Medical Quack: 05/01/2015

Whistle Blower Doctor’s Case Against Hospital Reinstated–$5.2 Million To Be Paid By IHHI Hospital

It’s been a while since we have had any IHHI news but it rocked the news wires quite a bit a few years back. There was a bit of everything here with the case of the hospital CEO setting up the Internal Med Physician. You can catch up at the link below on more of the story but the award mentioned was taken away due to the fact that later it was said the hospital was not responsible for the CEO’s action. Well that has been reversed so the award stands.

Jury Orders IHHI Hospital Chain to Pay Doctor $5.2 Million As Former Executive Planted a Gun and Gloves in the Doctor’s Car As a Set Up - The Case Filed in 2006 Finally Reaches Closure

IHHI Hospital exec framed doctor on gun charge, lawsuit says – Orange County CA

How often do you read about a CEO hiring a bunch of thugs to set up a doctor. Not too often but this CEO was psychopath of sorts. In the entire saga, there was more than that as FINRA was involved as the investor was in the porn business, taking out some money from that end and chartering expensive yacht tours and more.

FINRA Sanctions Firms for Selling Interests in Troubled Companies, One in the OC, Capital Holdings Financed IHHI–Chain of 8 Hospitals in the OC–Guns, Porn You Name It All Here

SEC Investigation Finds Medical Capital Holdings Diverting Investor Funds to Pornography and Other Businesses Aided by Former IHHI President – Orange County

The owner that created all the fuss with the doctors was out for a while and then when money got tight, he got back in. When the initial stir began all were afraid Chaudhuri was going to bleed the place dry. He came back with a Hedge Fund backing him, interesting is it not?

Control of IHHI Hospital Chain Returns to Kali P. Chaudhuri in Orange County Backed by a Hedge Fund - Some Are Nervous

At the hospitals, while this was going on, many went day to day not knowing if they would or would not have a job.

Medical Capital Holdings Closed by Federal Judge –IHHI Hospitals Waiting Outcome

Larry Anderson quits as president of hospital owner IHHI - Orange County, CA

Like I said it’s quite the story that evolved, when the hospital system got new financing, the blew some of it on porn. Anyway, most of that seems to be behind this small hospital chain now as far as I know. The doctor’s victory was a good one indeed. If you read some of the past articles you can tell that the hospital was siding the the CEO on some of this in an effort to shut down the physicians on staff who were protesting working conditions and then some. The CEO of the entire system quits and then they hire him back as a consultant? Strange stuff indeed so it looks like the Hedge Fund here could take hit with the fine. BD

TUCSON, Ariz., May 4, 2015 /PRNewswire-USNewswire/ -- Physician Michael Fitzgibbons, M.D., was awarded $5.2 million by a jury in compensation for distress he experienced because a hospital CEO had a loaded firearm planted in his car, occasioning his arrest, and had a tire slashed on his car, causing a serious accident while his daughter was driving on the freeway.

Dr. Fitzgibbons had opposed actions taken by Integrated Healthcare Holdings, Inc., on the grounds that he believed they would jeopardize patient safety. The trial jury found that IHHI's CEO Bruce Mogel, in retaliation, carried out threats to "humble" Fitzgibbons. Mogel told IHHI president Larry Anderson that he "could have [things] done to people who displeased him." For example, he told Anderson he knew people who would kidnap the wife or daughter of another person with whom they were having an ongoing business dispute.

The trial court then overturned the jury's verdict. IHHI argued that it should not be held liable for its CEO's conduct. "The hiring of a thug was a 'startling and unusual…occurrence.' There was no relationship between the nature of his work and the tort committed…. The alleged attack on Fitzgibbons was not reasonably foreseeable in the light of Mogel's responsibilities."

http://www.prnewswire.com/news-releases/aaps-52-million-jury-verdict-against-hospital-reinstated-300076709.html

Privacy Duping of America-The Intangible Threat Model Has Changed Significantly-Companies Hide The Code On the Web, $180 Billion Dollar A Year Business, Welcome to The Duperville World of Inequality..

This is a pretty good article from Wired Magazine and it’s the truth and pretty much a lot of what I say here, so good to see others join in and make the case to try to start up a wake up call for consumers. What you don’t see does hurt your or hurts your access. Again we go back once more to a post I made about a year ago in the fact that people can’t tell the difference between virtual world values and the real world. This is done on purpose to keep this confusion alive and well as it means big money for those mining and scoring your data. It’s out there and many don’t want to deal with this reality and the media does a good job down playing it as a whole with a few exceptions where folks like myself and others try to get the truth out there.

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…

Companies and banks mine and hold your data until they find a way to make money with it, so the data they mine today will cause you to lose access to something down the road if not done today. It is what it is. Take a look at how all your credit card data is mined and scored by Argus. What’s even more alarming is the fact that the US Consumer Protection Bureau that is supposed to help us, is doing the same thing. We have a very weak leader over there anyway that I sometimes question was placed there due to the politics of the big banks anyway, just a guy that does a little to keep the public thinking the agency is really worth it. It could be as Elizabeth Warren designed it, but far from it now with Cordray being a bit of Dudley DoLittle with just enough action to make some news here and there. Cordray is just like the rest of the regulators in only attempting to go after some low hanging fruit and has no clue on how to approach real white collar code hosing crimes.

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

Over at HHS we now live under the six degrees of Bob Rubin, former US Treasury secretary and Citi Executive as Burwell was a former Director of his so don’t expect much there as we have the same old thing, “Stat Rat Fever” and the continued issue of the “Sebelius Syndrome” with whacked out perceptions of the virtual values that don’t play out well in the real world. Speaking of Bob Rubin, it was pretty entertaining to hear the news story of him blaming Facebook for the polarity of the US at the last Milken Conference, so publicly he’s using the old blame shift methodologies to remove the focus from what he has created over the years. Give me a break. The VA crisis should have been a wake up call for HHS, but not, they still are “Stat Rat Fever” addicts as that’s all they know and believe will lead to improvements.

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

Why does some of this software not work out there? It’s because people don’t work that way and software folks want to make money and it’s hard to get software to work the way people do but it can be done but there’s a lot of models to scrap along the way and dump them. The public usually will take care of those models as they don’t get used. Where the real problem lies though with some of this is the continued push to force people to use broken models and that’s where the problem begin and continue.

“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..

The World Privacy Forum a couple years ago did an outstanding report which has been cited everywhere but sadly used by few to take into accounting as to what’s really going on. Take the White House for example, you never hear a word from them about “data selling” or scoring, as they verbally tip toe around that reality and stuff you with a bunch of verbiage that will keep you satisfied for a moment or two (grin).

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

The reality here is that companies and banks are treating you just like stock bots or a piece of currency to trade and market with little or no concern as to what impact it has. They don’t care as it’s all about money. They live on the fact that consumes are so easily duped. More consumers are aware to a degree of what’s going on but not sure on what to do. How do we do any type of regulation without knowing who the players are? It’s the stupidest thing that’s gone on in the news forever…who are they? We need an index to at least let the public know who’s selling the data and what kind of data. It’s like “let’s throw the suckers (consumers) some new rewards program that’s all done on a credit card so we can sell more of their data. Sadly too much of this works as American consumers are so cash strapped they need some of this to afford drugs and other items we need to live.

