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

Posted Apr 02 2009 12:53pm

It appears the investigation is going to phase 2, with a request to 20 other insurers to find out how they are using the data base.  Recently the AMA filed a class action suit as well to investigate and find out as well.  These are business intelligence data bases used to crank out the numbers and how the queries and algorithms run, remains to be seen, as we all saw how corrupted data bases run with Wall Street, you can program the servers and SQL statements to deliver the desired results, so this is becoming an investigation to find out “what were the desired results” and how were the major insurance firms using this information to have consumers pay more of the bill, balance billing, in other words. 

The 2 New Hot Words in Healthcare: Algorithms and Whistleblowers

The search for John Doe – Who’s running the queries (Algorithms) and wants to know

Who knows while they are in there, what else might surface.  The Pharmacy Benefit Data Bases, which do not fall under the auspices of HIPAA also contribute to information files as well and have been used by insurance companies as well, so it’s very strange on what gives here.  We are so worried about our genetic information leaking out and not being denied coverage, but what about our medications?  The genomics side is more of a guidance issue, while medications we take are the real time thing. 

The Ingenix Inquisition – Hearing Requested by Senator Rockefeller

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

We need new business models as the cost for research and development, better knows as science and biotech keeps growing, and that i something risk management, nor anyone can manage, but we all want it as there are amazing breakthroughs every week that lead to better healthcare and saving lives and there’s nobody in charge putting any filters on any of it today.  As transparency keeps evolving, there will be more business intelligence practices that may not be considered ethical to appear or be uncovered, and we will have more OMG (on my gosh) stories and facts to deal with, as all that has bee swept under the rug emerges.  It’s now the world awakening to those who have invested heavily and used business intelligence software to gain and create profits, while the rest of us have operated more like a PC with no anti-virus protection, so the malware is here.  BD 

Among health insurance CEOs, Stephen Hemsley of UnitedHealth is known for shying from the limelight and rarely submits to press interviews, let alone cross-examination at a congressional committee hearing. 

image So it was something of a star turn when he testified today before the Senate Commerce Committee over whether UnitedHealth and other insurers have systematically underpaid consumers for out-of-network care. Sen. John D. Rockefeller, the committee’s chairman, is delving into the industry’s controversial payment-setting practices more than two months after New York Attorney General Andrew Cuomo began reaching settlements with the industry’s biggest players over the issue

That didn’t appear to satisfy the committee chairman. Calling the UnitedHealth executives’ testimony “profoundly troubling ,” Rockefeller said he plans to ask government officials to look into how many federal employees may have been shortchanged for out-of-network care over the years. He’s also sending requests to nearly 20 insurers to explain how they used the Ingenix database.

Senator Puts UnitedHealth Execs on Payments Hot Seat - Health Blog - WSJ

Related Reading:

The Ingenix Inquisition – Hearing Requested by Senator Rockefeller

Health Insurance Underwriting procedures – Data Mining to Cherry Pick and some are listed on the Web

The AMA and the California Medical Association file legal suit – WellPoint and Ingenix

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Cigna and Aetna face lawsuit – AMA joining the the cause on payment issues
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