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Blue Cross Transaction Fees Go To Court in Michigan-Contracted Administrator Services-Algorithms For “Self Insured” Claims

It seems we are beginning to dig in to those transaction fees that are charged on medical claim processing and it may not be an easy one to understand and get to the bottom on some of these. When a medical claim is processed, it is run through several...

Published Wed, Mar 03 2011 11:31 AM by The Medical Quack

Filed under: Insurance, My Commentaries, health insurance, Health IT, Blue Cross, Algorithms, Michigan, Contracts, healthcare reform, administrators

FDA Grants Genentech (Roche) a Hearing on Avastin ’s Use for Metastatic Breast Cancer

The date for the hearing is a few months off and until that time the drug is still approved as a first line treatment of the HER2 Negative mBC (breast cancer). Genentech filed the request for a formal hearing and the opportunity to present additional...

Published Fri, Feb 02 2011 2:57 AM by The Medical Quack

Filed under: Medically Related, Pharma/FDA News, health insurance, Claims, Cancer, Oncology, Breast Cancer, Roche, healthcare reform, Susan G. Komen, Avastic, FDA. Genentech

Justin Bieber Says US Healthcare System is “Evil” As One of His Employees Got Stuck Having to Pay In the US While Traveling

Sometimes we may wonder how others outside the US look at our broken system and this about sums it up with some real life experience. I’m sure the singer is helping his body guard out if he needs it, but Bieber was apparently making the observation...

Published Wed, Feb 02 2011 1:34 PM by The Medical Quack

Filed under: Medically Related, Insurance, My Commentaries, healthcare, health insurance, Hospitals, Politics, Canada, Music, healthcare reform, medical care, baby, premature babies, Justin Bieber, delivery

CMS Head Dr. Don Berwick Addresses the Ways and Means Committee of the House (Luddites Included)

Here we go again with the impossible quest for the perfect answer and there isn’t one but we seem to have those stuck in the 70s still asking the same types of questions and kind of showing some type of juvenile type responses that I would not expect...

Published Fri, Feb 02 2011 11:51 AM by The Medical Quack

Filed under: Medically Related, Technology, My Commentaries, medicare, Congress, CMS, Politics, Algorithms, Medicare Advantage, healthcare reform, ObamaCare, Non participants, Don Berwick, grilling

Microsoft States More Techies Will be Moved Into Executive Positions–Congress, White House Are you Listening-This is a Good Idea

We all know Microsoft is the king of code and they do a lot of stuff right but right now are losing a bit of ground in the mobility area with consumers and thus the shake up and changing around. Sometimes new ideas are a good thing along with new...

Published Tue, Feb 02 2011 3:16 AM by The Medical Quack

Filed under: Medically Related, Microsoft/Windows News, My Commentaries, microsoft, Medical Records, Health IT, Education, HHS, Government, healthcare reform, role models, engineering, techies

HHS Creates 'Most Wanted' List Website for Healthcare Fraud - Office of the Inspector General

This is pretty hot stuff and is updated as to when the folks on the list get captured. There’s even a place on the site where you can report information about any of those listed on the “Most Wanted List” for healthcare fraud. To report one...

Published Sat, Feb 02 2011 4:26 PM by The Medical Quack

Filed under: Medically Related, Technology, HHS, Fraud, FBI, DOJ, healthcare reform, websites, report, Medicare fraud, Office of the Inspector General, tips, hotline

UnitedHealth Group Sued-Class Action Lawsuit Relative to Purchase of HealthNet in Northeast-Post Auditing With Demands For Providers to Repay Reimbursements

The lawsuit has to do with the provisions of ERISA which is the grounds for the insurance carrier demanding the providers repay what they were given. Here’s a good example of “audit algorithms” and how they are used to get money. The law suit...

Published Fri, Feb 02 2011 12:53 PM by The Medical Quack

Filed under: Medically Related, Insurance, health insurance, Lawsuit, ERISA, Doctors, Algorithms, audit, healthcare reform, HealthNet, payments, revenue, United HealthGroup

Old Geezer Bank Robber is Back - Robs Another Bank–No Oxygen Tank This Time

He’s back again and this all began in October of 2009 with the original post below for details. He was in Santa Barbara this time after having robbed 10 banks in San Diego. He left out the back door and now the FBI is offering a reward of $20k for information...