In the paragraph below the writer at Wired makes a good point about the real world and virtual world values, he can close a physical door and windows for privacy but you can’t do that in the virtual world at all. Again consumer at minimum deserve to know who’s doing all this data selling and who they sell to as the data out there is becoming more flawed all the time and the sad reality is nobody looks at the data, only the query results so you get “scored” by the error bars and the money making data selling folks don’t care. Three years ago I said this would become a profit epidemic and it has. Click on the image to the right and read about my small campaign and I have had a few folks contribute, mostly those who have already been screwed by the error bars in all of this.

Last week I was in an office and overhead a person screaming to one on the phone about being solicited by a drug company for clinical trials about blood thinners. They were very upset with the caller stating they had on record that this person takes them. Well guess what, read on the Medical Quack about me being on one of those lists that are sold. I couldn’t believe my ears in just over hearing this, so how big is the flawed data selling business? Quite large I assume as the odds of this happening to me and then hearing another person I thought were not that big, but even I was dumbfounded on how big this abuse really is to hear it.

We need a law passed to index and license all data sellers so we know who they are!! How in the hell do you as a consumer go back and correct the flawed data being reported out there about you when you don’t know where to go! If you get repackaged and resold, you can’t find who did it and prevent it from continuing. Read about Anthem, a crime of opportunity as who knows when those hackers might republish this data and disguise it as “legal” data and profit. It’s not that hard at all and on Twitter one of the Anonymous folks chimed in to tell me there are quite a few folks that hack with with data scientist skills to get and sell the data. Don’t fool yourself and think they will immediately sell the data as they may not, it could be a year before it pops up out there or more, right about the time your subscription for protecting your data expires maybe.

Anthem Data Breach–Crooks Want to Sell Data Too–The Impact of the “Data Selling For Profit Epidemic” That Exists in the US With Scoring Consumers Removing Access and Human Dignity

This is the real deal and what’s going on out there and I call it the Attack of the Killer Algorithms (click on image at the right) as that’s does all the work and we are “scored” as consumers secretly over and over and over and over, so you have no clue. It also keeps inequality growing at a rapid pace as you get scored into a box where you can’t get out and have to defend yourself against flawed data reported about you. You’re guilty by the data and you have to prove your innocence.

The US is way over the top with all of this and it comes back to money and nobody is being held accountable as so many at the top are all duped and they don’t get the brunt of this as money can buy them out of it if their data does happen to fall into some of this activity. Long and short is that we are all screwed here with no regulation and lack of people on the government side even smart enough to take any kind of action. Welcome to Duperville and other countries see this as well as there’s nothing hiding it either and that’s why consumers in the US have such a bad name as we buy up anything we read about, so be a skeptic when you need to be.

US “Data Selling Epidemic”-Privacy, mHealth and More Is Not Going Anywhere Until We Require All (Banks, Corporations, Insurers, Brokers, Etc.) To Buy A License to Distribute Data-You Need An Index Stupid To Identify Who to Regulate And Where…

It’s not tangible, so you don’t see it. And it changes the way that your information can be accessed and shared. The threat model is changing. I’m not just worried about people who are physically located in proximity getting access to images, and sounds, and information that I may broadcast. Now there are people and companies that are far removed from my physical location—that I may have no idea even exist—that now have access to my information.

In the physical world, if I want to keep something private, I can close the door, close the windows, adjust the blinds. There are very obvious, tangible things I can do to keep things private. I understand that if I change my clothes in front of an open window, that I’m risking people seeing me. And I understand that if don’t like that, I should either close the blinds or change somewhere else. This makes sense, and I don’t make mistakes and misunderstand the situation.

Every company in Silicon Valley is convinced that they’re going to come up with some new machine-learning algorithm that is going to help them mine gold out of people’s data. So they just need to keep all the data around until that happens. It does make sense to put some limits on that.

http://www.wired.com/2015/05/lorrie-faith-cranor-digital-privacy-control/

Koch Brothers Buy Irish Medical Device Company Protek Medical

Even the Koch Brothers are dabbling in the medical business, but this one, is an Irish company and as the article mentions, it will be dovetailed under their current subsidiary company Molex Electric, who makes cable supplies. Among other things the company makes disposable “probe” covers but it’s ok as it’s in Ireland and not related to abortion laws like the one in Virginia with mandatory vaginal probes.

You can also see a sterile tablet cover advertised on the website as well as many other products. BD

Koch Industries, the vast US industrial empire run by controversial billionaires David and Charles Koch, has bought Sligo medical device manufacturer Protek Medical. The Irish medical devices sector is one of the most innovative in the world and is attracting significant investment.

The brothers, who are major donors to conservative US political causes, bought Protek via a Koch subsidiary, Molex.

Protek employs 180 people at manufacturing facilities in Sligo and Galway.

It provides outsourcing services, producing custom-built equipment for the rapidly-growing medical device industry. Ireland has enjoyed huge success in this sector; the country is one of the largest exported of medical device products in Europe and 18 of the world's top 25 medical technology companies have a base in Ireland.

http://www.independent.ie/business/billionaire-kochs-take-over-irish-medtech-group-31248396.html

Got A Referral for a Specialist? Too Bad You Can’t Go There Anymore as The Doctor Works in a Competing Health System, EMR Records Expressed Over To The “Covered Provider”…

It’s not just insurance that keeps you from retaining your doctor, look at this at how competing Health Systems just capture you, your medical records and express you on over to where they want you to go. You have to go where it’s “financially advantageous” not to where the care could be better. Look at this story and listen to how the doctor communicates what happened.

The patient had full confidence in their long time cardiologist and the data just ripped this option right out from underneath the patient here and they had to go where they were told to go. So you want to keep your doctor, well you have a couple elements working against you and it’s all about money. First of all when you buy your insurance policy with a list of who’s in network, you could get surprised later as the Secret Scoring and Firing of Doctors continues to keep things non fluent here as insurers are using more Quants, some who probably worked for high frequency trading firms and banks, to keep the profits rolling down to the bottom line penny. Here’s a good archived article from the past that describes how United did a lot of this with Medicare patients with using algorithms only to just fire the doctors, no explanation given as again we had some Killer Algorithms at work here to disrupt your medical care. Read the other links here as the company themselves could not and still cannot keep up with what their own Quants are designing on these models and it keeps everyone disrupted and maybe not such a good fashion.

“The Secret Scoring of America’s Physicians” - Algorithmic Math Models For Insurance Network Contractual Exclusions, Relating to MDs Who See Medicare Advantage Patients..

