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Saturday, June 29, 2013

FTC “Reclaim Your Name Campaign” Not Good Enough–No Path for Regulation Identified–All Data Sellers Including Banks, Insurers, Etc. Should Be Required to Buy a License

If you have read here often enough then you have probably stumbled on to one of my post about privacy and the data sellers.  Certainly the FTC isimage addressing the data brokers here and again they are relying on trust.  Right now the credit agencies run some queries and “allow” you to see what they “allow” you to see so when someone else such as a bank or any other type of entity doing a credit check, they get a lot more than what you see.  Ok so we ask the data brokers to do the same, trust them…can’t trust credit agencies due to all the flawed data out there.  Flawed data is rising due to all the data selling taking place, a bit root cause.

As you can see there’s no root to regulate any of this other than just a couple data brokers saying “we will now let you see what we have”…probably due to folks threatening lawsuits somewhere along the line, as it’s flawed so much of the time.  When you take non credible data and combine it with credible data, the chance for flaws grows tremendously.  I read the FTC keynote speech here and there’s a lot left to be desired.  The proposed laws have no teeth and no room for any kind of regulation so we have a bunch of words called a law that technologists will quickly model to use data methodologies to skid on the legal words and still get and sell their data:)

The FTC didn’t mention the huge profits made and Barclays Bank just stated they were going to start selling their client data.  Sure it’s de-identified, but don’t hold your breath there as Quants and data scientists can rematch data pretty quickly these days and I used to do it when writing software to verify query results for my own use to ensure my software was working correctly, methodologies been around for a long time.  It depends on the “Query Master” if you ask me.  I just love to see companies like Walgreens on the SEC statement making around a billion dollars a year selling data, not. 

Privacy Wanted–So Let’s Require Those Who Sell Web Data to Register and Tax the Transactions and Publicly Disclose Who They Sell To With a Federal Registry

Then we have these folks, the e-scoring folks who will never let you see what they sell about you, and now we are talking credit data and not de-identified information. 

E-Scoring Credit Algorithms Invisible To Consumers Used to Market and Evaluate, Does Not Fall Under Federal Law And Such Are Used by Insurance Companies - How Will This Work With Exchanges –Attack of the Killer Algorithms Chapter 42

Again the data is getting more flawed by the sale as the agency buying the information has a few data bases they query it with and gee in a few days we have new analytics or predictive analytics out there for all to spend and buy.

So what happens when big data says your name is not machine complaint?  Happened to me as Google thought I was a real duck, machine has not learned enough yet:)  Yes I laughed at this one since it was only social networking and the guys over MIT got big kick out of it too but really you have a big conglomerate telling me that the name I have used for 58 years is not “machine compliant”..think about it and take a look at the Attack of the Killer Algorithm series to where these are every day events where the data gets it wrong or the model lied to make profits.  I also had my car insurer’s machine learning add a second driver to my policy, the folks who bought the house I sold, and it was months later, so see how mining gets it wrong too.  I’m just one person, have 2 incidents already so imagine how wide spread this is?  I also know how data bases and queries work as well and the levels of error factors. 

“I’m Sorry Your Google Plus Name Does Not Comply With Google “Names Policies”…Barbara “Duck Algorithm” & Was Using My Real Name All Along…Killer Algorithms Chapter 52

Now let’s get into the facial recognition…the newest tool out there for data sellers…link to 60 Minute report below on this, even the creator is worried about it’s misuse.  The answer is for step one folks to require ALL data sellers to buy a license, just like a stock broker does or a doctor or a real estate sales agent.  States have been having issues too with licensing data broker bots as their servers slow down to a crawl and you and I can’t get in so they put governor software software on the servers to limit the bots, that’s how busy and infiltrated this all is. 

Licensing and Excise Taxing Data Sellers, Facial Recognition Yet One More Tool Used To Secure & Match Data - The Epidemic, Billions in Profits for Banks and US Corporations Using Killer Algorithms to Further Erode Consumer Privacy

How about all these insurance companies buying your Master Card and Vista charge and debit records…the justification from Blue Cross will pretty funny actually when they said they were seeing if their insured were buying a size larger clothes..so there you go, the query masters at work and once they have the data what else do they query it with…only the query master knows for sure..and then they sell it in one form or another. 

Insurance Companies Are Buying Up Consumer Spending Data-Time is Here to License and Tax the Data Sellers-As Insurers Sell Tons of Data, Gets Flawed Data When Data Buyers Uses Out of Context Too

This is a good tweet and I agree and have used it a lot stating proprietary algorithms have become the unspoken law and they have with digital illiterate or digitally bliss government departments sadly.

