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Back in September California regulators were digging around and were looking to fine United Healthcare subsidiary Pacificare $10 billion in fines, based on data found in audits. We all know that getting a judgment and collecting are 2 different issues and some get settled out of court too. In 2008 Pacificare...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Tue, Dec 14 2010
Filed under:
Filed under: Medically Related, Insurance, Other Items of Interest, health insurance, HMO, Orange County, United HealthCare, Contracts, branding, PacifiCare, algorithms fraud, capitation, St. Josephs Hospitals, rebranding, subsidiaryies
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I address this topic here all the time with leaders needing more consumer digital literacy and the same applies for those running for office and I try to stay middle of the road with this blog, but this one just blew me away. The “non participants” in digital literacy today just don’t get it. ...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Fri, Oct 8 2010
Filed under:
Filed under: Insurance, My Commentaries, medicare, Health IT, Congress, Politics, healthcare reform, Non participants, algorithms fraud, GOP, participants, Pledge to America, digital literay
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When you give this some thought, when you send money to those who tend to be lost in the world of how technology and algorithms impact today’s world, they don’t mess with your business. Money going in this direction to the IT illiterate, who have no “Algo Man” to back up and research...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Mon, Oct 4 2010
Filed under:
Filed under: Medically Related, Insurance, My Commentaries, medicare, Health IT, VA, Congress, Social Security, Politics, Veterans Administration, healthcare reform, Non participants, algorithms fraud, GOP, participants, Pledge to America, digital literay
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This is a large number of violations stacked up here by the State, 992,936 with a fine of 10k for each violation. This could stand to be the largest fine in US history against a health insurance company. United Health Group is appealing the process of course. When United took over Pacificare...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Tue, Sep 7 2010
Filed under:
Filed under: Medically Related, Insurance, My Commentaries, health insurance, HMO, Orange County, United HealthCare, Contracts, branding, PacifiCare, algorithms fraud, capitation, St. Josephs Hospitals, rebranding, subsidiaryies
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In the last couple of years this is a big deal for practices in keep current as many are changing plans and a big part of this is due to consumers looking a policies that are less expensive and have higher deductibles to get what they feel they can afford in today’s economic conditions. Aggregating...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Thu, Aug 26 2010
Filed under:
Filed under: Medically Related, Technology, Insurance, states, aggregation, portal, algorithms fraud, exchanges, Aneesh Chopra, Health Insuranc, Medicaid healthcare reform
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I hate to sound like a broken record here but the provisions of what is on this bill are enough to make a CIO commit suicide. Our Governor gets is and is a big user of technology but for those who are not living in the real world today with technology this bill is asking for information that may...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Thu, Aug 26 2010
Filed under:
Filed under: Technology, Other Items of Interest, My Commentaries, EMR, healthcare, medicare, EHR, Claims, California, Fraud, Non Profit, Algorithms, Laws, incentives, Contracts, Schwarzenegger, security breaches, healthcare reform, shareholders, algorithms fraud, infrastruture
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I certainly hope there’s not more of these types of articles to write about but with the focus on profits and dollars today, I kind of have this feeling there will be more coming unfortunately. This is a non profit hospital that has come to blows with contracted insurance rates, something well...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Mon, Aug 23 2010
Filed under:
Filed under: Medically Related, Insurance, Hospital, healthcare, health insurance, Blue Cross, premiums, Contracts, healthcare reform, algorithms fraud, high frequency, Lovelace, New Mexico, Santa Fe
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Private insurers administrate Medicaid as mentioned in the article below and GAO is recommending that CMS audit and be sure the money is not being over paid. It’s time for CMS to begin their own algorithmic formulas and take on those that audit medical claims for payment to consumers. This...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Thu, Aug 5 2010
Filed under:
Filed under: Medically Related, Insurance, healthcare, health insurance, Medicaid, Budgets, CMS, General Accounting Office, algorithms fraud, GAO, managed care model
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How many more new plan offerings can we sift through? As soon as the payment algorithms and business models change, we have new plans and this is a cycle that doesn’t appear to be ending any time soon, so as consumers, even with the help of HHS and the nice website they devised what could be here today...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Mon, Jul 19 2010
Filed under:
Filed under: Medically Related, Insurance, health insurance, HMO, Orange County, United HealthCare, Contracts, branding, PacifiCare, algorithms fraud, capitation, St. Josephs Hospitals, rebranding, subsidiaryies
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Now with the ability of scientists to modify bacteria and other organisms with gene sequencing to advance personalized medicine and cures, George Church and others have recommended governmental control in the area of ethics in particular. If in the hands of the wrong people, such as terrorists...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Fri, Jul 9 2010
Filed under:
Filed under: Medically Related, Pharma/FDA News, Genetics, DNA, healthcare, Obama, Sequencing, White House, George Church, algorithms fraud, Synthetic Genomics, J Craig Venter Institute, synthetic biology
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Now who says medical billing is simple. If it were simple and not a ton of money to be made, we wouldn’t have all these various companies using business intelligence software to help the hospitals and doctors the analysis services and algorithms to get down to the last penny (grin). We are...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Tue, Jun 22 2010
Filed under:
Filed under: Technology, Insurance, medical billing, Claims, Business Intelligence, Emdeon, healthcare reform, providers, payors, algorithms fraud, financies, Chapin
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There’s certainly no shortage of business intelligence software today in healthcare and Thomson Reuters made a recent upgrade with their business intelligence algorithmic formulas. Every which direction we turn today we hear more and more about reporting, which is great, as along as those using...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Wed, Jun 9 2010
Filed under:
Filed under: Medically Related, Technology, Insurance, healthcare, Health IT, Performance, Business Intelligence, software, managment, algorithms fraud, Advantage Suite, Thomson Reuters
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Nobody likes fraud and every time someone is caught is is a plus. From prior posts and articles, this is more than just an effort on running algorithms as the people committing fraud are usually “better billers” as they have one focus only and don’t see patients. The link below contains...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Wed, May 26 2010
Filed under:
Filed under: Medically Related, Insurance, healthcare, health insurance, Blue Cross, Patients, Blue Shield, formulas, Contracts, Ingenix, scoring health claims, algorithms fraud, claim denials
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If you read below, the numbers collected and analyzed show that one out of every 14 claims are initially denied, that’s a pretty large number, when you stop and think that one person with health issues can line up 14 claims pretty quickly. The doctor told the patient that United Healthcare had...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Sat, Feb 6 2010
Filed under:
Filed under: Medically Related, Insurance, healthcare, health insurance, Patients, formulas, Contracts, Ingenix, Trizetto, scoring health claims, algorithms fraud, claim denials
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I posted this last October in 2008 and little did I know how true it would really play out to be as time moved on, those 2 items right there are what seems to make the dollars and profits in healthcare today. The DOJ certainly has been helped with the efforts of whistle blowers and there’s money...