I would also guess here too along this path that the medical records were de-identified and dumped into some research firm as well. You can see what Optum Labs with their partners Mayo, Dignity and more do with all that data to charge researchers and drug companies a fee to dig through all of it. As a matter of fact anyone, even if you do not go to the Mayo clinic can sign up and put your medical records on line..ummmm….yeah more data for Optum Labs, you think? It’s all about money and IBM is trying to do the same thing so just be aware.

Optum Labs Add Four Additional Data Miners To the Collaboration Looking for Data…

Nobody wants to use the almost free FDA data base, the Sentinel program to do the same thing, right? Gotta make money with patient data too. Sure there’s information to be mined from medical records but it’s not going to save the world and those drug companies that mine data from Optum, well they have marketers too so you have that angle working on what gets mined out of there for some more pharma marketing campaigns. As a matter of fact with all the steroid marketing going on and little clinical stuff from all this research at Optum, maybe marketing mining is the real objective here, you think?

“The Secret Scoring of America’s Physicians” - Algorithmic Math Models For Insurance Network Contractual Exclusions, Relating to MDs Who See Medicare Advantage Patients..

Basically what this doctor has written about here is money talks and referrals are sometimes uttered useless when it gets in the way of big money. Sometimes United themselves can’t even keep up with who’s in network as they went out and bid and won a contract and found they fired all the doctors already. The left quant at United doesn’t know what the right quant is doing here:)

Howard County School Board in Maryland Rescinds United Healthcare Contract As Retirees Didn’t Want the Medicare Advantage Plan, No Providers Available..

Anyway good input from this doctor as this is trending as he says, your healthcare is controlled by cost algorithms, not referrals anymore as the Quants with health insurers who probably used to create high frequency trading algos are at the controls.

The complex business of medicine is continuously evolving. As insurance companies, doctors and patients align themselves with different health care systems, the competition to keep patients has heightened to a disturbing level. This is not necessarily best for the patient. Here is my story illustrating this new phenomenon.

A female patient came to see me last month complaining of chest discomfort. Her stress test results suggested a major cardiac issue. Further diagnostics, specifically a cardiac catheterization, were needed. I called a colleague who specializes in this procedure, and set it up for the following week. Together, my patient of 15 years and I discussed her concerns and expectations. Then off she went to the next part of her journey. Her voyage through the health care system turned out more complicated than anticipated.

As it turns out; my well-respected colleague would not perform the procedure because this patient was an employee of a competing heath system. Thus, it was financially advantageous for her to have the procedure in that health system by their doctor, in their hospital.

This action ignored the fact that I had a long-standing clinical relationship with the patient and many of her family members. More importantly, it disregarded the patient’s request that I remain her cardiologist.

http://www.philly.com/philly/health/hearthealth/A_disturbing_medical_trend.html#2RjksMp7vBs32ili.99

Walgreens Spins Off Home Drug Infusion Company–Option Care Bought by Private Equity Firm Madison Dearborn Partners..Option One Formerly Walgreens Infusion Services Subsidiary

We all know that cutbacks and/or changes were coming with Walgreens as was noted in the big $ 8 billion dollar bond sale last year with debt. It’s kind of hard to miss that one and the fact that they have a couple hedge fund folks now sitting on their board.

Walgreens Has A Bond Sale to Help Finance Purchase of Boots Pharmacy in the UK–$8 Billion

Two Hedge Fund Executives Gain Board Seat Walgreens, Stock Buy Backs To Continue And Increase, As Well Cost Cutting With Products And Maybe Employees

Option One has around 5000 employees/contractors along with 92 pharmacies and 110 independent operated clinics. Wait a minute, did someone say clinics? Any bets on this PE firm some day wanting to sell those to Optum (grin). You never know…

Optum Clinics Holdings, New Subsidiary Incorporated In 2015 Raises Over 36 Million (Exchange of Shares) From Investors Unknown-Form D Used to Maintain Secrecy Of Who They Are For Now…

This is interesting as we just saw CVS buy Omni-Care to rush out and provide more drug services to seniors this week as well. We seem like we are also on the same path with too big to fail drug store chains, you think? BD

Walgreens Boots Alliance's home-infusion division has been relaunched as an independent company called Option Care, after the drugstore chain sold a majority stake in the business to a Chicago private equity firm.

Walgreens unloaded the business soon after completing its merger with European pharmacy chain Alliance Boots at the end of last year, as part of a corporatewide restructuring. The newly merged company plans to focus on its retail business and is looking to cut $1.5 billion in costs by the end of 2017.

Option Care mostly delivers medicines in the home, using a team of about 1,000 nurses. These are medicines like antibiotics and chemotherapy that have to be administered intravenously, either via injection or catheters.

The potential growth attracted private equity firm Madison Dearborn Partners, which has an undisclosed majority stake in the business. Terms of the deal were not disclosed when it was first announced in January. Walgreens retains minority ownership in Option Care and has three seats on the nine-member board of directors, Mastrapa said.

http://www.chicagotribune.com/business/breaking/ct-walgreens-option-care-0520-biz-20150519-story.html

Medical Society of New York Wins Down Coding Algorithm Case Against United Healthcare, Short Paying Doctors Again–Killer Algorithms For Big Profits Live Everywhere…

This has been a long case and just goes to show you how far back insurers have been using sophisticated and non sophisticated algorithms to cut payment to doctors. I saw this in the early HMO days in California with what we called the “floating patients” on their capitation payments as doctors were always getting ripped on their payments way back. I have been there and seen that one as it’s been going on for years. All you have to do is write a little code to run or not run and bingo the parameters are set to allow and disallow in less than a second.

I had to chuckle a little bit about the lead in line to this story as we have this great discovery statement “it could be a computer modifying your health insurance claim”..well it’s being going on for years and is nothing new. Why do people still picture health care claims all manually being handled by people? I don’t know, has not been that way for years.

This case is a physicians group who sued and what’s funny is you hear United bragging all the time about their web services and software and here doctors had to sue to get it improved so we do indeed have “selective” software interest and those that make money for the company come first, such as a lot of the apps that mine and record your data so United Behavioral, a big subsidiary of the company in northern California can score and sell you all over the place and create a “behavioral profile” on you. As a matter of fact, I don’t know if they combine the scoring from the voice algorithms that record and analyze your current state on the phone or not, but could be. As you see business trends it appears the company will do these sort of analytics to sell much faster than fixing a website that doctors use for their work with the company. The claims were settled based on stats and not on patient care the article states.

“This Call May Be Recorded for Quality Purposes”..Heck Not, Millions of Algorithms Have Been Turned Loose to Listen To and Analyze Your Voice When You Talk To Your Insurance Company As Algorithms Continue To Take Over the World…

Doesn’t this remind you of the Ingenix lawsuits from a few yeas back where current Medicare Chief Andy Slavitt was the CEO has his infamous Ingenix (sub of United Healthcare) algorithms short paying MDs for 15 years? It’s also kind of scary that this person too who knows how to rip with algos is running Medicare and he’s lined his pocket very well with all of it on top of being a former Goldman Sachs banker. It is very ironic and very much like the bank business that those who ripped the public and doctors with algorithms people didn’t even know existed, rise to the top with government. I know many MDs in southern California tell me with the use of complex contracts, they get paid from United at rates less than Medicare today.