Published Tue, Feb 02 2011 10:48 PM by The Medical Quack

Filed under: Medically Related, Other Items of Interest, healthcare, Seniors, Economy, Money, healthcare reform, bank robberies, human morals, Senior healthcare, oxygen tank

Florida Judge Rules Against Health Law– Need Some Judicial “Algo Men” to Influence Decisions on Costs With Methodology Entailment and IT Systems Functionality

This is one of the favorite topics here at the Medical Quack if you read here often enough with decisions made and the unintended consequences and more so importantly the cost that nobody can or wants to afford. Of course this is complicated so...

Published Mon, Jan 01 2011 6:36 PM by The Medical Quack

Filed under: Medically Related, Insurance, My Commentaries, health insurance, Politics, Florida, healthcare reform, judge, IT Systems, legal decisions, Algo Men, healthcare repeal, court cares

Hospital Administrator and Primary Care Doctor Negotiating an ACO (Humor-Video)

You have to love this one…Dr. Smith wants to get set up and doesn’t understand..like most of the rest of us. My hospital and I try to save money for the insurance companies, if any is left I will give you some… The lawyers are in charge… the doctor...

Published Fri, Jan 01 2011 12:47 AM by The Medical Quack

Filed under: Need a Laugh, My Commentaries, Hospital, medicare, Budgets, Doctors, Patients, healthcare reform, accountable care organization, ACO

Life Partners Confirms Investigation by SEC-Life Settlements Where Insured Are Living Longer Than the Risk Projections-Investors Paying Long Than They Want

This company is out of Texas and they use a physician from Reno to look over the patient’s records that are available and he makes the predictions on how long the person will live. These are investor groups that are buying up life insurance policies...

Published Thu, Jan 01 2011 4:08 AM by The Medical Quack

Filed under: Medically Related, Insurance, Investors, health insurance, Business Intelligence, Fraud, Wall Street, healthcare reform, life insurance, dead peasant, Human Hedge Funds, Life Partners

NHS-Health Secretary Submits Plan for Patients to Receive Chemotherapy at Local Retail Boots Store as Part of Reorganization

Boots is the equivalent in the UK of retail drug stores here in the US and they already offer additional options that we do not see in our drug store chains, such as dentistry services. This plan would call for patients to go to their nearest Boots...

Published Tue, Jan 01 2011 2:15 PM by The Medical Quack

Filed under: Medically Related, Other Items of Interest, Medicine, UK, Physicians, Cancer, Hospitals, Budgets, NHS, Doctors, nurses, retail drug stores, healthcare reform, Boots

Insurers Made $450 Million with Interest Income by Holding Medicare Funds for Around 46 Days Before Releasing Payment

One more finding from the Office of the Inspector General on how profits are being made and the 2 sides here conflict as far as if this would actually show a savings for Medicare if the time were slimmed down. The irritation I think is more of the...

Published Mon, Jan 01 2011 8:43 PM by The Medical Quack

Filed under: Medically Related, Technology, Insurance, EMR, medicare, EHR, Claims, HHS, CMS, Non Profit, Algorithms, incentives, Wellpoint, Contracts, healthcare reform, Meaningful Use, shareholders, OIG, Office of the Inspector General

U.S. Supreme To Decide if California Can Make Cuts to Medi-Cal Payments to Doctors

Even at current rates, most physicians lose money treating Medi-Cal patients. As a result, it is nearly impossible to find physicians accepting new Medi-Cal patients in certain specialties. Overall the big number is cutting the compensation by 10...

Published Wed, Jan 01 2011 12:08 AM by The Medical Quack

Filed under: Medically Related, Insurance, CMA, California, Medi-Cal, Heatlhcare, Doctors, Patients, Budget, Compensation, healthcare reform, Supreme Court, billing, rates, CARE, Jerry Brown

Blue Shield Not Listening to Insurance Commish in CA-Time for Mr. Jones to Hit Up the CA CIO for Some Auditing Algorithms

Ok, so what’s the reason for this title? The only leg apparently there is to stand on here is to prove that Blue Shield paid less than 70% on healthcare. Guess what you need some audit algorithms and not take them for their word as there might...

Published Fri, Jan 01 2011 5:22 PM by The Medical Quack

Filed under: Insurance, Microsoft/Windows News, My Commentaries, healthcare, health insurance, California, Non Profit, Algorithms, Blue Shield, premiums, audit, healthcare reform, medical care, rates, CIOs

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