it got the attention of some California lawmakers but if they don’t do it in public they can still contact the lawmakers without a public display.  </p> <h5><a href="http://ducknetweb.blogspot.com/2014/08/prime-healthcare-bids-for-daughters-of.html">Prime Healthcare Bids for daughters of Charity Hospitals in California Chain in California, While Two Former Employees File Suit Against the Company in Kansas Who Were Laid Off Without Promised Severance Packages</a></h5> <p>The lawsuit is looking to find general damages related to “so called harm” caused by the unions.  Meanwhile Daughters of the Charity Healthcare System have no comment which is the wise thing to do here and Prime is one of 7 bidding to purchase the hospital system, so it’s not like they are the one and only.  What is Prime afraid of as it is buying up hospitals like crazy across the US?  </p> <h5><a href="http://ducknetweb.blogspot.com/2014/01/hospitals-feeling-aca-crunch-in.html">Hospitals Feeling The ACA Crunch In California As Financially Strapped daughters of Charity Health System Put Six Hospitals Up For Sale</a></h5> <p>Healthcare is just really getting “stupid” at times today, and I should be more specific and say the business of healthcare is what’s getting stupid.  BD  </p> <p> <hr />On Monday, Prime Healthcare Services <a href="http://www.modernhealthcare.com/assets/pdf/CH96070826.PDF">filed a lawsuit</a> against employee unions for interfering in its bid to purchase a struggling not-for-profit health care system in California, <a href="http://www.modernhealthcare.com/article/20140826/NEWS/308269947&utm_source=AltURL&utm_medium=email&utm_campaign=am&AllowView=VXQ0UnpwZTVBdmFZL1IzSkUvSHRlRU9oalVvZEErSmE=?mh"><em>Modern Healthcare</em></a> reports (Kutscher, <em>Modern Healthcare</em>, 8/26).</p> <p>Prime Healthcare Services is looking to buy the six-hospital Daughters of Charity Health System (Mack, <a href="http://www.californiahealthline.org/capitol-desk/2014/8/unions-oppose-bid-by-health-care-chain"><em>California Healthline</em></a>, 8/15).</p> <p>The Service Employees International Union-United Healthcare Workers West and the California Nurses Association have voiced concerns about the bid, saying that such a purchase would reduce health care access for low-income patients and that Prime would cut health system workers' pay and benefits.</p> <p><a href="http://www.californiahealthline.org/articles/2014/8/27/prime-sues-unions-for-interfering-in-bid-to-buy-calif-health-system">http://www.californiahealthline.org/articles/2014/8/27/prime-sues-unions-for-interfering-in-bid-to-buy-calif-health-system</a></p>

Prime Healthcare Files Lawsuit Against Hospital Employee Unions–Wants Them Out of The Way So They Can Be Successful in Buying Daughters of Charity Health System

Well if this doesn’t beat all and really how much can the Union really do other than voice concerns, which they are entitled to do by all me...

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HHs Former Cyber Security Director Convicted of Child Pornography

<p><strong>Where’s the NSA when you need them, right?</strong>  Heck with all they have, why didn’t they catch this guy:)  <img align="right" alt="image" border="0" height="177" src="http://lh5.ggpht.com/-II8ttQXEYWI/U_52G-anDkI/AAAAAAABLMo/4BYbXCAiB0A/image%25255B3%25255D.png?imgmax=800" style="border-top: 0px; border-right: 0px; background-image: none; border-bottom: 0px; float: right; padding-top: 0px; padding-left: 0px; border-left: 0px; display: inline; padding-right: 0px" title="image" width="239" />I do like the content here too that Tech Dirt brought up about our next <a href="http://ducknetweb.blogspot.com/2014/04/secretary-sebelius-at-hhs-resigns-wrong.html">Sebelius Syndrome in</a> the making.  The new White House Cyber boss proudly tells everyone how little he knows about cyber security.  Well thank you not we are still living through enough of those out there, like Mary Jo White at the SEC, Richard Cordray at the Consumer Financial Protection agency and a host of other characters.  I can’t help but wonder too how the Oregon Exchange lawsuit with the digital illits up there plays out too.  Time for some folks that have some data mechanics logic that are not porn seekers on the side.  </p> <p>I agree here with is it too much to ask to weed out violent child rapists from the rank and files?  BD  </p> <p> <hr /></p> <blockquote><i>Timothy DeFoggi, 56, formerly of Germantown, Md., is the sixth individual to be convicted as part of an ongoing investigation targeting three child pornography websites, the Justice Department said. He faces sentencing on Nov. 7 based on the findings Tuesday that he engaged in a child-exploitation enterprise, conspired to advertise and distribute child pornography, and accessed a computer with intent to view child pornography in connection with his membership in a child-pornography website.</i></blockquote> Oh, well that's just great. The head cyber-security guy for a government organization that includes divisions for <a href="http://en.wikipedia.org/wiki/United_States_Department_of_Health_and_Human_Services#Former_operating_divisions_and_agencies">preventing child abuse and child support enforcement</a> was a pedophile at best. Let's be clear: according to the evidence presented by prosecutors, DeFoggi is simply as bad as it gets. <blockquote> <p><i>"Through the website, DeFoggi accessed child pornography, solicited child pornography from other members, and exchanged private messages with other members where he expressed an interest in the violent rape and murder of children," prosecutors added. "DeFoggi even suggested meeting one member in person to fulfill their mutual fantasies to violently rape and murder children."</i></p> </blockquote> <p><a href="https://www.techdirt.com/articles/20140827/09082928339/ex-cyber-security-director-convicted-kiddy-porn.shtml">https://www.techdirt.com/articles/20140827/09082928339/ex-cyber-security-director-convicted-kiddy-porn.shtml</a></p>

HHs Former Cyber Security Director Convicted of Child Pornography

Where’s the NSA when you need them, right?   Heck with all they have, why didn’t they catch this guy:)  I do like the content here too that ...