Ingenix Gets Contract from State of Alabama To Review For Fraud – Same Company Underpaid Doctors for 15 Years Settled Recently with the AMA– Algorithmically Incorrect Calculations

It is a bit bizarre as what the doctors groups were suing for was the absence of what United and Optum brag about providing for clinicians all the time..and to me this kind of says we have some Astro Turfing going on out there as why would the MDs being suing for this if what we read in the news is true? This contradicts some of what is put out there today. You can read more on News Rigging at this below and watch a video to see what that’s all about.

News Rigging Has Arrived! Astroturf and Manipulation of Media Messages-TED Video About “The Fake Grass Roots” Of Big Pharma and Other Campaigns That Fool and Fool Again…

The doctors do have reason to be concerned as when you look at secrecy of what United and Optum are doing with buying up clinics in the US, they will again reduce payments and control what doctors will be able to earn and those algorithms will literally just be shoved down their throats at some point. If you read any of what Zeke Emanuel writes at the HHS think tank that writes most of US Healthcare policy anymore and where Jonathon Gruber works as a fellow, Zeke tells you over and over how great Optum is so be aware and be alert as they grow in plain site that everyone misses with adding new subsidiaries all the time.

Optum Clinics Holdings, New Subsidiary Incorporated In 2015 Raises Over 36 Million (Exchange of Shares) From Investors Unknown-Form D Used to Maintain Secrecy Of Who They Are For Now…

So here we have a small victor with United/Optum adding the services they brag to all that they provide, but seems all of it may not be true at all. United runs algorithms and uses Quants to model insurance polices and other items to make money first before focusing on provider services that don’t provide an immediate ROI as does all their data selling activity as well. BD

If you’re wondering who denied or modified your health insurance claims, the answer may be it was a computer.

Minnetonka, Minn.-based UnitedHealthcare has reached an $11.5 million settlement with four physician organizations regarding charges that the firm uses software to automatically adjudicate medical claims.

UnitedHealthcare on April 27 settled a nearly 15-year-old case with the Medical Society of the State of New York, the Connecticut State Medical Society, the North Carolina Medical Society and the Tennessee Medical Association.

The physician groups charged that UnitedHealthcare’s payment practices for in-network physicians were unfair, including allegations that the insurer used automated software that sometimes improperly adjudicated claims submitted by participating physicians.

The suit said that UnitedHealthcare used software that automatically “downcoded” procedures or denied payments to physicians identified as “high utilizers.”

Downcoding is a practice through which an insurer changes coding to a new category that leads to lower reimbursement.

UnitedHealthcare also routinely refused to pay at least part of a claim for healthcare services rendered on a given day in what’s known as “bundling,” according to the suit.

As part of the settlement, UnitedHealthcare promised to spend at least $9 million in extensive enhancements to their provider self-service website by the end of this year, increasing efficiency and reducing delays in managing and resolving claims. The agreement also calls for $2.5 million in attorney fees.

http://libn.com/2015/05/06/unitedhealthcare-reaches-11-5m-settlement/#ixzz3ayMxAmL1

“Information Blocking” Finally Revealed for the Hoax and Make Believe Story That It Is With Medical Records Sharing and Interoperating…

I said from the start that this was an absolute made up story and nice to see Dr. Halamka at Harvard Medical address this. I have seen tons of articles written about this nonsense and now it’s all the way up to the FTC and members of Congress thinking this is real! It just goes to show you the power of News Rigging for political gain..

News Rigging Has Arrived! Astroturf and Manipulation of Media Messages-TED Video About “The Fake Grass Roots” Of Big Pharma and Other Campaigns That Fool and Fool Again…

First off, what medical record company has the time or resources to do this? Second what interest would they have? It’s not going to create more business or revenue dollars, so again this has been from day one a political hoax and look how many from what they read in various news articles were sucked in.

I look at it as selling a political perception only for someone to gain some favors and/or marketing gain here. Way back in the early days when I still wrote code, I created a medical records program that I sold for a short time and thus I relate to my background in what I was creating as a tool for the doctors as it’s “their” tool not mine as I always said. Why as a developer would I even “think” of writing code to create some sort of “Information Blocking” code module? There’s absolutely no reason on earth, so again this and this entire concept and made up “concern” has been nothing but a fluke.

The only thing close I can get out of this hoax that’s been going through the media for a year or so now is that some EMRs are not playing with someone else's software so cleverly someone decided to make some EMR companies “the bad boys”. Well who are they? Nobody ever has a name do they? It’s just this chatter and fear and the soaking of those who don’t understand data mechanics and code and look how well it stuck as a “fear factor”. It is and was total bunk.

Here’s a couple clips from Dr. Halamka’s post below and the 3rd paragraph is where he addresses his feelings too, as apparently he’s never seen or encountered any of this either and he’s all over the place, way beyond what I do and then some. This what is so bad out there today and recently I wrote about “News Rigging” (link above) from several focuses, the stock market, the use of journobots and knock off news articles and the upcoming paying 20 cents to read a news article if that happens as it has been noted in the news. Who knows, maybe that’s fake too (grin).

Major US Newspapers Sign Up and Invest With New Start Up That Will Charge You To Read The News–20 Cents Per Article, Probably Written by a Bot and Goes On You Credit Card–And Bolsters the $180 Million Dollar Year Personal Data Selling Business

Watch this video below (lots of pharma fake grass roots topics covered here too) and you’ll get it with this reporter from CBS news..…we had Astro Turfing of the “EMR Information Blocking” fabricated stories to generate more fear factors…and hopefully the FTC and Congress will see what’s been on their plate, a perception of some who don’t write code, don’t understand scripting, mathematical models, and not a true reflection the real world. All have been “astro turfed” to the max.

The big issue here is the fact that people can’t tell the difference between virtual and real world values anymore and thus people get sucked in if you don’t entertain being a little bit of a skeptic when things don’t sound right. I try with writing this blog to point out the dupers when I can and the links below are also about the same subject material. We do have folks that are confused and can’t tell the difference between a virtual and real world value and we all get fooled sometime.

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…

AMA Joins The “People Don’t Work That Way” Club, Creates Recommendations To Adjust Meaningful Use, Which Now Has Blossomed Into An Almost Non Comprehensible Outline Of Rules and Regulations..

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”?

How Many More “Bloomberg Big Gulp” Failed “Proof of Concept” Models Can We Sustain Before Everyone Splits a Gasket?

“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..

