Consumer Watchdog Warns Sebelius on Health Insurers – Good Reason for This as Insurer Subsidiaries Are in The Game to Play
Posted Jun 29 2010 4:23pm
Perhaps I have had some readers over here at the Medical Quack as this is one of my areas of focus. Companies don’t just buy subsidiaries as an investment any longer, they become working cores to collaborate and supply services, data , etc. to the other subsidiaries or the parent company or holding company. This is something we all need to wake up to today as it is happening all around us. When you toil around with data and having been a former code writer it’s not too difficult sometimes to project and figure out what direction things are headed. I went a little out on a limb last year just wanting to be sure we had someone at the top level who had some Health IT background as even back then I could see how this was going to turn into a war of data and business intelligence, and guess what, it’s out there as clear as day today.
I meant no disrespect, but common sense tells you that when you have the knowledge and can make the decisions yourself by having some first hand education and experience things move along a little faster as you don’t have to “ask” and wait for “studies”. This works in any business and again in February of 2009 I could see this entire world of “algorithmic formulas” coming to light as it is all tied to money.
Prior to this post back in January of 2009 I made this post and it is also very true today, algorithms and whistle blowers are the two hot trends in healthcare, just read the news today.
When you have some knowledge of how both business and data come together, it helps to create “reasonable” and “attainable” deadline dates as you kind of know how long the data structures that support this stuff is going to take.
Insurance companies have quite a few subsidiaries today and their actions support the over all corporation and you see this on their Wall Street reports, so again they intermingle with all the other subsidiaries. With actions happening under a subsidiary name versus the main company, sometimes it is hard to figure all this out and I try my best here. Maybe this is a dumb question but why does HHS use Ingenix software as a shining star example of community data? Remember these are the same folks (subsidiary of United Healthcare) that under paid everyone for 15 years with the data base that short paid doctors and patients? Do we just give them blind trust and figure they now have “clean” algorithms?
The lawsuits have not stopped and 2 weeks ago another group filed a class action suit for the same thing relating to the outpatient surgery centers getting paid short and this one brings in the 3rd parties they use to audit claims, and could include companies like Trizetto, who is owned by a private equity company in the UK.
While I am at it, how about the Chinese Gateway company bought 2 subsidiaries down, that will help facilitate selling more Chinese drugs/devices here in the US and in other places in the world? Is this one way the insurer is looking to keep costs for healthcare down in the US? Remember all these subsidiaries of big companies exchange data and work together today and there are no lame ducks, Medical Quack included as far as not being lame (grin).
What is also a bit odd is that these same subsidiaries get anti fraud contracts, in other words find fraud with algorithmic software formulas, but maybe they are good at it since they had the rest of us for 15 years with the short pay on the Ingenix data base? For the employers, they offer even more software to analyze.
Why do companies get anti-fraud contracts to prevent fraud like the one below. I truly believe that due to names and subsidiaries and with all the recent acquisitions and mergers, it’s hard to know what barrel your apples are going into, so again this is the company that under paid and now gets an anti fraud contract and there are more, so are we hiring the hacker in so many words and can there be trust now?
The link above is a good summary too of how they sell your medication records for a profit too, along with a couple others. If that isn’t enough, you can read about the pay for performance money they have now set up to pay the pharmacists at Walgreens for signing you up for a wellness program.
Oh and one more item, they own some Wellness companies too so maybe it’s one of these where they feel consumers should be enrolled? The first link is from February of this year.
Other insurers are doing the same and you might want to give some thought to information that is stored in pharmacy benefit manager data bases, there’s no guarantee for privacy here and who knows where and how your data gets sold, a lot of gray. Other insurers are doing the same with wellness too.
Again today it’s a good idea to keep up with who you are doing business with and what are the “working” subsidiaries” under the main umbrella doing? This is how they get their huge advantage at times and people have no clue on where their money is going or how it is used, and on top of that how it may be funding businesses outside the US, when the culture right now is to help the US get back on track.
Once more it is all about those algorithms and we as citizens are running around with swords and daggers while all the above shows the type of “machine gun” technology we are up against. This may be in part of what the Consumer Watchdog is saying be advising Kathleen Sebelius on why not to trust insurance companies. There’s a lot to all of this and this was just a portion of one carrier and their subsidiaries, and there’s a lot more. Blue Cross also has a venture capital division that was started from profits that came from premium payments.
Algorithms give and they take away, working behind the scenes as designed by programmers at the direction of company officials to meet their goals. The so called “bully tactics” are nothing more than “algorithms” they use to toss out to substantiate their decision making processes, and they can be clean or they can be dirty. BD
A consumer group warned in a letter to U.S. Health and Human Services Secretary that health insurers “cannot be trusted” when lobbying over provisions of the new federal law.
Judy Dugan, research director from Consumer Watchdog, went further, saying, “The California rate scandal shows that insurers cannot be trusted with a hand calculator, much less the language of health regulation.”
The group said the MLR is “at serious risk. If insurers get away with bully tactics on this early implementation, the rest of the health reform law will be increasingly difficult to implement in ways that curb costs and protect consumers,” the letter states.
The National Association of Insurance Commissioners () was tasked in the federal reform law with helping Sebelius determine appropriate MLR numbers, an effort it was supposed to complete by June 1. However, the NAIC said its work on MLRs would be delayed until later this summer.
Consumer Watchdog fears the role the NAIC will play.
“The NAIC has detailed knowledge of insurance but it is also closely tied to the insurance industry,” said Dugan. “Its president and board are drawn from state insurance commissioners, who often come from the insurance industry and whose common ‘next job’ is in the executive suites of the insurance industry. It is not a recipe for tough regulation of the industry.”