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University of Arizona Medical Center Former Chief of Surgery Vindicated Of All Charges–Panel Recommends Reinstatement..

<p>This was a nasty battle and you can reference the link below and get caught up.  The doctor was a whistle blower<img align="right" alt="image" border="0" height="151" src="http://lh3.ggpht.com/-W2q7oczPGw0/U_2JlyhekwI/AAAAAAABLMY/2sr93bbMb24/image%25255B6%25255D.png?imgmax=800" style="border-top: 0px; border-right: 0px; background-image: none; border-bottom: 0px; float: right; padding-top: 0px; padding-left: 0px; border-left: 0px; display: inline; padding-right: 0px" title="image" width="163" />r so that explains the politics here as it’s never easy for them, but his claims were important as he exposed serious problems with the transplant record keeping and they fired him afterwards.  The battle then went forward with Dr. Steve Goldschmid, dean of the UA College of Medicine.  </p> <h5><a href="http://ducknetweb.blogspot.com/2014/01/big-nasty-battle-at-university-of.html">Big Nasty Battle At University of Arizona Medical Center As World Famous Heart And Other Organ Transplant Program Is On Hold As Chief of Surgery Files Whistleblower Suit After Being Suspended</a></h5> <p><em>“Before his suspension, Gruessner had brought stability to a historically troubled department that’s vital to Tucson. He more than doubled the number of surgeons, added new transplant services and rebuilt Southern Arizona’s lone top-level trauma center for people with life-threatening injuries.”</em></p> <p>Below is one video of several interviewing the doctor on what happened and his thoughts.   BD</p> <p><iframe style="height: 277px; width: 510px" height="315" src="//www.youtube.com/embed/k6tLMVnKlbo" frameborder="0" width="560" allowfullscreen="allowfullscreen"></iframe></p> <p> <hr />TUCSON - Twenty days after his<a href="http://www.kvoa.com/news/suspended-uamc-surgeon-asks-for-his-job-back/"> hearing,</a> a three person independent panel has cleared Dr. Rainer Gruessner of all charges. The UAMC transplant surgeon asked to have his job back, after he was suspended with pay last December, accused of altering a hospital database.</p> <p>The panel found that Gruessner acted reasonably, and came to the conclusion that his termination was not justified. They recommended University Physicians Healthcare should issue Dr. Gruessner a public apology, saying Dr. Gruessner deserves to have his name cleared.</p> <p>The panel also recommended Gruessner be reinstated as a faculty member, but not with his previous privileges or titles. To help him re-enter into practice, he would be considered a 'Professor of Surgery.' </p> <p>"I am absolutely delighted that I've finally been fully vindicated after fighting to be able to tell my story. If only the administration would have given me the opportunity a year ago, we could have avoided all of the costs and heartache over the last year," said Gruessner.</p> <p><a href="http://www.kvoa.com/news/uamc-doc-cleared-of-all-charges-by-independent-panel/">http://www.kvoa.com/news/uamc-doc-cleared-of-all-charges-by-independent-panel/</a></p>

University of Arizona Medical Center Former Chief of Surgery Vindicated Of All Charges–Panel Recommends Reinstatement..

This was a nasty battle and you can reference the link below and get caught up.  The doctor was a whistle blower r so that explains the poli...

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CardioMEMS HF System-FDA Approved Implanted Monitoring Device Helps Reduce Hospital Admissions For Patients With Congestive Heart Failure