Below the line are the clips from Dr. Halamka’s blog and there’s a link at the bottom to read his entire blog post. When you have an expert such as himself who’s both a physician and computer scientist calling it out, time listen up to where the credibility lies. BD

“It does not make sense to officially sanction a “charter organization” and seed it with $10 million, creating yet another player in an already crowded field of groups working on interoperability. I agree that coordinating the standards development organizations makes a lot of sense -- why not just direct ONC to create a permanent Task Force that reports to the HIT Standards Committee, and let ONC support it out of existing resources?
The drafts have other significant issues

“standards to measure interoperability” – I have no idea what that means. I suggest that ONC create and report outcome measures that require interoperability rather than trying to measure the process of interoperability. With Meaningful Use Stage 2 we experienced the failure of process measures to truly measure interoperability - transitions of care sent from and to the same organizations, transitions of care sent to an outside organization then thrown away.

“information blocking” - I believe this concept is like the Loch Ness Monster, often described but rarely seen. As written, the information blocking language will result in some vendors lobbying in new political forums (Federal Trade Commission and Inspector General) to investigate every instance where they are getting beaten in the market by other vendors. The criteria are not objective and will be unenforceable except in the most egregious cases, which none of us have ever experienced.

“De-certification” makes no sense. Every provider would have to be granted a hardship exemption, so what is the point of the decertification?”

http://geekdoctor.blogspot.com/2015/05/21st-century-cures-act.html

CVS Buys Omnicare–Selling Drugs to the Elderly Via Nursing Homes and Assisted Living Homes And Pays Over $2 Million Dollar Fine In California for False Advertising

Here’s another big gobble and former White House ACA leader and Medicare Head, Nancy DeParle who sits on the CVS Board can count more money into her wallet. The fine in California just happened to be announced today as well. The fine was for selling items in the store and prescriptions for more than their advertised prices. A few years ago Walgreens and Omni-Care did a swap of business lines so Walgreens could get the Home Infusion business from Omni-Care.

Walgreens and Omnicare Swap Businesses–Giving Long Term Pharmacy Care to Omni and They Get Omni’s Home Infusion Business

A couple years ago Omni-Care purchased this infusion business as well. The company offers the services of a lot of in house consultants.

CVS Caremark Buys Coram Infusion Business From Apria Healthcare for Over $2 Billion

What is somewhat crazy is we had this with the FTC saying that Omni-Care couldn’t buy PharMerica and then today it doesn’t make any difference as look what all is under the CVS umbrella.

FTC Says No to Omnicare Take Over of PharMerica and Files Lawsuit to Block as The Combined Company Would Control 60% of Drugs Supplied to Nursing Homes

Omni-Care also bough Continuing Care RX which serves 40,000 beds of long term care facilities a couple years ago. Both CVS and Omni-Care have certainly racked in their share of fines from the DOJ and DEA over the years too. Omnicare employs about 13,000 employees at 160 locations in The US. BD

CVS Health will spend more than $10 billion to buy pharmacy services provider Omnicare and tap a growing target for prescription drug distribution: care for the elderly.

The deal announced Thursday will give one of the nation's biggest pharmacy benefits managers national reach in dispensing prescription drugs to assisted living and skilled nursing homes, long-term care facilities, hospitals and other health care providers. Omnicare's long-term care business operates in 47 states and the District of Columbia.

Cincinnati's Omnicare also provides pharmacy consulting and runs another segment that provides specialty pharmacy services.

Specialty drugs are complex medications that treat certain forms of cancer or hepatitis C, among other conditions. They often represent treatment breakthroughs but can cost considerably more than other prescriptions. Use of these drugs is climbing, and insurers and employers are looking for help containing that cost.

http://www.telegram.com/article/20150521/NEWS/150529789

“Economists, They Think That They are Scientists, They Come Up With What They Call Laws, They’re Not Laws” …

Quant Paul Wilmott says it all….if you like this clip, scroll down to the second video in the footer and watch the Quant documentary. Read about what they do as they are designing the insurance policies you buy.

“It’s just an idea or a frame work that may or may not work and based on very shaky foundations with all kinds of nonsense coming out of it”….sums it up pretty well.

In the meantime this says for Economists and how useless they have become and why:) BD

“The Great Math Mystery”–Software Engineering-Looking for Where It Does and Doesn’t Work-The Physics Connection…

There’s a lot of good discussion here with both the history of math and how it relates and works with the real world. The laws of physics in a game are only mathematical rules created by a programmer says MIT.

To me anyway, this makes a case for data scientists to have a connection with physics as software design can get out of hand, we saw that last year with a fund raising project to where many took on the creator, his numbers were trying to defy physics.

It’s fascinating to see how math is used to solve problems and create answers; however there are limitations in some areas. Is math a product of the human brain, interesting question that is asked.

The study on Lemurs is interesting as they are trying to compare the brain and math to humans. This is interesting but again nothing that will impact you other than more incentives giving away credit cards for you to spend more so additional data can be collected about you…

We perceive numbers as humans, probably pre-programmed the video states. That’s where we run into trouble today with math models that cheat and thus there goes the perception levels and people are lead into areas that are not true. Boy do we see that in the news.

Error bars, like daily weather is just too complex to predict for more than a week. Interesting though as the video continues on to spot other areas to where long term models won’t work well, like the behavior of water, the stock market, human psychology and more. This statement actually says something here too on why government healthcare models won’t work, it’s not effective long term and we have some Algo Duped folks trying to make it work long term and now one by one we are seeing such models from HHS and CMS starting to fail.

Catch the videos over at the Killer Algorithms page for more on how that evolves, as right now we’re on a no-win path with folks looking for Algo Fairies and Unicorns, they just don’t exist. This does not mean short term models are bad though either but the longer the model, the greater the error factors. In another topic, I write about this all the time with the data selling epidemic and sure enough the error bars grow on what is collected and sold about us, hands down. Again the oddness of this though is getting government and the public to accept this fact so we can move forward and the perceptions sold by the media today are strong and do quite a bit of manipulation and polarization out there, by design sometimes.

Engineers have the elegance of math that meets the messiness of the real world. They deal in the domain of the approximate, the practical. The make changes, omit things and rework so things work. They take shortcuts that approximate an answer.

For engineers, “approximate is close enough” so keep that in mind with the business of healthcare as it’s not like the big data projects of genomics and science to where they need more definition, but the way you get marketed and I head this all the time, they push you to have higher levels of accuracy than needed, and again look at HHS and CMS, they go out of their skulls with some of this. Recently HHS Secretary Burwell came out with yet another “huge numbers push” and again time to think about “being close enough” here as in time as this keeps building she will drive everyone out of their minds as people don’t work that way, but she’s been Algo Duped, the Sebelius Syndrome lives on. There’s many afflicted with this belief as well and you see it all the time with Congress, Mary Jo White at the SEC (markets are not rigged) and so on. Most people that have written code are substantially aware of this and self included, we can’t fathom the beliefs we hear but remember the press is there pushing this perception as well so it’s all around you.

So remember when you sit down in from of your medical records system, think about how engineers struggle to make things “simple enough” and how they trade precision for practicality. Close enough was good enough to get the US to Mars.

