Back in 2009 I made the post below about the “tentacles” out there that relate back to the 15 year time frame where United and most of the large health insurance companies used a data base for normal and customary charges. Here’s one more settlement and there’s more out there. This relates back to Andrew Cuomo finding the algorithms in quoting the out of network fees to be low balled. You take the numbers, average and run some code that produces the magical number and in this case the magic was not really there. I talk a lot about Algo Duping today and here’s one example that began years ago.
United benefitted both ways in paying lesser amounts in claims and then from the other insurers paying to license and use the algorithms. It is what it is. I read recently I hope this is correct that United makes less than half their revenue insuring people and the big money comes from subsidiaries like Optum, they do numbers, analytics and sell data for a big portion of their business. Ingenix aka Optum now has been in the data selling business for a long time and they make millions in profits selling your data.
One More Good Reason to Tax the Data Sellers– Create Additional Funding for the NIH and FDA From Sources That Otherwise Are Too Greedy to Share & Contribute
If you go back 3 years I had this to say about asking the question if the US needs a Department of Algorithms or something along that line to verify and find accuracy and value and I think this suggestion still holds 3 years later as a valid idea. I have written queries until they come out my ears and back when I used to write, accuracy was and is my main focus.
There’s more of these lawsuits floating around out there and as they settle we hear in the news. About a year ago I tried to make it my effort here to help the consumer “recognize” some of the effects of algorithms in business today and started this series called “The Attack of the Killer Algorithms” where I somewhat demonstrate how the algorithms played their roles with “real life human episodes” took place. I’m still going a year later and just added Chapter 48. IT Infrastructure rules the world, government, you name it and try to recognize some of this if you can because there’s billions made in this business. Why do you think Health IT is so expensive. It takes a lot of time to develop them as well, I remember long hours at the keyboard myself and many sleepless nights way back when I was writing.
If you want logic and some hands on experience interpretations on how some of this plays out, then you might like some of my posts, but it is scary and I apologize if I scare anyone but here my theme is logic, accuracy and pursuit of the truth as seen through my eyes and I try to keep the “denial viruses” at bay the best I can. I use material too here from people that also are a lot smarter than me:) BD
Aetna said it will take a $78 million after-tax charge in the current quarter for the settlement, and that the charge will not affect operating earnings .
Patients and doctors accused Aetna of using databases once provided by Ingenix Inc, a unit of UnitedHealth Group Inc ( UNH.N ), to systematically underpay claims involving services and supplies from out-of-network providers.