<img align="right" alt="image" border="0" height="137" src="http://lh4.ggpht.com/-TzCgilhOTx4/U_1UYZDt_2I/AAAAAAABLMI/7kCH6tIM0sU/image%25255B2%25255D.png?imgmax=800" style="border-top: 0px; border-right: 0px; background-image: none; border-bottom: 0px; float: right; padding-top: 0px; padding-left: 0px; border-left: 0px; display: inline; padding-right: 0px" title="image" width="187" /> <p>This is a very worthwhile medical device and the video below shows a quick summary of how it works.  </p> <p>The patient lays on a pad to transmit the information and it measures the pressure in the pulmonary artery.  </p> <p>Any pressure changes can be seen and caught before the patient has to go to the ER with any fluid build up.  Medications can be adjusted if needed.  </p> <p>You can see the pad in the video whereby the device is checked at the end of the procedure.</p> <p>There’s no shortage of screens in the operating room.  It’s energized from the outside so there’s no having to go in and retrieve the device either.  This is the first tool cardiologists have to truly monitor the patient’s condition.  BD  </p> <p><iframe style="height: 280px; width: 497px" height="315" src="//www.youtube.com/embed/Zuf6yiqmfWY" frameborder="0" width="560" allowfullscreen="allowfullscreen"></iframe></p> <p> <hr />The CardioMEMS HF System is the first and only FDA-approved heart failure monitoring device that has been proven to significantly reduce hospital admissions when used by physicians to manage the condition. The technology features a sensor that is implanted through a catheter into the pulmonary artery (PA) to directly measure PA pressure. Increased PA pressures appear before weight and blood pressure changes, which are often used as indirect measures of worsening heart failure.</p> <p>“All the patient has to do is lie back on a special pad,” explained Bradford E. Warden, M.D., director of the WVU Heart Institute and chief of the WVU School of Medicine Section of Cardiology. “Radio waves are then transmitted to an external electronic system, and the device measures pressure in the pulmonary artery. It lets us notice any pressure changes three or four weeks before the patient develops pulmonary edema (fluid in the lungs) from exacerbated congestive heart failure. It gives us a chance to get pulmonary edema under control by adjusting medications while keeping the patient out of the hospital and in the comfort of his or her own home.”</p> <p>“The last time, I was having shortness of breath,” explained Uchic. “I have to go over to Oakland (Md.) if I need to see someone in a hurry. This monitor will help the doctor decide if I should take more of my diuretic or other medications, and it should save me a trip to the hospital.”</p> <p><a href="http://www.newswise.com/articles/view/622471/?sc=rsla&utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+NewswiseLatestNews+%28Newswise%3A+Latest+News%29">http://www.newswise.com/articles/view/622471/?sc=rsla&utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+NewswiseLatestNews+%28Newswise%3A+Latest+News%29</a></p>

CardioMEMS HF System-FDA Approved Implanted Monitoring Device Helps Reduce Hospital Admissions For Patients With Congestive Heart Failure

This is a very worthwhile medical device and the video below shows a quick summary of how it works.  The patient lays on a pad to transm...

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Patient in California Finds Out the Hard Way That His Doctor No Longer Honors Blue Shield Insurance Bought Through Covered California–More Consumer Targeted Killer Algorithm At Work…

<p>I remember Regal before their affiliation with the Heritage Providers and it was no problem in the earlier days but their affiliation now is changing things for patients.  Since the patient purchased his policy through Covered California, it was ok, then one day, <img align="right" src="http://lh3.ggpht.com/-jTGeJHjIH3g/U0JHjQjrdqI/AAAAAAABJ0M/ro0qWSegIGw/image%25255B5%25255D.png?imgmax=800" style="float: right; display: inline" />he can’t see his doctor anymore as they don’t see any Covered California patients.  That is frustrating and this might go back to the mess with doctors getting paid 30% less from Blue Cross and Blue Shield with policies bought through the exchange.  It was so bad for a while that the insurers had to go back and up the reimbursement a bit and still the lists of who was in network and who was not was still a mess.  </p> <p>In some cases the insurers were sending the doctor reimbursements to the patients who wanted to keep the money.  </p> <h5><a href="http://ducknetweb.blogspot.com/2014/04/blue-shield-billing-fiasco-with.html">Blue Shield Billing Fiasco With Policies Bought Via Covered California - Checks Are Going To the Patients and Not the Doctors Who Some How Ended Up No Longer As Covered Providers…More Killer Algorithms Creating More Obstacles to Getting Care…</a></h5> <p>Here’s what one doctor has to say:</p> <p><em>“Blue Shield announced to all that for their Covered California Health Plan all its Blue Shield providers are on the plan. I had patients sign up specifically because they saw I was on the plan (the same happened to other physicians as well). However once the plan went into effect most of the physicians contracted with Blue Shield were no longer listed as contracted providers. </em></p> <p><em>Furthermore after we provided services to  these patients the Explanation of Medical Benefits from<img align="right" alt="image" border="0" height="66" src="http://lh3.ggpht.com/-o8BB4kpUNLk/U_0lgRAI0mI/AAAAAAABLL4/04SyotkWO1I/image%25255B4%25255D.png?imgmax=800" style="border-top: 0px; border-right: 0px; background-image: none; border-bottom: 0px; float: right; padding-top: 0px; padding-left: 0px; border-left: 0px; display: inline; padding-right: 0px" title="image" width="249" /> Blue Shield showed that we were discounted some 20-30% of our previously paid services and the check was now going to the patient and not the provider.   We have been trying to get these checks from the patients who love getting these Blue Shield checks and keeping them. As physicians are finding this out they are mad and are starting to demand payment up front from the patient and give them a superbill so they can bill Blue Shield. What a mess.”</em></p> <p><strong>So maybe Regal decided not to mess with it at all?</strong>  What really made the patient mad is the fact that Heritage gets grants from the Feds for being an Accountable Care Organization and is so well touted as being a model, and yet there’s no model here and no care for him and<strong> he especially was not happy about the mention of Medicare patients getting free dance lessons and healthy cooking classes as well as casino excursions when he couldn’t see his doctor.</strong>  </p> <p>So here we go, everything working fine and then all stops due to a bunch of crappy algorithms that won’t work together.  This is what the big problem is with Obamacare, everyone’s math that doesn’t jive.  BD  </p> <h5><a href="http://ducknetweb.blogspot.com/2014/03/obamacare-one-big-attack-of-killer.html">Obamacare - One Big “Attack of the Killer Algorithms” No Matter Which Direction You Turn, Compounded With a Lot of Government and Consumer “Algo Duping”….</a></h5> <p> <hr />We've had the same doctor for 20 years. On August 1st his individual practice merged into <a href="https://www.regalmed.com/">Regal Medical Group</a>, a large, multi-area medical group. Regal Medical Group is an <a href="http://en.wikipedia.org/wiki/Independent_practice_association">Independent Practice (or Physician) Association</a>, or a group of individual doctors who combine their practices into one large group.</p> <p>No problem, we thought. Sure, they're located farther away, but it's not terrible. Worth the extra time driving to keep a doctor who knows us and knows our history. But we just discovered how wrong we were.</p> <p>I've written <a href="http://crooksandliars.com/karoli/why-i-defend-obamacare-and-plan-fight-it-ha">in the past about our son's ongoing health issues</a>. Last year, he signed up for Covered California and bought the Platinum plan through Blue Shield. It's expensive for a 25-year old, but he wisely decided it was worth paying extra for the peace of mind he would get from knowing he'd have deductible-free coverage for his health issues. His doctor was in the network, so all was good.</p> <p>Until the merger. This week, he had a flareup on the diabetes management side of things and so he called the doctor and made a sort-of-emergency appointment. He showed up for the appointment this morning, presented his insurance card and was told they don't take any insurance under Covered California.</p> <p>I couldn't quite believe the text I saw from him. Blue Shield policies are exactly the same from a coverage and deductible standpoint, whether purchased on the exchange or not. Regal Medical Group accepts Blue Shield coverage for employers and other sponsors, including Medicare. </p> <p>They just don't take coverage under the ACA. </p> <p>Regal Medical Group, by the way, is a for-profit concern. Their arrogance in this situation is enough to make me want to spread the word far and wide that greed is no substitute for compassion, particularly when their patients can pay.</p> <p><a href="http://crooksandliars.com/2014/08/regal-medical-group-refuses-all-covered?utm_source=dlvr.it&utm_medium=twitter">http://crooksandliars.com/2014/08/regal-medical-group-refuses-all-covered?utm_source=dlvr.it&utm_medium=twitter</a></p>