So you precision folks when it comes to the “business” of healthcare, give this some thought as we will get better but there will never be the levels of precision that the White House, HHS, CMS and more want you to believe exists as again they do have a level of duping taking place and often that all comes back to making money and further scoring US citizens out of opportunities that used to exist. That is where math is used by those to control and make money, but that being said, this vide gives you a pretty good understanding on how things work all the way around, great video! BD

https://www.youtube.com/watch?v=JOtAFiI39_I

Union Protesting, Accuses Kaiser of Firing Psychologist Who Was a Whistleblower

Kaiser has been under fire for a few years now with not providing adequate mental care and this appears to be a continuation of the process here with the union now bringing it to the forefront again, with the firing of a psychologist who blew the whistle on some aspects of this.

When you read around the web you can see where Kaiser is shifting some behavioral health areas over to Optum as contracts are signed. You can see it on the web pages themselves for some of the contracts they hold, go to Optum as a covered entity for mental health care, it’s right in plain sight. One hospital executive recently told me they took the easy way out with signing such contracts versus more in house coverage.

Kaiser Permanente Mental Health Workers Demand a Fix for Inadequate Care

So again, keep an eye on the “too big to fail” big insurer, UHC/Optum as you may find their subsidiaries in places you may have never thought of. BD

For years, Kaiser Permanente, the largest HMO in the Bay Area, has been criticized by the National Union of Healthcare Workers, which represents mental health care professionals in Kaiser facilities around California, for providing insufficient mental health services for its members. In 2013, the California Department of Managed Health Care vindicated those complaints when it fined the HMO $4 million for "failing to provide mental health treatment in a timely manner," according to the Sacramento Bee. The DMCH also ordered Kaiser to cease and desist from violating state law, which requires HMOs to provide mental as well as physical health care.
Kaiser was supposed to fix the problems, but in February of this year, the DMCH issued a report slamming the company for continuing to fail to meet the legal standards for mental health care, according to the LA Times.

http://www.sfweekly.com/thesnitch/2015/05/14/union-accuses-kaiser-of-firing-whistleblowing-psychologist

QSSI (United Healthcare Subsidiary) Calls It Quits With Healthcare.Gov-Stepping Down as Primary Contractor/Manager

This is interesting and it could be due to the 8 month extension given QSSI expiring and maybe HHS/CMS decided not to renew? There could be other reasons as well. Our current head of Medicare, Andy Slavitt was the former CEO of this United Subsidiary and moved from that slot to where he is now and was given a rare waiver to be He received a rare waiver to allow him to be involved in contracting issues involving Optum and the United Healthcare Group.

If you read here often enough you have probably heard me mention about the big door opening at HHS beginning back when Lois Quam, another former United Healthcare Executive was hired by Hillary Clinton with her first healthcare campaign. Quam was also one of the key executives that escaped criminal prosecution back in 2007 when the Department of Justice investigated UHC for back dating stocks. Many executives were found to have done it but the former CEO took the fall and Hemsley who admitted and gave his back dated stocks back right away continued to move forward and become the CEO of United Health Group today.

QSSI has been at the center of political controversy since the company won an HHS contract and then 2 weeks later were bought by United and Andy Slavitt, current head of Medicare came right along with the deal and a loop hole in current laws allowed him to pocket almost 5 million in tax free income. You do kind of wonder why a millionaire several times over wants to run Medicare, right? Before QSSI Mr. Slavitt also served as CEO of another United Healthcare company, Ingenix which also had a number of lawsuits based on false positives in anti fraud software as well as the algorithms that allowed doctors and patients to be short paid for 15 years on out of network claims. The AMA settled that lawsuit with Ingenix and with other insurers who licensed it, such as Blue Cross and Health Net. Aetna later would decided they could get out of the deal and built a case around lack of interest for not participating in the pay back they agreed to initially.

Before all of this though, Mr. Slavitt was a one time Goldman Sachs banker earlier in his career.

We might also remember the news of former HHS Secretary Sebelius running to register QSSI with the SEC and only to her dismay later she found out that United had not in essence violated any SEC laws with now disclosing the QSSI purchase as it appeared at the time it met the rules of non significance in the laws.

SEC Rules Ask for Disclosure Only When Subsidiary Operations Are “Significant”-Was The Federal Hub Contract Awarded to QSSI Not Significant When the Company Was Bought By United Health Group?–Subsidiary Watch

So as the progression moved on, QSSI with a large India foot print and domicile continued to be awarded contract for fixing Healthcare.Gov and other health insurance exchanges at the state levels.

India Technology To Fix US Healthcare.Gov Website Now And Has Assumed The Lead Project Manager and Integrator Role, QSSI Listed As Indian Domiciled With United Healthcare SEC Filings

So again we circle around back to this waiver that allows Mr. Slavitt, while head of Medicare to still be active in contracts negotiated for Optum and United Healthcare. Frankly I’m surprised other insurers have not been a little upset over the long time advantage/relationship United has had over the years with HHS and CMS as former employees tell me they were always there to mentor and help HHS/CMS with their business models, and some of which are not doing so hot right now as no set of mathematics runs forever without updates or replacements, or ditching a model all together.

Long and short of it is just as what occurs in the financial business, all the actions take place with subsidiaries today and if you are not paying attention, companies like United grow via their subsidiaries and are in areas of business way beyond just insurance policies and managing care. You can search this blog and find multiple blog posts to learn up on what else they do. Back in 2013 I did a small summary to include some of their businesses to include owning and operating a custodial bank as well, and again subsidiaries do allow for the major corporation to stay outside the immediate radar.

So who’s going to be the head contractor now at Healthcare.Gov I guess is the question and are we going to also have “too big to fail” health insurers on the landscape just like the banks? Here’s a new subsidiary of interest that just incorporated a couple months ago worth a read. BD

Optum Clinics Holdings, New Subsidiary Incorporated In 2015 Raises Over 36 Million (Exchange of Shares) From Investors Unknown-Form D Used to Maintain Secrecy Of Who They Are For Now…

QSSI, the politically-connected information technology firm that rescued the problem-plagued Healthcare.gov website unexpectedly announced Thursday that it is stepping down as prime manager.

The surprise departure of QSSI, the Columbia, Md.-based subsidiary of the IT health firm Optum and the health insurance giant United Healthcare Group, will raise new doubts about the future viability of President Obama’s signature program, Obamacare.

Three IT companies will have managed Healthcare.gov in its brief two-year history once QSSI is replaced.

A spokesman for the Centers for Medicare and Medicaid, which manages Obamacare, declined to comment on QSSI’s decision, including whether the firm’s departure was voluntary.

http://dailycaller.com/2015/05/14/politically-connected-obamacare-website-company-suddenly-quits/

Optum Clinics Holdings, New Subsidiary Incorporated In 2015 Raises Over 36 Million (Exchange of Shares) From Investors Unknown-Form D Used to Maintain Secrecy Of Who They Are For Now…

Here’s yet one more subsidiary of the giant insurance/technology behemoth that has been created this year. This is probably due to the fact that United/Optum just purchased MedExpress, a large chain of clinics across the US. MedExpress by the way unless it changed on the site openly solicits doctors to get in touch with them if they want to sell their practice. Hope not too many go that route myself.

