Excess Scoring of US Consumers, US Citizens-Scored into Oblivion By Proprietary Algorithms and Formulas, Never Duplicated or Tested for Accuracy-Profits of Big Business And A White House Executive Command To Continue the Abuse..

<p>If you read here often enough then you know I address this topic from time to time as companies and people do cheat<img align="right" alt="image" border="0" height="197" src="http://lh3.googleusercontent.com/-xYedW7-NsGY/Vf-Ykm7sk0I/AAAAAAABMiM/505DI8wzOgg/image%25255B15%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="335" /> with their software.  If you watch the markets you see folks like Nanex post charts every day giving out visuals on where the cheating is.  Unfortunately the “honest” folks that are putting out information on where the cheating takes place don’t seem to get enough attention out there.  On markets, look at old Mary Jo White for example.  Anyone who writes code just rolled when we had the Congressional hearings on markets not being rigged.  In case you missed that one, here’s a link from the archives…</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>It just seems the consumers (I’m in here too) are just never going to get any kind of a break.  Excess Scoring is around everywhere and particularly in healthcare to where it’s out of control.  I’m sure like me you read some “goofy” study that is pretty spurious on what is being correlated together and what do you know, next month some company is using it to score you as it’s called a “study”.  If this is going to persist, we need better studies published as companies again determine that they have some form of contextual accuracy when they don’t.</p> <p>In the last couple of days, yet another big blow for consumers with the newest executive order that says “the government knows what’s best for you”, which I tend not to agree with most of the time.  This is really bad as it’s giving data sellers a license to go hog wild.  In the health care area, many get around selling your actual data and will sell one of their proprietary formula scores about you.  This helps them get around HIPAA and it gets used in some risk assessment or resold again.  Here’s the first two paragraphs of the <a href="https://www.whitehouse.gov/the-press-office/2015/09/15/executive-order-using-behavioral-science-insights-better-serve-american"><strong>Obama Executive Order on Behavior Science Insights</strong></a> and it’s certainly more than enough to make your hair stand on end. </p> <p>I have said many times in all the White House meetings on privacy, not once could they mutter the words “data sellers” at all.  White House would always dance around it and followed the same old failed routine of having lawyers write verbiage that any old coder could work right around the interpretation.  It happens the time.  I think also they made up this name: “ behavioral science insights” and I almost expect them to begin calling health insurance a science pretty soon.  Actually a couple years ago I wrote a post to that effect as well.</p> <p><em>“A growing body of evidence demonstrates that behavioral science insights -- research findings from fields such as behavioral <img align="right" alt="image" border="0" height="181" src="http://lh3.googleusercontent.com/-gN2MvXASlnw/Vf-YlV__U5I/AAAAAAABMiQ/2Yx45ARv3y8/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="335" />economics and psychology about how people make decisions and act on them -- can be used to design government policies to better serve the American people.</em></p> <p><em>Where Federal policies have been designed to reflect behavioral science insights, they have substantially improved outcomes for the individuals, families, communities, and businesses those policies serve. For example, automatic enrollment and automatic escalation in retirement savings plans have made it easier to save for the future, and have helped Americans accumulate billions of dollars in additional retirement savings. Similarly, streamlining the application process for Federal financial aid has made college more financially accessible for millions of students.”</em></p> <p>Added to this we all know that United Healthcare has big stakes in Behavioral Health with ownership of many subsidiaries in that business.  Actually the company has a subsidiary just about in the Silicon Valley in California that other companies like Kaiser, who was fined for lack of behavioral health services contracts with for one example.  United through their former Ingenix subsidiary, now called Optum Insights has been pushing this for years with extreme “scoring” of patients and finding risks and reasons to deny payment in some areas.  Right now the company is being sued over some of this.  </p> <h5><a href="http://ducknetweb.blogspot.com/2013/03/class-action-lawsuit-filed-against.html">Class Action Lawsuit Filed Against UnitedHealthGroup and Their Various Subsidiaries There Of Relative to Mental Health Claim Denials & Violation of Parity Laws</a></h5> <p>A few years ago it was Ingenix (who’s CEO was Andy Slavitt who’s currently running Medicare) that brought in this obscure metric system of predicting and scoring people on who they “think” would take their medications.  Keep in mind this is all proprietary and prescription records when not obtained from a HIPAA complaint entity are open game to be “scored” and sold.</p> <h5><a href="http://ducknetweb.blogspot.com/2010/10/express-scripts-new-program-to-contact.html">Express Scripts- New Program to Contact and Predict Patients Who May Not Be Taking Their Medicine Based On Ingenix Algorithms–We Want the Revenue Please Don’t Stop</a></h5> <p>If you move forward with this a few years, you can see today how bad the metrics and data are and if you pay cash, the software pharmacists are required to use for follow up, you get “scored” as an Outlier if there’s not enough data.  In other words, you get one star if the metrics can’t fulfill the query so there you go, flawed scoring.  Again I don’t know what’ wrong with the White House and this case of Stat Rat Fever they have,<img align="right" alt="image" border="0" height="153" src="http://lh3.googleusercontent.com/-r4DiSFryNM0/Vf-Yl8HgQLI/AAAAAAABMiU/ZLUJfKKVkx4/image%25255B11%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="321" /> but this is flat scoring people with metrics that have nothing to do with taking medications.  If you are male, you get a ding, if you have kids at home, another ding as they might distract you.  Again this is the insanity being promoted by the White House.  </p> <h5><a href="http://ducknetweb.blogspot.com/2015/07/patients-who-pay-cash-when-filling.html">Patients Who Pay “Cash” When Filling Prescriptions Are Now Called “Outliers, Pharmacists Required to Fix Outliers as They Show Up As Non Medication Adherence Compliant With 5 Star Systems Full of Flawed Data…</a></h5> <p>There’s a lot of Excess Scoring going on with doctors.  I’ve heard some stories directly on that on how it happens.  The truth of the matter here is that again, doctors are algorithmically scored and dropped from network.  Cost is the item here, not how good the doctor is by all means.  Some doctors have tried to negotiate to be back in networks so they are not having to drop patients, but with United, there’s no discussion, algorithms says you are gone.  Again we come back to Andy Slavitt running CMS as this is what he did with math business models at United Healthcare, he’s an Algo Man and a one time Goldman banker.</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>Seriously I thought when I read the so called “Behavior Sciences Insights” Executive Order, it really sounds like Mr. Slavitt wrote it for the President.  You read enough of old United reports and studies and it sounds just like them.  Here’s another one of his lawsuits just now setting from the Ingenix Algo Days.  </p> <h5><a href="http://ducknetweb.blogspot.com/2015/09/another-united-healthcare-ingenix.html">Another United Healthcare (Ingenix) Lawsuit Settling Over 9 Million-Short Paying Ambulatory Surgery Centers-Current CMS Director and One Time Goldman Sachs Banker, Andy Slavitt was CEO of Ingenix for Years…</a></h5> <p>So our President has give the OK for big business and banks to scrape and sell our data and they get to use the name<img align="right" alt="image" border="0" height="196" src="http://lh3.googleusercontent.com/-cS6dHxWcbH8/Vf-YmvEqa3I/AAAAAAABMig/QECzqDgiGYI/image%25255B16%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="333" /> behavioral science insights.  Behavior belongs in the area of psychiatry or neurology but we have all these amateur data scientists with lots of spurious correlations that will twist and spin their formulas into being in this category.  I have seen apps that come out and use some ancient NIH study and use a dated study that’s no longer relevant as the science for their app and this it totally wrong.  We end up with a huge problem in the use which I call Operation Perception Deception and you know I can’t hardly listen to the White House sit up there and belt out flawed numbers any more and based on all I see on the web, I’m not alone.  We’re not stupid and we just shake our heads.  This is not the first time that the White House dove into the area of what I call “junk science” as I saw in one of their emails on Climate Control, using numbers nobody could predict.  It’s all about context and how much you can be convinced to believe, even when the information is erroneous and flawed.  </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> <p>I fully understand the precision and detail with genomic research and that’s not what this is about, this is rather about address the Junker so called data scientist that creates some spurious correlation with a number crunch and calls it “science” when it’s not.  You read that crap in the news all the time and it’s so rampant that a Harvard Student created a site to exploit it called<strong> </strong><a href="http://ducknetweb.blogspot.com/2014/05/spurious-correlations-per-capita.html"><strong>“The Spurious Correlations Site”</strong></a> where you can make your own and mock the ridiculous number crunch studies that are called science.  I said a couple years ago, time to call foul on Proprietary Predictive Scoring Algorithms that can’t be replicated as it’s killing consumers to have gazillions of “scores” finding something wrong with you or having you at risk at almost every walk of life.  </p> <h5><a href="http://ducknetweb.blogspot.com/2014/08/somebody-needs-to-start-calling-foul-on.html">Somebody Needs to Start Calling “Foul” On Proprietary Predictive Algorithms When They Cannot Be Replicated For Accuracy As This Accelerates Inequality and Promotes Even More Data Selling For Profit</a></h5> <p>Time for a video break as this “game” promotion explains exactly what the new Executive Order from the White House is allowing..Open market on your personal data so they can study and try to predict your every move.  </p> <p><iframe height="315" src="https://www.youtube.com/embed/x2eCAgQ1DTo" frameborder="0" width="560" allowfullscreen="allowfullscreen"></iframe></p> <p>The full post on this is at the link below from a couple of years ago, explaining how this activity keeps inequality growing  at an accelerated pace in the US.  No other country runs as many algorithms and “scores” their consumers abusively like the US does.  It’s all about money, $180 billion<img align="right" height="197" src="http://lh5.ggpht.com/-4dAaL3F8HHA/U6L3-VlNoGI/AAAAAAABKo4/_oLHb_h1n6E/image%25255B3%25255D.png?imgmax=800" style="float: right; display: inline" width="324" /> a year in round figures with selling personal data.  </p> <h5><a href="http://ducknetweb.blogspot.com/2014/06/data-selling-and-direct-correlation-to.html"><strong>Data Selling and the Direct Correlation To Accelerated Inequality - Epidemic Spreading Like A Virus Moving Money Keeping Corporations Cash Rich and Consumers Cash Poor</strong></a></h5> <p><a href="http://www.youcaring.com/other/help-preserve-our-privacy-/258776"><strong>Here’s my somewhat passive campaign</strong></a> to get a law passed to index and license all data sellers as who in the hell are they?  How do you find them when they are reporting flawed data about you when your data has been repackaged?  You don’t and consumers live with flawed profiles they can’t fix and are denied access to something.  <strong>This is what our President thinks is so great it appears.</strong>  </p> <p>This is why we are not “great” any more as consumers are absolutely pounded into the dirt with risk assessments (many of which don’t even apply to them) and other “scores” that are flawed.  What a huge injustice and the really bad thing here is that flawed data gets the same price as good data.  People and companies do cheat with code and math models.  If you read the news today, <a href="http://fortune.com/2015/09/20/vw-winterkorn-apology-emissions/">VW blatantly cheated with their emissions software</a>, folks it’s all cheating code.  You have companies like Nanex that point out cheating code on the stock market every day as well, but does government do anything? No, instead we get this, more abuse with flawed data bought and sold and we don’t even know who’s doing it.  Check this out below with credit cards…see how all your 100-200 line items on everything you charge is sold, MasterCard making gazillions doing this.</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>Here’s where you’ll end up for sale once you have been repackaged and by who, you’ll never know.  </p> <h5><a href="http://ducknetweb.blogspot.com/2015/02/the-data-exchange-buy-and-sell-data-on.html">“The Data Exchange” Buy and Sell Data on Self Service Website, One More Reason to Index and License Data Sellers-This Appears to be Open Game for Selling Repackaged Personal Data-No Privacy At All</a></h5> <p>Our President just flat turned his back on US consumers with this order and again no wonder in the White House why<img align="right" src="http://lh3.googleusercontent.com/-r3DyQ8OXX8U/VWNXE79B4_I/AAAAAAABMUQ/d7p1kWV6goc/image%25255B8%25255D.png?imgmax=800" style="float: right; display: inline" /> they could never come to use the words “Data Sellers” in any of their privacy meetings.  