Patient in California Finds Out the Hard Way That His Doctor No Longer Honors Blue Shield Insurance Bought Through Covered California–More Consumer Targeted Killer Algorithm At Work…

I remember Regal before their affiliation with the Heritage Providers and it was no problem in the earlier days but their affiliation now is...

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Ingenix (Optum-United Healthcare) Lawsuits Still Bouncing Around Out There–One Recently Settled in New Jersey With Horizon Blue Cross Blue Shield That Was Still Using the Flawed and Corrupt Data Base for Out of Network Payment Calculations

<p>This is unbelievable if I am reading this correctly as I had assumed that all insurers who licensed the data bases and software from United had agreed to switch to to the new “Fair” data base, but it looks like Horizon Blue Cross/Blue Shield was still using it as that’s<img align="right" alt="image" border="0" height="137" src="http://lh6.ggpht.com/-uYFTlF3ei1E/U_yuL-6K7QI/AAAAAAABLLo/pnQiKVFiJpA/image%25255B3%25255D.png?imgmax=800" style="border-left-width: 0px; border-right-width: 0px; background-image: none; border-bottom-width: 0px; float: right; padding-top: 0px; padding-left: 0px; display: inline; padding-right: 0px; border-top-width: 0px" title="image" width="269" /> part of the settlement here, not to use it anymore.  The big AMA court case filed by Cuomo in New York was for 15 years of short paying doctors all across the country.  It was not just United/Optum involved here as they licensed it to other insurers, like Aetna who proposed their case at the end of last year for underpaying for around 15 years.  Health Net if I remember correctly was one of the first to stop using the data base and settle.  </p> <h5><a href="http://ducknetweb.blogspot.com/2009/12/ama-announced-settlement-of-class.html">AMA Announced Settlement of Class Action Suit of $350 Million with Ingenix (United Healthcare)</a></h5> <p><strong>Now a couple months ago Aetna wants to get out of their proposed settlement o f $120 million and it made notice to the court a week before the hearing.</strong>  They licensed the same data base and software too.  Now a judge is looking at the contract again and if it is found that the doctors have a case, it will go to jury trial.   The American Medical Association,the Texas Medical Association, and the medical societies of California, Connecticut, Florida, Georgia, North Carolina, New Jersey, New York, Tennessee, and Washington sued Aetna in 2009 over its use of databases licensed from Ingenix, a UnitedHealth Group Inc. subsidiary.  Physicians who have been in business since 2003 and provided out of network services might be able to join this lawsuit.  Here’s the back link on the initial settlement announcement of what they are trying to get out of now.  Aetna also keeps a number of <a href="http://ducknetweb.blogspot.com/2014/01/aetna-completes-200-million-dollar.html">reinsurance options</a> located in the Cayman Islands as well.  </p> <h5><a href="http://ducknetweb.blogspot.com/2013/01/aetna-payment-of-120-million-to-settle.html">Aetna Payment of $120 Million To Settle 15 Year Ingenix/United HealthCare Out of Network Erroneous Payment Algorithms Cuts Income for 4th Quarter</a></h5> <p>Now back to Horizon Blue Cross Blue Shield, there was no money given here with the exception of payment of legal fees for the class members.  It’s also noted that there’s probably an appeal on the menu here too.  A Cigna case settled with no money awarded as they too like Health Net stopped using the data base and agreed in 2009 to stop using the data base and software, unlike this case with Horizon.   There are over 180,000 out of network providers with Horizon Blue Cross that were short paid.   </p> <p>Horizon has also agreed to remove language that cancelled all assignments of rights by subscribers.  Now back in 2009, the current number two person at CMS, Andy Slavitt was the CEO of Ingenix, which is now named Optum Insights.  This is who Secretary Burwell feels is who will best serve CMS?  </p> <h5><a href="http://ducknetweb.blogspot.com/2014/06/how-hard-did-united-have-to-lobby-to.html">How Hard Did United Have to Lobby To Get Someone In The Deputy Administrator Job at CMS? Sebelius Syndrome Lives On With Burwell, In Good Company With Mary Jo White and Richard Cordray To Name A Couple Others…</a></h5> <p>Back in 2009 I was concerned about technology “dupees” being hired at HHS as well, in other words being no contest for the extreme Quant and actuary driven formulas used by insurers for profit an turns out that I was sadly correct and I now refer to it as the <a href="http://ducknetweb.blogspot.com/2014/04/secretary-sebelius-at-hhs-resigns-wrong.html">Sebelius Syndrome,</a> which also lives in the court systems, in Congress, at the SEC and at the DOJ from time to time.  There’s been a lot of discussion about Optum Insights and the <a href="http://ducknetweb.blogspot.com/2014/02/one-more-state-massachusetts-bringing.html">United/Optum subsidiary</a> that has been creating the software fixes for insurance exchanges and recently the state of Vermont said they were not aware of the AMA lawsuit when giving QSSI a contract to fix their exchange, and all I can say is there was not much due diligence done there at all, much less a Google search, it’s all out there on the web.  </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></h5> <h5><a href="http://ducknetweb.blogspot.com/2009/02/kathleen-sebelius-kansas-governor-for.html">Kathleen Sebelius, Kansas Governor for HHS – Please not! Put the “Smart” People in these key positions</a></h5> <p>Sadly it’s the same process with Quant generated models most of the time, similar to the AMA lawsuit referenced above where the government gets out foxed with math again and now audits found that insurers for 5-6 years overbilled CMS to the tune of $70 billion, again using complex math models adjusting risk for larger payments.  I’m sure just like banks, as was done with the AMA settlement, nobody will have to admit any guilt here on the math model used and CMS doesn’t know what direction to go next on getting the $70 billion back.  <strong>The link below tells more about this recent audit and it worked for 5-6 years and generated a lot of money on Medicare Advantage claims for insurers</strong>.  I also seem to think Secretary Burwell understands it all and again former Ingenix CEO Andy Slavitt is now the number two person at CMS answering to Tavenner, who is also in the same boat with not understanding how complex math models work.  She recently hired a former Wal-Mart executive to be her legal counsel so I don’t see much action there either, so the work done by the auditors here in finding this automated math model for making $70 billion might go untouched as well and the <a href="http://ducknetweb.blogspot.com/2014/04/secretary-sebelius-at-hhs-resigns-wrong.html">Sebelius Syndrome</a> might just live on.  </p> <h5><a href="http://ducknetweb.blogspot.com/2014/08/cms-discovers-that-insurers-offering.html">CMS Discovers That Insurers Offering Medicare Part D “Really Know To Sharp Shoot A Model With Adjusting Risk For Profit”, A Common Everyday Occurrence in Financial Markets…</a></h5> <p>Again when most other insurers settled early on, it’s just amazing to find that Horizon was able to hang on to the Ingenix data base and software until this court case was settled and was still being used.  It’s the math models that get buried out there, again due to lack of data mechanics logic that we see everywhere today with government getting duped and duped again.  The settlement on this was not published until July of 2014 and again one more example of how insurers work complexities to their advantage for profit.  </p> <p>Sadly, this is how the Feds get duped and duped again.  Members of Congress have explored the conflict of interest, but again without understanding the complex Quant created and driven math models used by insurers, they are kind of up a creek and really have little impact other than making some noise which is a tiny bit better than nothing.  The only Federal agency I’m aware of that’s actually hiring some quants to help them with bank models (same thing quant drive models for profit) is the <a href="http://ducknetweb.blogspot.com/2014/05/government-is-finally-hiring-some-data.html">Office of the Comptroller</a> and it’s at baby stages there as well.  Stroll on over to watch some of the videos from folks smarter than me at the <a href="http://www.ducknet.net/attack-of-the-killer-algorithms/">Killer Algorithms page ,</a> to include quants, to see and understand how all this works, it’s a great learning experience and will make you mad in the process, but it is what it is and is pretty much what keeps <a href="http://ducknetweb.blogspot.com/2014/08/somebody-needs-to-start-calling-foul-on.html">inequality acceleration</a> alive in the US for the sake of corporate profits.  </p> <p>So here you have it, years later since the 2009 settlement with the AMA with the data base still being used by Horizon and the sub story of Aetna now trying to weasel out of their settlement proposal.  All kinds of legal arguments can be used around math models and code when it comes to judicial cases as such and when the cards are stacked against the government and they don’t <img align="right" height="252" src="http://lh6.ggpht.com/-3szEXZPRIqQ/U7qv_R169gI/AAAAAAABKxc/evT7Y_hxGEc/image121.png?imgmax=800" style="float: right; display: inline" width="380" />have quants on the other side to assist the lawyers, well we all lose for sure.  Just as one other note here, the role of being a doctor too with all of this is hitting hard as well as they too get “scored” with more and more models and that also stands to reduce what they get paid via the use of complex contracts, some even getting paid at rates even less than Medicare. </p> <h5><a href="http://ducknetweb.blogspot.com/2014/08/the-secret-scoring-of-americas.html">“The Secret Scoring of America’s Physicians” - Algorithmic Math Models For Insurance Network Contractual Exclusions, Relating to MDs Who See Medicare Advantage Patients..</a></h5> <p>You can almost see the frustrations with high level tech folks walking out and quitting the government as it does get frustrating when you have folks <a href="http://www.ducknet.net/attack-of-the-killer-algorithms/">“Algo Duped”</a> almost to the point of no return at times, and it’s very scary. </p> <p>I might guess the levels of frustration were there too with <a href="http://en.wikipedia.org/wiki/Todd_Park">Todd Park, the US CTO</a>, as it’s been reported that he’s going to help get smarter folks recruited for the federal government and that statement itself to me is<strong> full-on proof of a smart technologist  recognizing the Algo Duping that takes place at high levels of government today.</strong>   I can barely read or appreciate some of what comes from the White House email bot anymore as again I see the levels of distraction and the stat rat mentality that keeps hurting the real world only seem to grow.  </p> <p> Again I found it amazing that the data base and software was still in use at this point but again right now we have other big issues with <a href="http://ducknetweb.blogspot.com/2014/03/virtual-worlds-real-world-we-have.html">“The Grays”</a> in the US to where<strong> folks can’t figure out what’s a virtual value and what’s a real world value half the time and we see it all the time with people acting like magpies just repeating stats and numbers all the time</strong>, while the real world values get stuffed under the carpet until the real inequality issues erupt again.  I don’t know how long our government can continue to function this way with this huge level of distraction but the media is sucked in as well, as all they do is publish meaningless stats to keep everyone distracted.  BD</p> <h5><a href="http://ducknetweb.blogspot.com/2014/06/junk-science-appearing-everywhere-even.html">Junk Science Appearing Everywhere, Even The White House “PR Templated” Correspondence Creates Spurious Correlations…</a></h5> <hr />July 14 — Horizon Blue Cross Blue Shield of New Jersey has agreed to amend its out-of-network payment procedures by discontinuing use of an allegedly faulty charging database and providing more transparency for the basis of its payment decisions to its subscribers and health care providers in a settlement approved by a federal judge in New Jersey. <p>The settlement, which provides no monetary damages to the class members, was approved in<strong> an unpublished decision by Judge Stanley R. Chesler on July 9</strong> and settles claims that Horizon violated the Employee Retirement Income Security Act by using the Ingenix database to calculate out-of-network charges.</p> <p>Eric D. Katz, partner at Mazie Slater Katz & Freeman LLC in Roseland, N.J., told Bloomberg BNA on July 14 that the group of objectors that he represents plans to appeal the court's decision.</p> <p><strong>According to the court, Horizon has agreed as part of the settlement to discontinue the use of two databases released by Ingenix Inc. as well as a proprietary medical services and supplies charge data profile known as “Top-of-Range” when calculating allowable payments to out-of-network health-care providers.</strong></p> <p>The insurer has also agreed to revise its health plan language and marketing materials and handbooks to provide a clearer statement of how it derives the allowable payment amounts to out-of-network providers.</p> <p>“We are pleased that Horizon agreed to discontinue two reimbursement methodologies and make clear in the future the basis of out of network reimbursements to all policy holders,” he told Bloomberg BNA on July 14.</p> <p>The class members in the instant case alleged that Horizon failed to appropriately reimburse them for out-of-network services they received because it used the “flawed, corrupted and outdated Ingenix" database to determine the UCR for a service</p> <p><a href="http://www.bna.com/horizons-ingenix-settlement-n17179892313/">http://www.bna.com/horizons-ingenix-settlement-n17179892313/</a></p>