Optum (United Healthcare) Buys MedExpress Urgent Care Business- 141 Full Service Clinics In 11 States–Company Advertises They Are In the Market to Buy Your MD Practice, As A “Too Big To Fail Insurer” Moves Forward With More Acquisitions

The list of investors are not listed but we might look at the cast of companies already doing business with United/Optum to speculate, like Mayo, Dignity, etc. who are already involved in the pursuit of taking over revenue cycling in hospitals where ever they can land a contract. This usually involves firing existing hospital employees and hiring them at a cheaper rate or with less benefits. If you look at any job pages for comments on Optum 360, most of them say the drop in benefits is huge with being rehired by Optum 360, all to cut costs of course. A former Dignity employee really voiced that pretty loud on one of the jobs boards I read.

Mayo Clinic is the Latest to Outsource Revenue Cycling to Optum 360, A United Healthcare/Dignity Health Company Pursuing Hospital Contracts All Over the US For Profit…

There could be any kind of additional investors as well besides the usual cast of companies as well to maybe even include other subsidiaries that United and Optum owns. As the article mentions, Optum Clinics filed a form D and the information is filed this way to keep the investors highly confidential as it’s something more than likely they don’t want to reveal right now, so a little bit of secrecy here with the new Optum/United subsidiary. You can use the link here to view the filing with the SEC and see who the officers are and a few other tidbits of information here.

We do know that Optum is very much interested in the urgent care clinics and I believe they have nine already under their own branding in Texas for one and in a couple other states. This makes me think back a bit to Zeke Emanuel and his past writings on the web where he talks about a big healthcare entity like Optum (and he loves Optum as he can’t get enough of them or write enough it seems) taking over, maybe even for a lot of what Medicare does, so seems a bit spooky does it not? You have to remember we now have a former Optum Executive running Medicare, Andy Slavitt who’s also accredited with being a former Goldman Sachs banker too. You can look old Zeke up and read his sometimes over zealous writings and his “love” for Optum over and over, and remember he thinks you are of little use after the age of 75, and who didn’t read that on the web a short while back.

What I found interesting too is the question on this page asking for people to comment and give the writer some information as “why are they doing this”. Read what was said here in quotes too below…it’s all about money and the part about potential customers feeling more safe…there’s a choke on that one as for healthcare we go to where we get better care, not because of the fact that they are well financed.

Oh well, back to the folks confusing virtual and real world values again, a huge problem.

“Despite Steven R Fenlon’s reporting disadvantages, Optum Clinics Holdings, Inc. could benefit from this reporting. First, it helps potential customers feel more safe to deal with a firm that is well financed. The odds are higher that it will stay in the business. Second, this could attract other investors such as venture-capital firms, funds and angels. Third, positive PR effects could even bring leasing firms and venture lenders.”

So one might guess they wanted the money to buy more clinics, remodel the ones they got with buying MedExpress, or both and a few other things thrown in. If you have not looked into the huge array of subsidiaries Untied/Optum has, it’s worth a look as 2/3 of their business comes from insurance and 1/3 is coming from software and analytics, and you can go back to the old Ingenix software (which is now called Optum Insights) that’s been around for a while and was the bottom line for the AMA lawsuit a few years ago with lowballing customary fees on out of network charges for 15 years, Ingenix Algorithms you could say.

In addition companies who own a pharmacy benefit manager like to sell drugs and make money too. For years Optum has had their own but they bought another one to incorporate which has some data selling skeptics (besides me) on the web wondering what this is going to fully do for privacy efforts. The amount of data for sale about you whenever you fill a prescription is huge today, making money to usually include Milleman and Optum yanking data out to analyze and sell to the likes of IMS, the biggest data seller of healthcare information out there who did an IPO last year. So again, thinking about how subsidiary companies would maybe work together, well clinics and patients need a PBM right?

United Healthcare Buys Catamaran Pharmacy Benefit Manager Just As the PBM Gets Hit With A Class Action Lawsuit For Low Balling Pharmacy Reimbursements..And More Patient Data to Sell and Analyze For Profit

So the mystery remains for now at least as to who kicked in $36 Million to fund this new Optum Clinics Holding? We might find out in time, so stay tuned. BD

Optum Clinics Holdings, Inc., Corporation just submitted form D for $36.98 million financing. Optum Clinics Holdings was able to sell $36.98 million. That is 100.00% of the fundraising offer. The total fundraising amount was $36.98 million. The fundraising form was filled on 2015-05-05. The reason for the financing was: Exchange of shares valued at $36,979,733.

Optum Clinics Holdings is based in Minnesota. The company’s business is not disclosed. The form D was signed by Steven R Fenlon Assistant Secretary. The company was incorporated in 2015. The filler’s address is: 9900 Bren Road East, Minnetonka, Mn, Minnesota, 55343. John L. Larsen is the related person in the form and it has address: 9900 Bren Road East, Minnetonka, Mn, Minnesota, 55343.

http://www.octafinance.com/optum-clinics-holdings-just-had-published-form-d-regarding-36-98-million-financing/40338/#ixzz3ZlHUDaFa

“Tech Neck” Devices Causing New Medical Condition From Constantly Looking Down At Your Cellphone, Tablet, Etc.

This is pretty interesting and does make sense and I think we can all relate to this one, again depending on how much time you spend with your nose in a device today.

Nobody seems to immune to this one, all ages as a matter of fact. We all do it. Chiropractors now say there is a bit of a switch going on from patients with lower back pain to upper back.

This gives a new meaning to a “pain in the neck”. So now if you use devices frequently during the day there’s new stretching therapies out there and I guess this is yet one more possible argument that could be made with EMRs? Oh who knows as I see a little bit of everything out there and this means that all the doctors and nurses who take care of me might have this too (grin). This article is with a chiropractic focus here too so maybe physicians might have some input from their side too?

One thing is correct though, we do spend a lot of time with our noses stuck in devices:) BD

KCTV5

Looking down at your tablet or smart phone constantly throughout the day, he said, forces a person's head into a forward position, putting stress on muscles, nerves and vertebrae. Doctors say for every inch a person tilts or cranes their head forward, they put an extra 10 pounds of pressure on their neck.

“We're starting to see disc degeneration at a younger age and people with chronic headaches and neck pain who never really had an issue and I think the long-term consequences of this is that people are getting arthritis in their neck at a much younger age,” Rogers said.

http://www.kctv5.com/story/28946249/hfr-tech-neck-your-devices-could-be-creating-serious-medical-problems

Using BitCoin Blockchain Technology, Next Up To Secure Medical Records?

This is interesting and banks are just barely trying to get into this themselves with using the technology in the financial area so waste no time here with the suggestion of using the technology to secure medical records.

So what’s next, a BitCoin wallet to store your medical records? It’s an interesting idea that has yet to unfold so stay tuned as the war to protect privacy continues. BD

Even though the benefits of creating and maintaining electronic medical records of patients has been established (it is found that maintaining records considerably increases the quality of care provided to patients) the exorbitant cost of managing and maintaining the system has put many hospitals off from implementing it.

