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Is This a Case for a New Law – Illegal Algorithms? How Do You Sleep at Night Rockefeller asked the CEO of United Health Care

Posted Apr 21 2009 11:47pm

The Ingenix Inquisition continues with efforts to find out if federal employees were also potential victims.  We have laws for almost everything else you can think of out there, and algorithms determine about 95% of all business decisions today.  Come to think of it, how about the algorithms that were run by Wall Street?

UnitedHealth Executive testified at the Senate – Rockefeller was not very satisfied

This could also open doors for prosecuting those who write and send out malicious code on the web too.  If an algorithm is image determined to be creating a source of money that is not legal, it could be considered an illegal algorithm.   With the growth of business intelligence today, this could be something to think about, but Congress would need help from the likes of Microsoft and Google to get the wording correct.  This would also lead the way to having some experts in the judicial system as well in this area.  Intellectual property has really not come under any real scrutiny or enforcement areas of the law and yet, formulas or algorithms are created all the time that unfairly cheat or are illegally used for the sake of driving revenue or stealing, which ever the case is.  Patent offices of course are there to check and protect the legitimate software vendors and with open source software problems are not hidden with a huge assortment of users, but it’s some of those “other” items floating around out there that are strictly there for analytical and revenue generating purposes that integrate with other systems that might be in question.  These too were some of the areas both misunderstood or not addressed by the SEC as well with the Madoff case. 

Madoff's Scheme – One Reason To Put the “Smart People” in the Right Places So We Don’t Get Fooled Again

Audit functions would be the tools used to determine if a business algorithm is functioning properly and fair I would guess.  Anyway, just some rambling thoughts here on a couple ideas I had this evening.  The Texas Medical Association and Legislature have begun work on a similar type of penal code as relates to physicians and creating some fraud statutes. 

With the age of transparency on us, all the deep buried algorithms that may have been either somewhat proprietary or hidden are now becoming visible.  This is not a case for every program to be scrutinized, but rather those that are more or less financially based to be legally constructed. 

In this case of the data base being used, from what has been in the press it appears that the formulas used were not accurate and perhaps not legal, in other words the SQL statements that produced the “desired” results. “Desired” results should be within the limit of the law, just as a contract that was illegally written would be scrutinized as well to determine whether or not it was correctly executed and signed.  BD

U.S. Sen. Jay Rockefeller (D, W.Va.) has asked the Inspector General of the Office of Personnel Management to investigate whether federal employees were overcharged for health care because their plans use a database operated by UnitedHealth Group subsidiary Ingenix.

"I am concerned that federal employees participating in the Federal Employees Health Benefits Program may have been charged excessive out-of-pocket costs because of the health plans' use of the Ingenix database products to determine rates for out-of-network services," Rockefeller wrote in a note dated March 31.  Rockefeller wrote that he wants to know, going back 10 years, how many FEHB plans used Ingenix to set rates and how many federal employees were affected.

Rockefeller was unconvinced. "I don't know, frankly, how you sleep at night," he told Slavitt and United President and CEO Stephen Hemsley.

AMNews: April 20, 2009. Senator calls for new look at Ingenix database ... American Medical News

Related Reading:

Texas Joining the Ingenix Inquisition with Introducing Bill for New Penal Codes – Fraud Against Practitioners

The 2 New Hot Words in Healthcare: Algorithms and Whistleblowers

The AMA and the California Medical Association file legal suit – WellPoint and Ingenix
The search for John Doe – Who’s running the queries (Algorithms) and wants to know
The Ingenix Inquisition – Hearing Requested by Senator Rockefeller
Andrew Cuomo – You Have to Like This Guy – Healthcare Reform
Prescriptions risk score used to deny health insurance
Ingenix Publishes Episode Treatment Groups Methodology – Recreating themselves?
Health Care Insurers Suggest Algorithms and Business Intelligence solutions to provide health insurance solution

UnitedHealth, I.B.M. and Arizona physicians Test Medical Home Plan – But No EHR?

Madoff Employee Breaks Silence – The IT Guy Talks about the “Root Kits” of Madoff’s Wall Street

Excessive Incentives and Rules – Where Did the Wisdom Go in HealthCare?
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