Again don’t be a Dupe of Hazard, be aware that companies do cheat with their computer code for profit and our President thinks this is ok.  </p> <p>How much confidence do you expect a person to have with all this excess scoring?  Everywhere you turn, you have a risk for something, some risks you have never even heard of but some study shows that less than 1% is the risk and next thing you know the “junker data scientists” are modeling around it like it has statistical value when it does not with some really ridiculous correlations.  </p> <p>So the White House appears to be of the philosophy of keep fooling people from what I am reading.  See the image to the left, Mark Twain.  Sadly, Operation Perception-Deception is in full swing today and it starts right at the White House.  I think Congress is too overwhelmed to even react or know what they should react to as well.</p> <p>This President has turned his back on any dignity, privacy, etc. there is to offer to the common citizen.  Is he that naïve or is this a plan to turn us all in to serfs that eventually will become convinced we are that flawed data model that’s being created?  I think people will get mad and take some kind of action before that really happens.  White House is definitely with this Executive Order pretty much just calling all of us the <strong>Dupes of Hazard.</strong>  </p> <h5><a href="http://ducknetweb.blogspot.com/2015/06/operation-perception-deception-into.html">Operation “Perception-Deception” Into Full Swing in the US, With Killer Algorithms, Algo Fairies, Algo Duping, The Grays, and Of Course, Flags As Consumers Confuse Virtual World Values With the Real World…</a></h5> <p>So next week maybe we’ll have more “selfies” from the White House?  That seems to be a great way to keep 5th graders distracted and maybe some adults too.  As soon as those starting rolling out, I knew the administration had crossed over into virtual values and would probably never return to the real world.  </p>

Excess Scoring of US Consumers, US Citizens-Scored into Oblivion By Proprietary Algorithms and Formulas, Never Duplicated or Tested for Accuracy-Profits of Big Business And A White House Executive Command To Continue the Abuse..

If you read here often enough then you know I address this topic from time to time as companies and people do cheat with their software.  I...

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Another United Healthcare (Ingenix) Lawsuit Settling Over 9 Million-Short Paying Ambulatory Surgery Centers-Current CMS Director and One Time Goldman Sachs Banker, Andy Slavitt was CEO of Ingenix for Years…

<p>This settlement was a long time coming and it appears now it’s on the way for over $9 million.  You may or may not remember when this lawsuit was filed against United Healthcare/Ingenix subsidiary six years ago so you can use the link below to read up.  This lawsuit was filed after the big lawsuit was filed against United Healthcare/Ingenix by the AMA which also settled a couple years ago.  Andy Slavitt, a one time Goldman Sachs banker ran Ingenix for years and we had a lot of history on that in the news as well.  </p> <p><em>“The </em><a href="http://www.health-law.com/Downey_AmendedClassAction.pdf"><em>lawsuit</em></a><em>, which the Downey Surgical Clinic and Tarzana Surgery Center are pursuing in federal court on behalf of ASCs<img align="right" alt="image" border="0" height="122" src="http://lh3.googleusercontent.com/-36aOCKLMdhY/VfTGZgRZoOI/AAAAAAABMhw/RPwj1tJ75W0/image%25255B5%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="267" /> nationwide, alleges <strong>that UnitedHealth calculated its usual, customary and reasonable rates for out-of-network claims through the use of in-network or Medicare rates and an arbitrary multiplier, instead of through geographical comparisons and its Ingenix database, as it had reported.</strong> This violates federal health benefits and anti-corruption laws as well as California business codes, say attorneys, and hurts surgical facilities.”</em></p> <h5><a href="http://ducknetweb.blogspot.com/2010/05/outpatient-surgery-centers-file-class.html">Outpatient Surgery Centers File Class Action Lawsuit Against UnitedHealth and Ingenix for Underpayments</a></h5> <p>The banking impact is pretty thick over at HHS and CMS right now with Secretary Burwell running HHS and she was a former director for Bob Rubin, a former Secretary of the Treasury and both a Goldman and Citibank executive.  I keep referring to her leadership as being the equivalent of the “six degrees of Bob Rubin” as about all we hear from her are stories about making numbers and stats and then we get “selfies” with bicycle helmets on for some extra variety.  