Ingenix (Optum-United Healthcare) Lawsuits Still Bouncing Around Out There–One Recently Settled in New Jersey With Horizon Blue Cross Blue Shield That Was Still Using the Flawed and Corrupt Data Base for Out of Network Payment Calculations

This is unbelievable if I am reading this correctly as I had assumed that all insurers who licensed the data bases and software from United ...

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Suicides At NYU And New York Presbyterian–2 Physician Interns Jumped To Their Deaths

<p>The first suicide fell 26 stories and people walking by heard the thud and it was pretty ugly according <img align="right" alt="image" border="0" height="173" src="http://lh3.ggpht.com/-0yb4XLZoqWU/U_wFwL8S9JI/AAAAAAABLLY/asw7aGbB-fQ/image%25255B3%25255D.png?imgmax=800" style="border-left-width: 0px; border-right-width: 0px; background-image: none; border-bottom-width: 0px; float: right; padding-top: 0px; padding-left: 0px; display: inline; padding-right: 0px; border-top-width: 0px" title="image" width="220" />to those who saw the doctor’s body.  He had just completed his residency at NYU and he left his keys and NYU ID on the roof.  </p> <p>The second suicide was the death of a first year resident at New York Presbyterian/Weill Cornell Medical Center.  The hospitals have set up counseling centers as a result.   This was two in one week.  BD  </p> <hr />A 25-year-old medical intern jumped out of the window of a New York Presbyterian Hospital facility on Friday morning. <p>According to the Post, the unidentified man jumped out of his apartment window on the 20th story of the Helmsley Medical Building, a residence for hospital workers and a guest facility for the hospital near East 70th Street and York Avenue. Though his body was found on a third floor landing at around 9:20 a.m., he may have jumped sometime overnight.</p> <p>An NYPD spokesman had no information about this incident, and New York Presbyterian did not respond to request for comment.</p> <p><strong>Earlier this week, Sean O'Rourke, a recent graduate of the NYU School of Medicine, jumped to his death from the top of his former dorm building.</strong> The school says they'll be offering counseling service to students, faculty and staff.</p> <p><a href="http://gothamist.com/2014/08/23/medical_intern_dead_after_jumping_o.php">http://gothamist.com/2014/08/23/medical_intern_dead_after_jumping_o.php</a></p>

Suicides At NYU And New York Presbyterian–2 Physician Interns Jumped To Their Deaths

The first suicide fell 26 stories and people walking by heard the thud and it was pretty ugly according to those who saw the doctor’s body. ...

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Apax Partners Exploring Sale of Trizetto Health IT To Include Debt, Maybe Worth As Much as $3 Billion

<p>Trizetto was run by a former CEO from Cerner, Trace Devanny for a short while, who was CEO of Trizetto.   He decided to jump  ship in May of 2013 and now is at Nuance as President of their Healthcare business.  Trizetto was formerly in Newport Beach and moved to Colorado and perhaps he didn’t want to leave southern California.   I heard some rumbling too about Nuance maybe coming up for sale too, but can’t say anymore than that as that’s all I heard.  </p> <h5><a href="http://ducknetweb.blogspot.com/2010/07/ex-cerner-president-hired-by-trizetto.html">Ex Cerner President Hired by Trizetto as CEO – More Money on This Side As Payment Algorithms Are Not Certified and Held Accountable as is EHR Software</a></h5> <p>A few years ago we heard a lot about TriZetto and then they became rather quiet after their big entrance into the insurer owned <a href="http://ducknetweb.blogspot.com/2009/10/trizetto-announces-new-feature-for.html">PHR business.</a>  Trizetto does a lot of business with Blue Cross owned Care-More, here in California and I would venture to say they are one of their top 5 clients just due to size.  If I remember correctly TriZetto is a big software client of Ingenix, aka Optum now for a lot of their analytics.  They started doing chronic illness studies a while back, link below is from 3-4 years ago, scraping data for compliance, so they have been into information and data selling for a while as well as being software and analytics consultants.   </p> <h5><a href="http://ducknetweb.blogspot.com/2010/08/trizetto-adding-disease-management.html">Trizetto Adding Disease Management Algorithms For Insurers With “Value Based Benefit Solutions” To Manage Program Members And Log Compliance</a></h5> <h5><a href="http://ducknetweb.blogspot.com/2010/11/trizetto-partners-with-medai-for.html">Trizetto Partners With MEDai For Analytics, Data Mining and Clinical Outcome Analysis–Payer Algorithms/Transactions “Cha Ching”</a></h5> <h5><a href="http://ducknetweb.blogspot.com/2010/10/trizetto-creates-portal-to-connect.html">Trizetto Creates Portal to Connect Providers and Payers– Algorithms To Hasten Transaction Fees With Processing Claims That “Score Patients And Authorization Requests”</a></h5> <p>Private equity is certainly picking up a lot of businesses and we still don’t know what PE folks may end up owning the old drugs from Glaxo either.  BD</p> <h5><a href="http://ducknetweb.blogspot.com/2014/08/private-equity-firms-exploring-options.html">Private Equity Firms Exploring Options to Buy Old Drug Brands FromGlaxoSmithKline and Sanofi,Glaxo Has Already Opened the Door Asking For Bids From PE Firms</a></h5> <p> <hr />NEW YORK (Reuters) - Private equity firm Apax Partners LLP is exploring a sale of U.S. healthcare information technology company TriZetto Corp, hoping to fetch as much as $3 billion including debt, according to people familiar with the matter.</p> <p>London-based Apax has hired investment bank JPMorgan Chase & Co to run an auction for TriZetto, a software vendor to the U.S. health insurance industry, the people said this week.</p> <p>TriZetto will target other companies in its sector as potential buyers, such as information technology consulting company Cognizant Technology Solutions Corp , although private equity firms are also expected to weigh offers, some of the people added.</p> <p>TriZetto had 12-month earnings before interest, tax, depreciation and amortization of more than $190 million as of June 30, one of the sources added.</p> <p>The sources asked not to be named because the matter is not public. Apax and TriZetto declined to comment while JPMorgan and Cognizant representatives did not immediately respond to requests for comment.</p> <p><a href="http://www.chicagotribune.com/sns-rt-us-trizetto-sale-20140819-story.html">http://www.chicagotribune.com/sns-rt-us-trizetto-sale-20140819-story.html</a></p>

Apax Partners Exploring Sale of Trizetto Health IT To Include Debt, Maybe Worth As Much as $3 Billion

Trizetto was run by a former CEO from Cerner, Trace Devanny for a short while, who was CEO of Trizetto.   He decided to jump  ship in May of...