Ok so moving forward we have this “big” announcement that one of the data brokers is going to allow you to see what they have about you…they are not doing this to be nice…let’s move forward and a couple more do the same…well guess what…now let’s get a dashboard of many brokers and who’s going to profit and make money doing that platform…software builds on itself.  It will end up just as complex as insurance exchanges with some data broker getting a federal contract in the name of transparency to do it. 

See is this how data folks think where the average consumer can’t see down the road with the mechanics and money making portions of all of this.  Oh gosh and gee to provide this for consumers the FTC will be asking Congress for grants to support this and help educate consumers on how to use it…not hard to visualize the direction this could go:)  If Congress says no, as they probably would not understanding all of the mechanics, then do we have the FTC asking for private industry to help toss in some money, like HHS did with the exchanges for insurance? 

Platforms can be very good and useful but they can also be money makers to create more markets for more software that ends up being useless and the results taken out of context.  Video at the link below shows NASA and others in a forum discussion about “what are we doing with big data” and is one of the few that brings in the Quants and data scientists and their work.  Pull a rabbit out of the hat as they try non linear methodologies at times. 

Big Data/Analytics If Used Out of Context and Without True Values Stand To Be A Huge Discriminatory Practice Against Consumers–More Honest Data Scientists Needed to Formulate Accuracy/Value To Keep Algo Duping For Profit Out of the Game

Then we have our consumer protection chief desperately trying to figure out how consumers interact with financial transactions and his answer is to build a data base…pretty funny and yet sad as we don’t have time for Richard Cordray to learn all of this, put a technologist in his place and back that person with legal help.  We have it totally backwards now and he’s treading water without some IT infrastructure knowledge. happens all the time any more and then we have these huge unintended consequences as private industry models around the government bliss and sticks them behind the 8 ball every time and that’s where I see him sitting today sadly. 

Richard Cordray, Fail With Understanding Flawed Models and Algorithms -Big Case of“Algo Duping”With Big Data-Save Time, Hire Quants Who Know How Consumer Financial Models Are Built and Function…Geez

After all the big conglomerates have made billions selling your data and you find errors, well guess who’s ticket it’s on to fix it, your dime and there’s no accountability.  60 Minutes got that right too as consumers have had to hire attorneys, etc. to fight a lot of this, again once your data is sold, it’s strict overhead to offer customer service to fix it and again the video will show you what you get, not much as they made their money and there’s no interest in spending non profitable time and efforts to fix it.  They are on to the next sale. 

Again if the US government is every going to get serious about privacy they should update themselves with the times and start a system where we can identify and track who all the data sellers are, what they are selling and reselling and to who.  As I have mentioned on many occasions an excise tax on the billions in profits made could easily go to help fund the consumer agencies of the NIH and FDA, two of the most important government agencies we need.   

Time Has Come to License and Tax the Data Sellers of the Web, Companies, Banks, Social Networks..Any One Making a Profit-Latest Microsoft/Google Privacy War Helping the Cause –Consumers Deserve to Know What Is Being Sold and To Who in a Searchable Format

In summary with both privacy and accountability, this falls far short of what is really needed with any teeth for sure and again it is so sad that it appears that technologists are not fully consulted with some of this as you get people like me poking holes in it all over the place.  Certainly there’s nothing going to be perfect but license and taxing gives an avenue to regulation, what is needed as I’m tired of seeing the government that is supposed to help protect consumers spending much of their time behind the 8 ball.  Hire some quants and see what goes on with the other side instead of just trusting what you hear. 

The Algo Duping page videos will help educate and you understand where I am coming from in mostly layman’s terms and the videos are worth watching as they are done by people smarter than me but also offer the truth and logic without the OMG emotional distractions, it is what it is.  Sounds like some of the folks have been sucked in with some Algo Duping and unless you look at some other angles anyone can be sucked in believing fictions numbers and models.  I have been trying the “free” version of a privacy monitoring service called Safe Shepherd and they do run algorithms and see what is reported on you but we have a bait and switch here too as they want me to “pay” around $14 a month to have the service remove what they find, so they get you coming and going as a consumer, more money here and more money there…

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Numbers don’t lie but people do.  Licensing and excise taxing along with a federal look up site with a simplified format on what kind of data is sold and who they sell it to would go a long ways, much more efficient and create a revenue stream than going the platform route to complicate it even more for consumers who are already getting ripped with flawed data and it’s getting worse.  Violations, then we have potential fines or loss of a license at stake, much better for regulation than what I read in this claim your data idea. The tax for the profiteers could use a sale tax model, every quarter and who knows we might capture some of that tax money that goes outside the country under a model like this too.  BD 

Big Data, Flawed Data, Business Intelligence, Where’s The Future and What Has Been Our Past…A World With ”Algo Duping” of Society and Consumers

One industry under the microscope is data brokerages. These are business-to-business companies that collect thousands of details — like the shopping habits, vacation preferences, estimated income, ethnicity, hobbies, predilections for gambling or smoking and health concerns — about millions of consumers, the better to help marketers identify potential new customers as well as maintain their already loyal clients.