Burwell of course has brought over folks from both Citi and Wal-Mart, so Stat Rat Fever can live on, but care and cost doesn’t get any better.  The monopoly of United versus other insurers has been a long time effort and area of growth as you can go back a number of years for this story below and see even back then HHS/CMS what giving Ingenix big strokes, while others were suing them.  </p> <p>Is is any wonder that Burwell went the exceptional length to give Andy Slavitt legal and government protections from all these suits?  It makes you wonder how she thinks as well with having such confidence in a former Goldman banker being able to run CMS?  She wants an Algo Man to make her numbers and as I said a while back, HHS/CMS is on the same Stat Rat Fever path of virtual perceptions that has just about killed the VA…numbers come first before lives.  You can see the similarities in the models being created.  By the way, former CMS employees have told me that’s it’s been an understatement for years to ask United Healthcare for help in building their models if they got stuck.  </p> <h5><a href="http://ducknetweb.blogspot.com/2010/06/for-top-program-combines-prototype-from.html"><strong>"Reach for the Top" Program Combines Prototype from Ingenix (A Wholly Owned Subsidiary of United Healthcare) for Public/Private Community Health Data on HHS.Gov Site</strong></a></h5> <p>Here’s the big settlement that was uncovered by then AG Cuomo in New York to where the data base was low balled with low charges to calculate what customary out of network fees would be.  </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> <h5><a href="http://ducknetweb.blogspot.com/2012/02/ama-announces-doctors-and-patients-can.html">AMA Announces Doctors And Patients Can Expect To See the UnitedHealthCare/Ingenix Class Action Settlement Checks In the Mail Soon - Out of Network Short Payments–Attack of the Killer Algorithms Chapter 19</a></h5> <p>In addition other major insurers licensed and use the Ingenix data based, controlled by current CMS director Andy Slavitt, and they too got hit up with lawsuits, lots of them.  They all were using that data base and software to create bigger profit and stuck it to the doctors and patients as well on out of network visit charges.  </p> <h5><a href="http://ducknetweb.blogspot.com/2009/08/ingenix-data-base-has-some-long.html"><strong>Ingenix Data Base Has Some Long Reaching Legal Tentacles with Aetna, Blue Cross, Blue Shield, Humana</strong></a></h5> <p>Even Safeco car insurance with subrogation efforts filed a lawsuit as well against Ingenix.  You can look up Andy Slavitt and Ingenix on the web if you like and see all the connections.  What is also interesting is how cagey United Healthcare was in moving Andy Slavitt from Ingenix as well.  They did a name change, now called “Optum Insights” as every knew the bad law suit connections of Ingenix and moved him over as CEO of QSSI, another United Healthcare subsidiary.   QSSI as we all might remember ended up being somewhat of a hero with insurance exchanges in being able to create them and as a contractor to fix Healthcare.Gov.  </p> <h5><a href="http://ducknetweb.blogspot.com/2011/04/unitedhealth-group-announced-re.html">UnitedHealth Group Announced Re-Branding of Business Units-Focus on “Optum”–Changes Ingenix Name to OptumInsight</a></h5> <p>When you think of it, it is pretty amazing how United worked this relying on the fact that nobody would remember or realize who and what Andy Slavitt was and what he did.  He’s an Algo Man who received early training at Goldman Sachs who learned how to manipulate business models with math and that’s what’s running CMS today on a temporary basis.  </p> <h5><a href="http://ducknetweb.blogspot.com/2010/04/class-action-lawsuit-against-safeco-car.html">Class Action Lawsuit Against Safeco Car Insurance Continues – Alleged Use of Ingenix Payment Algorithms for Shorting Claim Payments With Medical Expenses Related to Car Accidents</a></h5> <p>In Connecticut a few years ago before the name change, it became so bad with the Ingenix <img align="right" alt="image" border="0" height="166" src="http://lh3.googleusercontent.com/-uuzyVSRz_IM/VfTGae8FaFI/AAAAAAABMh4/mSVtCunbYcc/image%25255B9%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="301" />subsidiary demanding information from doctors that the medical society has to take them on.  </p> <h5><a href="http://ducknetweb.blogspot.com/2010/02/connecticut-state-medical-society.html"><strong>Connecticut State Medical Society Demands that United Healthcare/Ingenix Stop The Requests For Patient Records</strong></a></h5> <p>Here’s another example of a class action lawsuit that was filed against Ingenix, using that same data base to pay chiropractors less as well.  