Anthem Blue Cross to Pay $6 Million in Fines for Illegally Dropping Policy Holders–Fixing the Policy Dropping Algorithm Pa
Posted Jun 23 2013 3:29pm
Here we go again with looking at automation and as I keep saying there are life impacting decisions made about all of us every day on servers that run 24/7 and our fear of the “context” of such analytics. Apparently in this case here we are needing some additional ‘human” involvement here as we all know how an algorithm can run through, based on the parameters programmed and make major changes..just look at the stock market for yet another example. Only your “Query Master” knows for sure and writes the code used.. Back in 2011, Med Solutions and Blue Cross were caught with the Stress Test Denial Algorithm. See what I mean when I say about half the money spent on analytics will be a waste of investment as more are looking at value instead of a straight math formula for profit that hurts consumers. Med Solutions and Blue Cross got stung on that one with looking at profit versus value.
In this case there was no wrong doing of course (just fix the parameters of the algorithms looking at health costs over $100.000) as we keep seeing. Nobody gets in trouble yet for models and subsequent algorithms that make these decisions. There’s no restitution here or relief for policy holders so the old algorithms were not judged to be illegal. Some day, we need to get to this pint and begin looking at models as that’s how the financial world functions and some models either lie or fabricate risk as well as deploying a higher level of errors today.
This happens everywhere. $6 million seems to be a cheap settlement for a suit that wanted a billion, but again until such cases are proven with looking at models and the math, well this is about as good as it gets for those pursuing cases in this area, so more quants and model sleuths continue to be needed in almost all areas of government, so they know how the other side works and models for profit. A city attorney was the one responsible for the law suit. A PLOS One study though says people sustain physical pain with math so as long as we keep electing and keeping folks in office that are susceptible to such (and Wall Street is not of course) we get settlements like this which are better than nothing, but no big teeth digging to the core and only touching the surface. This is a full on study and the more I read in the news the more faith I am putting in this “real” study by all means:) BD
LOS ANGELES (AP) — The city attorney announced a $6 million settlement Thursday to resolve a lawsuit that alleged health insurer Anthem Blue Cross illegally dropped more than 6,000 policyholders from coverage.
The settlement is far less than the $1 billion in fines and restitution former Los Angeles City Attorney Rocky Delgadillo threatened when the lawsuit was filed in 2008.
At the time, Delgadillo said some of the dropped policies affected elderly patients and patients with health costs that topped $100,000. Anthem denied the allegations then, and is admitting no fault in the settlement now.