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As the article states below, 8 of the 13 received letters, so do we now have “cherry picking” starting for mal practice insurance like it exists for health insurance beginning? The 8 doctors specifically deal with high risk deliveries so go figure, here come the risk management assessments? ...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Wed, Mar 2 2011
Filed under:
Filed under: Medically Related, Insurance, healthcare, Doctors, Algorithms, New York, Bronx, malpractice, obgyn, babies, Medical Liability Mutual Insurance
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This is good to see some progress being made. Technology will eventually help recognize some of these patterns too with running reports and queries to look for items that fall outside the normal realms. One example in this article shows one doctor making $6 million on hemorrhoid surgeries...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Fri, Feb 18 2011
Filed under:
Filed under: Medically Related, Insurance, healthcare, medicare, medical billing, Fraud, Doctors, Investigation, FBI, Algorithms, nurses, DOJ, crime
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Patrick Soon-Shiong M.D. is the Los Angeles billionaire investor who has scooped up the company. Overall the product is a good thing as far as the reminder system and keep folks on track. My only concerns is the privacy factors and the data that it creates for sale. In today’s world...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Fri, Feb 4 2011
Filed under:
Filed under: Medically Related, Technology, Insurance, Pharma/FDA News, EMR, drugs, healthcare, EHR, Pharma, PHR, Prescriptions, data bases, Business Intelligence, Fines, personal health record, Algorithms, formulas, Express Scripts, overcharges, Vitality, Cobert Report, nsurance
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Coventry Healthcare found the error and has fixed the algorithm , which is called a “computer glitch” here, but it’s just another algorithm. I am trying my best to educate readers here on the power of those algorithms and how the automated processes control not only the information we receive...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Tue, Jan 25 2011
Filed under:
Filed under: Medically Related, Insurance, healthcare, Medical Records, health insurance, Health IT, Patients, Data, Algorithms, EOB, Coventry, SQL statements, University of Missouri, identification cards
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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 be mistakes and errors. If you read the...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Fri, Jan 14 2011
Filed under:
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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This is a good deal if in fact it is available for use for the government and not outsourced to contractors as when you read the news , they are not making any waves when handling claims for Medicare in finding fraud as fraudulent claims as well as legitimate claims all add up to transaction fees, the...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Thu, Dec 16 2010
Filed under:
Filed under: Medically Related, Technology, Insurance, My Commentaries, EMR, healthcare, medicare, EHR, Claims, Fraud, Non Profit, Algorithms, incentives, Contracts, Ingenix, healthcare reform, shareholders, United Heatlhcare
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Do you wonder where your healthcare dollars go sometimes? Here’s one example of the huge revenues and profits made from the payer side and all attained with those algorithms for business intelligence primarily. The company offers centralized finance, information systems, claims processing...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Thu, Dec 16 2010
Filed under:
Filed under: Medically Related, Insurance, healthcare, health insurance, Wall Street, Algorithms, Profits, dividends, behavioral health, Centene
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Earlier this year the state had to reverse a cutback as the new healthcare reform disallowed states to reduce their eligibility and now basically it looks like they are looking for relief somewhere along the line here to reduce it in another fashion. We are probably all aware of the Medicaid transplant...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Fri, Dec 10 2010
Filed under:
Filed under: Medically Related, Insurance, My Commentaries, healthcare, health insurance, Medicaid, Budgets, Transplants, Algorithms, Cost, Arizona, dummies, Health IT illiteracy, Governor Brewer
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The average layman is normally not aware of all the processes and transaction charges that are coupled with processing a medical claim. This is a huge profit area with algorithmic formulas that are sold to companies in the business of processing claims in healthcare. As we all have read,...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Wed, Dec 8 2010
Filed under:
Filed under: Medically Related, Technology, Insurance, My Commentaries, healthcare, health insurance, EHR, HHS, Algorithms, Mergers and Acquisitions, Ingenix, transactions, UnitedHealthGroup, Executive Heatlh Resources
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Here’s the daisy chain subsidiary watch here with Optum Health, a division of United buying IPS Worldwide. With all the acquisitions and mergers going on today it gets to be a challenge to try and keep up on who’s buying who, and more importantly who’s combining and potentially analyzing data for...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Mon, Nov 22 2010
Filed under:
Filed under: Medically Related, Insurance, healthcare, health insurance, Budgets, Australia, Data, Algorithms, United HealthCare, OptumHealth, behavioral underwriting, Asia, PPC Worldwide, IPS Worldwide
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We have huge groups of “non participants” in Washington that sit in denial with Health IT and so many, the likes of Bill Gates and even Steven Colbert have tried to reach though but it’s like talking to rocks resting on a stack of 8 track tapes and there’s plenty of those in both parties. They...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Wed, Nov 17 2010
Filed under:
Filed under: Medically Related, Insurance, healthcare, health insurance, CMS, NHS, Government, Politics, Senate, Algorithms, role models, GOP, Berwick, Finance, Algo man
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The good doctor has hardly been in office long enough to make a dent yet, but hopefully the Senate Finance Committee will be open ears rather than continuing to venture on what we have seen in the news with the “witch-hunt” tactics that have been reported. I really get spooked and fearful as to...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Thu, Nov 11 2010
Filed under:
Filed under: Medically Related, Insurance, My Commentaries, healthcare, health insurance, CMS, NHS, Government, Politics, Senate, Algorithms, role models, GOP, Berwick, Finance, Algo man
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Here’s a screenshot below from a prior post that gives one a Wellpoint email address if your have “Congressional concerns” and I don’t know about you, but if I had issues I think I would send my issues direct to Congress as a citizen, right? Again, I come back to the same statement I have made...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Fri, Oct 29 2010
Filed under:
Filed under: Medically Related, Technology, Insurance, EMR, healthcare, medicare, EHR, Claims, Fraud, Non Profit, Algorithms, incentives, Wellpoint, Contracts, Ingenix, healthcare reform, Grassley, shareholders, United Heatlhcare
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We are all working to make as much data as possible public but sometimes until we are ready for prime time it may not be in our best interests to display data that is riddled with errors until audits are done and a certain amount of credibility can be shown. I have been reading along a bit with...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Tue, Oct 26 2010
Filed under:
Filed under: Medically Related, Technology, Insurance, My Commentaries, EMR, healthcare, medicare, EHR, Physicians, Claims, Fraud, Medical Claims, Non Profit, Algorithms, Contracts, Ingenix, healthcare reform, shareholders, United Heatlhcare
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Profits increased 23% as membership gained and the lack of patients going for care added to a lesser payout of benefits. The actual profit was $1.28 Billion. The company also has many subsidiaries that contributed to the bottom line and this y ear United has been on shopping spree too. ...
Posted to
The Medical Quack .... by Barbara Duck
by
The Medical Quack
on
Wed, Oct 20 2010
Filed under:
Filed under: Medically Related, Insurance, healthcare, Claims, Algorithms, Laws, United HealthCare, audits, legislation, bills, medical care, New Jersy