In addition, some patients before the Affordable Care Act was passed had to to to battle against Ingenix as well.  It’s those math models and algorithms that calculate the access and the charges.  </p> <h5><a href="http://ducknetweb.blogspot.com/2009/10/chiropractor-files-class-action-breach.html">Chiropractor Files Class Action Breach of Contract Lawsuit Against Safeco Car Insurance – Use of Ingenix Data Base Claimants Were Paid Less</a></h5> <h5><a href="http://ducknetweb.blogspot.com/2009/06/one-womans-battle-with-ingenix-who-has.html">One Woman’s Battle with Ingenix Who Has Cancer</a></h5> <p>We were bombarded with studies and reports from another company called Lewin about saving money in healthcare.  They got to be so obnoxious when they started using the “T” word on how they felt trillions could be saved with healthcare.  Those Lewin reports were everywhere and wouldn’t you know that Lewis is yet another subsidiary of United Healthcare.  Here’s digging back a little bit on an Ingenix model relating to “Episode Treatment Groups”.  That one didn’t work too well in practice as the model wasn’t good. </p> <h5><a href="http://ducknetweb.blogspot.com/2009/03/ingenix-publishes-episode-treatment.html"><strong>Ingenix Publishes Episode Treatment Groups Methodology – Recreating themselves?</strong></a></h5> <p>Under Slavitt’s rule at Ingenix, we had this report sent out telling Oncologists they were not following rules with treating cancer.  Again, the rules were created by Ingenix.  </p> <h5><a href="http://ducknetweb.blogspot.com/2010/02/united-healthcare-sends-oncology.html">United HealthCare Sends Oncology Reports to Doctors – Assessing Cancer Treatment Rules Compiled by Ingenix</a></h5> <p>It even got better (worse) and bolder under the Slavitt CEO regime with stating we needed “cheaper” doctors.  You can read more at the link below.  Reducing hospital visits has not reduced the cost of healthcare, it’s reduced the number of hospital visits.  </p> <h5><a href="http://ducknetweb.blogspot.com/2009/05/united-health-care-says-cheaper.html">United Health Care Says Cheaper Efficient Doctors and Reducing Hospital Visits by the Elderly Would Help Reduce the Cost of Healthcare</a></h5> <h5><a href="http://ducknetweb.blogspot.com/2015/07/doctors-in-network-leave-united.html">Doctors In Network Leave United Healthcare–Tired of Getting Paid At Rates 12% Less Than Medicare…</a></h5> <p>It was less than a year ago that a Blue Cross insurance firm finally quit using the flawed Ingenix data base!  I thought this was pretty wild as most all were pretty anxious to settle or took steps in that direction but this company held on and kept using the “flawed” numbers, to again pay doctors less.  </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>It might also help to note that in many areas and states, doctors are currently getting paid as an average about 12% less than Medicare rates.  You can see where Mr. Slavitt’s direction is headed here at Medicare and it will serve to get worse as more scoring makes it harder for patients to get care.  Now I realize some stats and numbers are needed but the quant mentality now at health insurers is just like it is at the banks except people can get hurt and not get the care they need based on flawed data in flawed algorithms.  </p> <p>A couple years ago, a <strong>little publicized Supreme Court Ruling</strong> gave doctors the ability to group together to litigate with insurers and Oxford, another subsidiary of United Healthcare, fought this for years and years with a lot of money.  When this ruling changed by the Supreme Court, it was no longer required to be one doctor up against an entire insurance company when complains and issues came up.  </p> <h5><a href="http://ducknetweb.blogspot.com/2013/06/us-supreme-court-rules-physicians-can.html">US Supreme Court Rules Physicians Can Work As A Group To Fight Unfair Business Practices of Health Insurers–Victory Over United Healthcare (Oxford Subsidiary)–Context Once Again With Contracts</a></h5> <p>When United starting firing doctors all across the country, this new ruling was used right away by medical organizations to file suit against the insurer and of course we had the secret scoring of doctors using mathematical algorithmic formulas making the decisions.</p> <h5><a href="http://ducknetweb.blogspot.com/2014/08/the-secret-scoring-of-americas.html"><strong>“The Secret Scoring of America’s Physicians” - Algorithmic Math Models For Insurance Network Contractual Exclusions, Relating to MDs Who See Medicare Advantage Patients..