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. 

“The lawsuit, which the Downey Surgical Clinic and Tarzana Surgery Center are pursuing in federal court on behalf of ASCsimage nationwide, alleges 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. This violates federal health benefits and anti-corruption laws as well as California business codes, say attorneys, and hurts surgical facilities.”

Outpatient Surgery Centers File Class Action Lawsuit Against UnitedHealth and Ingenix for Underpayments

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. 

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. 

"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

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. 

AMA Announced Settlement of Class Action Suit of $350 Million with Ingenix (United Healthcare)
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

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. 

Ingenix Data Base Has Some Long Reaching Legal Tentacles with Aetna, Blue Cross, Blue Shield, Humana

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. 

UnitedHealth Group Announced Re-Branding of Business Units-Focus on “Optum”–Changes Ingenix Name to OptumInsight

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. 

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

In Connecticut a few years ago before the name change, it became so bad with the Ingenix imagesubsidiary demanding information from doctors that the medical society has to take them on. 

Connecticut State Medical Society Demands that United Healthcare/Ingenix Stop The Requests For Patient Records

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. 

Chiropractor Files Class Action Breach of Contract Lawsuit Against Safeco Car Insurance – Use of Ingenix Data Base Claimants Were Paid Less
One Woman’s Battle with Ingenix Who Has Cancer

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.

Ingenix Publishes Episode Treatment Groups Methodology – Recreating themselves?

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. 

United HealthCare Sends Oncology Reports to Doctors – Assessing Cancer Treatment Rules Compiled by Ingenix

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. 

United Health Care Says Cheaper Efficient Doctors and Reducing Hospital Visits by the Elderly Would Help Reduce the Cost of Healthcare
Doctors In Network Leave United Healthcare–Tired of Getting Paid At Rates 12% Less Than Medicare…

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. 

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

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. 

A couple years ago, a little publicized Supreme Court Ruling 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. 

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

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.

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

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.

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

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. 

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
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…

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. 

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. 

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. 

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…

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 

LOS ANGELES--(BUSINESS WIRE)--On behalf of out-of-network California 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.

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.

“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.”


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