Blockchain technology, the lifeline of the Bitcoin network has the potential to address the concerns regarding access, security, scalability and privacy of electronic medical records. A centralized platform that decentralizes healthcare data is not too far. Conceptually, patient’s data can be stored on the bitcoin blockchain or similar technology creating a multisig address for each patient’s records. The patient can be provided with a private key and a multisig address for his data. In addition, each healthcare provider using this record keeping system can be assigned a universal signature. Using the same multisig principle used by bitcoin wallets, a patient can choose to grant access to any healthcare provider of his choice by using his signature along with that of the hospital. This way, the patients will have full access to their own data and they can choose the healthcare provider they would like to share it with. It will also save hospitals from the huge costs associated with setting up and maintaining patients’ electronic records.

http://www.newsbtc.com/2015/05/02/blockchain-to-revolutionize-healthcare/

Woman in New Jersey Gets 3 Years in Jail for 500K Of Fraudulent Insurance Claims-Don’t Try This At Home, Health Insurers Only Ones Allowed To Commit Fraud , Not You

I read this story and it’s hardly news worthy and I’m not saying I approve of fraud by any means, but look at the dollar amount? The woman is a registered nurse, so folks wise up, she deal with claims and is on the inside track so if she’s getting caught, well you can think about that one. In other words the point I’m trying to make here is that even insiders in the healthcare business are not smart enough to fool health insurers algorithms that do fraud prevention.

Seriously when you look at what’s in the news, is the media outside of the Center for Public Integrity covering the big $70 Billion Dollar Fraud that insurers automated over 5 years against Medicare and give us updates? Hell no, we have to read about some nurse and 500k of fraud…what does the news media think is news? Open your eyes here folks and see how the professionals use algorithmic formulas to rip Medicare..that’s the big story and much bigger than what Medicare spends on drugs. The two links below will bring you up to date in case you missed it. Kinds of sounds like banks, does it not?

CMS to Rerun the Medicare Advantage Risk Scores–Dating Back to 2008 To Catch the Automated Risk Fiddlers of Said Insurer Fraud Amounting to Around $70 Billion–Be Ready For It…

CMS Discovers That Insurers Offering Medicare Advantage “Really Know How To Sharp Shoot A Model With Adjusting Risk For Profit”, A Common Everyday Occurrence in Financial Markets…

So we have the news that CMS is going to re-run the Medicare Risk Assessment algorithm and keep in mind that Medicare is run by a one time Goldman Sachs banker, Andy Slavitt who was also with Ingenix as their CEO since he originally created the company United bought. For those who may not remember, Ingenix is the subsidiary company of United Healthcare that the AMA sued in a class action lawsuit and settled with for short paying doctors and patients for 15 years on out of network medical bills. It’s interesting when you hear Mr. Slavitt talk about it after all the lawsuits filed over “false positives” and their accusations of algorithms “fraud-fraud” if you will years later.

Today we hear that the anti fraud and out of network Ingenix calculators were just something that was there for years, and they kind of felt bad about it but just never got around to fixing it. How many others today could get away with that explanation? A while back both Humana and United discussed setting some money aside for the rerun if in fact CMS does run it as I don’t remember in the past CMS ever taking such an aggressive move for a money grab. They should get the $70 billion or part of it back as we were ripped as taxpayers, but then again, insurers know when Medicare is backed up against the wall with insurers threatening to cut benefits for the Medicare Part D coverage they get away with it, so “fraud is ok when the risk of cutting care to seniors comes up”, been working that way for a while now with playing their “Ace in the Hole” and think about it, works every time when you hear Congress shifting from cutting Medicare D to giving insurers an increase.

The increase is the “legal” money for taking care of costs which is fine as we know healthcare is going up all the time in costs, but again, should insurers be allow to commit fraud and give themselves a $70 billion dollar raise? I find it interesting to see insurers basically in the same business as Medicare ripping the algos when it comes to wanting more from the government? Just remember insurers have tons of profiles from their Biz Intel software so from the other side of the coin they have to protect their business from fraud, but again don’t play both sides of the street and do the same thing they are trying to control.

So getting back to this woman in New Jersey, three yeas for 500k? Seems like that’s a pretty stiff sentence and yes there’s a sentence to be handed out here as fraud is never good, but like I said, “Don’t Try This At Home” as insurers with their anti fraud algorithm models they have collected over the years know how most of them work and program analytical software to look for those patterns and tendencies with people. Insurers go over the edge and then some to get as much data and information about you as they can “because they can and it’s there”. They have error bars too in their analytics and watching for false positives is yet another concern too with insurers when suspecting fraud, so data leads you where to look but it doesn’t always mean fraud. Humans still have to figure that out. Keep in mind too that all the major insurers run on the S&P 500 index and they are also very active in stock buy backs to enrich their CEOs, so part of what you pay for polices is wrapped up in that too.

Insurance Carrier stock Buy Backs Continue to Rise While Consumers Are Finding It Harder to Afford Some Policies and Care With Dealing With High Deductibles And Narrow Networks…

One more item here worth a read is the software insurers use at their call centers, be aware as you are “scored” here too on your current state on the phone at the time and there’s tons of behavioral analytic companies that want to dig in a research all of this to layer even more scoring here and certainly find a large degree of us a probably half insane or are potential targets to defraud them or Medicare (grin). Insurers are a little over the top with their analytics today and you pay for that too with your policies.

It’s not that this voice analytical software is that great, it does allow for additional scoring and preventing access for you somewhere along the line. You don’t know when you have been scored and how much the insurer made doing it. So this registered nurse with a 3 year sentence, hmmmm…what kind of scores did she get? It’s something to ponder as this is what’s going on out there that further creates more inequality and denies people access today. Read on below about the millions of algorithms that go ripping around insurer call centers and more.

“This Call May Be Recorded for Quality Purposes”..Heck Not, Millions of Algorithms Have Been Turned Loose to Listen To and Analyze Your Voice When You Talk To Your Insurance Company As Algorithms Continue To Take Over the World…

Anyway I just thought this was a rather “stiff” sentence and didn’t really fit the crime in view of what else is going on out there. BD

FREEHOLD —A Middletown woman was sentenced to three years in prison for submitting more than $500,000 in fake health insurance claims.

Donna Dzienisewski, 41, was sentenced to the prison term on Friday after admitting she submitted 107 claims to Horizon Blue Cross-Blue Shield of New Jersey for reimbursement of medical procedures even though she only visited the doctor six times and only incurred slightly more than $2,600 in legitimate medical expenses, acting state Attorney General John Hoffman said.

"More than 100 times, Dzienisewski lied to her insurer so that she could enrich herself with well over $100,000 over a two-year span," Hoffman said in a press release. "The egregious and dishonest nature of her crime has rightfully led to a prison term."

http://www.nj.com/monmouth/index.ssf/2015/05/middletown_woman_sentenced_to_prison_for_500k_heal.html