</strong></a></h5> <h5><a href="http://ducknetweb.blogspot.com/2015/02/united-healthcare-extending-narrow.html"><strong>United Healthcare Extending Narrow Networks in California–More Secret Scoring of Doctors in the US–Telling The Doctors If They Are “Allowed” To Be In Network…</strong></a></h5> <p>Andy Slavitt and the Algo Man processes of math go back beyond just medical care as well.  You can look at this article below and see how this flawed system of “medication adherence prediction scoring” got started.  This is a dangerous guy with his numbers as he really forgets about the human side of care and look what he did at Express Scripts before he left.  He sold them some Ingenix algorithms to start this flawed scoring game.  The metrics used have little to do with taking medications and focus on your “other behaviors” that they “think” will impact you taking a glass of water and swallowing pills.</p> <h5><a href="http://ducknetweb.blogspot.com/2010/10/express-scripts-new-program-to-contact.html"><strong>Express Scripts- New Program to Contact and Predict Patients Who May Not Be Taking Their Medicine Based On Ingenix Algorithms–We Want the Revenue Please Don’t Stop</strong></a></h5> <p>It gets worse too as Express Scripts has doubled down on this and even “brags” on their website about this flawed model that is proprietary and nobody can re-produce.  This is garbage in any area of psychology as mental health algorithms that are used to “score” people can be unfair, biased, and discriminating.  Check out both of these links and remember the basis for all of this again goes back to the Algo Man Andy Slavitt, former CEO of Ingenix and current temporarily in charge at CMS.  Do you want him running CMS permanently?  He’s there to make Burwell look good in meeting her stats and that’s about it, and maybe help some other subsidiaries of United Health, like the their military subsidiary cash in bigger with Gov.  United has a military subsidiary that focuses on contracts and along with the west coast Tri-Care contract they also have LHI that does Vet evaluations before the Vets get entered into the VA system.  LHI also does big inoculation programs for US troops before they are deployed overseas.  <img align="right" height="153" src="https://encrypted-tbn0.gstatic.com/images?q=tbn:ANd9GcQK0RlHWvimeF8D0WCCjjcjtXPpUcav1Ph--W7JCspiO38Op5WT" style="float: right; display: inline" width="366" /></p> <h5><a href="http://ducknetweb.blogspot.com/2015/06/medication-adherence-predictions-enter.html">Medication Adherence Predictions Enter the World of Quantitated Justifications For Things That Are Just Not True, Members of the Proprietary “Code Hosing” Clubs Out There Destroying Your Privacy</a></h5> <h5><a href="http://ducknetweb.blogspot.com/2015/07/patients-who-pay-cash-when-filling.html">Patients Who Pay “Cash” When Filling Prescriptions Are Now Called “Outliers, Pharmacists Required to Fix Outliers as They Show Up As Non Medication Adherence Compliant With 5 Star Systems Full of Flawed Data…</a></h5> <p>So coming back around here, this is yet one more Ingenix law suit to settle over short paying doctors again.   Keep in mind all these creative Algos at Ingenix (now renamed Optum Insights” were under the realm of Andy Slavitt, who runs CMS now and is that what you want, more of these?  If not tell your Senator to vote NO on his confirmation as our Algo Duped President Obama has nominated him to run CMS and bomb us continuously with more “Stat Rat Fever” so his boss, Secretary Burwell can too meet her numbers.  This is awful and it’s the reality of what’s happening today and what’s been going on for years with manipulating risk to gain profits.  No money’s being saved at all but rather just being shifted around by a bunch of models and algorithms.  </p> <p>So this is yet one more example of Mr. Slavitt’s handiwork as an Algo Man and and cutting pay for MDs seems to be top on his list as well as what patients are covered for.  Don’t be fooled by the new CMS program called Value-Based Insurance Design as you will be “scored” and some of that data sold just to enable you to by pass a copay here and there.  That’s the way it works with quants modeling healthcare, just like they do with banks and stocks.  I often wonder how many quants health insurers have hired from banks and high frequency firms…you know they have and if you can’t get your head around that one, you might end up in the growing group of consumers I call “the dupes of hazard”.  Plain and simple we don’t have access to the technology, math and models being used against us and especially the algorithms with all the excess scoring taking place.  A little at a time, just like in the markets with exchanges, one algorithm is programmed to search out and interact with another one and query a response for something to execute to deny or allow access.  </p> <p>Also of interest is the Optum 360 subsidiary which is a partnership with Dignity Health.  