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Alabama Is The Next State Up With United Healthcare Firing Medicare Advantage Doctors–Notice From State Medical Association

<p>The state medical association put out a release to notify consumers who have Medicare Advantage Policies with United Healthcare, that their state is next on the hit list.  If you go back all of this started in Connecticut and there’s still lawsuits pending on that action taken with the CMA, TMA and other medical associations  who have done a “me too” to join the lawsuit.  A couple weeks ago I ran this post below <img align="right" src="http://lh4.ggpht.com/-GPn1iE76d3k/T5D3QJ8PWFI/AAAAAAAA6jk/kMvDzt1Smc0/image_thumb%25255B3%25255D.png?imgmax=800" style="float: right; display: inline" />about how it was impacting folks in Tennessee and you can see in the video and comments that consumers were by algorithmic error being sent to the wrong kind of doctors as a replacement, i.e. gynecologists as their new family practice MD and more.  </p> <h5><a href="http://ducknetweb.blogspot.com/2014/08/patients-in-tennessee-speak-out-about.html">Patients In Tennessee Speak Out About United Healthcare Firing Their Doctors As the Effort Continues To Reduce Their Own In House Overhead With Managing Fewer Doctor NPI Accounts, Contracts and Billing…More Killer Algorithms At Work Hurting Seniors</a></h5> <p>We don’t know how many are affected in Alabama but in each state it has been substantial for sure, such as Massachusetts and New York. As a matter of fact there's a group of lawyers investigating the out of network charges in New York to make sure the insurer is not back up to their old tricks that lead to the bit AMA lawsuit to where doctors were paid short for 15 years on out of network claims due to algorithmic figures in the calculations.  </p> <h5><a href="http://ducknetweb.blogspot.com/2014/06/law-firm-investigating-unitedhealthcare.html">Law Firm Investigating UnitedHealthCare Claim Payments in New York Stating Under-Reimbursement By Manipulating Algorithmic Benefit Calculations…</a></h5> <p>Now in New Jersey, the narrow networks are expanding into employer insurance with yet more offering from United Healthcare which gives some kind of price break around 10% for the employer furnishing the insurance, but employees cannot see a doctor or go to<img align="right" src="http://lh3.ggpht.com/-q1ZlYU3i__8/UnXCngdfnNI/AAAAAAABIbk/HRJc-_5HyMI/image%25255B9%25255D.png?imgmax=800" style="float: right; display: inline" /> a hospital outside of New Jersey.  </p> <h5><a href="http://ducknetweb.blogspot.com/2014/08/narrow-networks-for-employers-soon.html">Narrow Networks For Employers Soon An Option in New Jersey With “New Jersey Only” Plan Offering From United Healthcare As The Company Keeps Working Their Risk Assessments and Reimbursement Reductions..</a></h5> <p>The medical board of Alabama is pretty much saying the doctors were fired because “<a href="http://ducknetweb.blogspot.com/2014/05/three-health-insurers-working-with-non.html">algorithms said</a>”…</p> <p>On the other hand United and other insurers sure knew how to work their algorithms on over billing Medicare with fiddling with risk and programmatically causing an up coding or up billing situation when parameters were met with those on Medicare Advantage plans, $70 billion over charged in a period of 5-6 years.  So United knows how to play the math model/computer code game very well.  Don’t dare up code on claims submitted to them, but they can do it and get away with it when billing CMS on Medicare Advantage plans and it took CMS 5-6 years to find it.  BD </p> <h5><a href="http://ducknetweb.blogspot.com/2014/08/cms-discovers-that-insurers-offering.html"><strong>CMS Discovers That Insurers Offering Medicare Part D “Really Know To Sharp Shoot A Model With Adjusting Risk For Profit”, A Common Everyday Occurrence in Financial Markets…</strong></a> <hr /></h5> <p>If you are a patient on Medicare and enrolled in UnitedHealthcare's Advantage program, you may have been notified recently that your doctor is no longer covered in UnitedHealthcare's network of physicians. </p> <p>That means that if your physician has been dropped from the network and you elect to continue to see him or her, you will likely have to pay more out-of-pocket for your health care.</p> <p>The physicians of Alabama and the Medical Association of the State of Alabama want all patients affected by UnitedHealthcare's recent decision to know this action was taken unilaterally by UnitedHealthcare. <strong>There was no consultation with or input from the physicians who were dropped from the network. Further, the decisions reached by UnitedHealthcare are not an indication of the quality of care provided by those physicians.</strong></p> <p><a href="http://blog.al.com/press-releases/2014/08/notice_to_patients_regarding_u_1.html">http://blog.al.com/press-releases/2014/08/notice_to_patients_regarding_u_1.html</a></p>

Alabama Is The Next State Up With United Healthcare Firing Medicare Advantage Doctors–Notice From State Medical Association

The state medical association put out a release to notify consumers who have Medicare Advantage Policies with United Healthcare, that their ...

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