This is a subsidiary that is organized to outsource hospital billing and revenue cycling and pretty much fires current hospital billing folks and brings in contracted help at a lesser pay and worse benefits to take over that portion of the hospital’s business.  Pay attention here as this is what Mayo is doing and yes there’s some data selling profit that goes along with this as well.  </p> <h5><a href="http://ducknetweb.blogspot.com/2015/04/mayo-clinic-is-latest-to-outsource.html">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…</a></h5> <p>Here’s part of the press release below and the link at the bottom will take you to the full release to read.  The nightmares of Ingenix of days past will continue if Andy Slavitt is confirmed as head of CMS, so please tell your Senator to vote NO.  BD  </p> <hr />LOS ANGELES--(<a href="http://www.businesswire.com/">BUSINESS WIRE</a>)--On behalf of<b> </b>out-of-network<b> </b>California<b> </b>Ambulatory Surgery Centers (ASCs), Hooper, Lundy and Bookman, PC, (HLB) is pleased to announce that it today filed a motion for preliminary approval to settle a class action complaint it filed more than six years ago. <p>The parties estimate that there are approximately 250 ASCs that could qualify to participate in the settlement. Assuming that the court preliminarily approves the parties’ settlement, notice of the settlement and further instructions outlining how to participate in the settlement process will be sent to all potential class members.</p> <p>“After a long battle, we believe that we have reached a fair settlement that will adequately compensate the class of surgery centers whose claims were underpaid,” said HLB Attorney Daron Tooch, lead attorney representing the ASCs. “We would particularly like to thank our class representatives, Downey Surgical Clinic and Tarzana Surgery Center, for their patience and persistence in this litigation.”</p> <p><a href="http://www.businesswire.com/news/home/20150910006679/en/Hooper-Lundy-Bookman-Settles-Out-Of-Network-Surgery-Center#.VfRaaFNtfEQ">http://www.businesswire.com/news/home/20150910006679/en/Hooper-Lundy-Bookman-Settles-Out-Of-Network-Surgery-Center#.VfRaaFNtfEQ</a></p>

Another United Healthcare (Ingenix) Lawsuit Settling Over 9 Million-Short Paying Ambulatory Surgery Centers-Current CMS Director and One Time Goldman Sachs Banker, Andy Slavitt was CEO of Ingenix for Years…

This settlement was a long time coming and it appears now it’s on the way for over $9 million.  You may or may not remember when this lawsui...

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Zero days–Security Leaks for Sale (Documentary) Code Wars…Aka Attack of the Killer Algorithms…

<p>Here we go again and another great documentary from the folks at VPRO.  Scroll down to the bottom of this page to watch the Quants of Wall Street as well.  If you are in healthcare, you should have an interest here as insurance companies have hired armies<img align="right" alt="image" border="0" height="151" src="http://lh3.googleusercontent.com/-kOTD1WcbyZI/Ve_BTuuHwwI/AAAAAAABMhU/xUHK40TBp2w/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="300" /> of them and their models are not that far off from what the banks and shadow banking business does.  </p> <h5><a href="http://ducknetweb.blogspot.com/2014/10/data-scientistsquants-in-health.html">Data Scientists/quants in the Health Insurance Business–Modeling Beyond the Speed and Capabilities of Humans To Keep Up With The Affordable Care Act–Turning Into A World of Killer Algorithms That We All Hate..</a></h5> <p>This is great as they use the Norse website, which I have shown to many over the years on how you can see who’s hacking in real time.  Pay a visit if you have not seen it.   They talk about the motivation of “money” so nothing new there.  Hackers can sell the flaw but they may or may not be responsible how the buying party uses it.  So you have a hack that can expose all kinds of information to include credit cards and more…what do they do?  Remember the Anthem security leak?  Read below and see how crooks can repackage and sell that data just like new and legal data.  BD </p> <h5><a href="http://ducknetweb.blogspot.com/2015/02/anthem-data-breachcrooks-want-to-sell.html">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</a></h5> <p> </p> <p><iframe height="315" src="https://www.youtube.com/embed/4BTTiWkdT8Q" frameborder="0" width="560" allowfullscreen="allowfullscreen"></iframe></p>

Zero days–Security Leaks for Sale (Documentary) Code Wars…Aka Attack of the Killer Algorithms…

Here we go again and another great documentary from the folks at VPRO.  Scroll down to the bottom of this page to watch the Quants of Wall S...

Read more »