Although some of these companies do permit people to opt out of their marketing databases, most do not have systems to allow consumers to see records held about them and correct possible errors. Because of this lack of transparency, federal regulators and privacy advocates have long warned about the potential for such data-mining to discriminate against consumers based on sensitive details like financial or health information

http://bits.blogs.nytimes.com/2013/06/26/reclaim-your-name/

Friday, June 28, 2013

FDA Approves 1st Non Hormone Drug for Hot Flashes–Low Dose Paroxetine Used for Depression

The FDA panel voted against the drug and it is unusual for the FDA to approve a drug that does not get panel approval.  Was it due to the fact that there imagewas no non hormonal drug out there for hot flashes?  It supposedly met the goals in clinical trials but those who voted against it said it was only minimally effective.  Does it do better than natural black cohosh is the question that comes to mind.  So I guess if one is on Paxil that has the same active ingredient, you could be getting a double bang for the buck?  We do know that hormones work but they also have their inherent cancer dangers as well.  If you want to learn more about hot flashes scroll down and check out “Hot Flash Havoc” and you will learn a lot.  It costs a few dollars to view but worth it.  I did an interview with the producer a couple years ago. BD


The first nonhormonal drug to treat hot flashes won approval from the Food and Drug Administration on Friday, offering a new alternative to menopausal women.

The move was surprising because an advisory committee to the F.D.A. voted 10 to 4 in March against approval.

The treatment, which will be called Brisdelle, was developed by Noven Pharmaceuticals and consists of a low dose of paroxetine, which is used at higher doses in the antidepressant Paxil.

While the F.D.A. does not have to follow the recommendations of its advisory panels, it is highly unusual for it to approve a drug that receives a strong negative vote. Committee members who voted against it said while there was a need for a nonhormonal therapy, Noven’s candidate was only minimally effective.

The agency did not explain why it went against the panel’s recommendation, saying only that it viewed Brisdelle as a useful treatment that had met its goals in clinical trials.

http://www.nytimes.com/2013/06/29/business/fda-approves-a-drug-for-hot-flashes.html

ACO “Pioneers” in CMS Program May Leave or Opt for Other Programs–Those With Fewer Penalty Algorithms Looking More Appealing And Require Less Software Purchases & Training

When ACOs first came out, really nobody quite knew what they were and the structure but all knew they should join one as all were about saving money with good care.  Now we have some folks either wanting to jump ship or move into another program with fewer penalties and no incentives, kind of takes the pressure off.  You really can’t blame them as the business models of insurers almost change by the hour and contract and compensation are hard to nail down.  Also too the Supreme Court made a big announcement whereby doctors can now work as groups with litigating billing or contractual agreements.  It doesn’t have to be the big corporation against one doctor any more as what had been in most contracts.  Also, ask any patient what an ACO is…see what answer you get.

US Supreme Court Rules Physicians Can Work As A Group To Fight Unfair Business Practices of Health Insurers–Victory Over United Healthcare (Oxford Subsidiary)–Context Once Again With Contracts

It costs money to be in the ACO game as well and software investments that are expensive are right in there, so some may be looking at additional expenses there in addition to what they already have to care for patients.  I don’t know if this means anything or not but back in April of 2011 I wondered if the incentives were going to be eaten up with software expenses (link below)…and if that’s the case then “get me out of here” (grin).  Some of such software is sold by subsidiaries of health insurance companies anyway so if that’s the case on some of the expense, then no use in double dipping insurers for additional profits I think is the way most doctors would look at it. You may have a tough time though figuring it out as the SEC has some rules issues that don’t allow for tiered subsidiaries to all be listed, called the vanishing subs and why I continue with my “subsidiary watch” posts to help connect some dots.  The link above is actually a real good story that helps explain how a United Healthcare subsidiary slipped in to get the Federal Hub data contract.

Will Healthcare ACO Incentives Be Consumed by Software and Vendor Expenses When It’s All Said and Done?

It was just back in December of 2012, last year that CMS (link below) was looking for yet another vendor to verify qualifications for the new insurance exchanges so I guess that United Healthcare subsidiary didn’t have enough code writing algorithms  together after all and now we have yet one more contract. 

CMS Needs Vendor With Sufficient Algorithmic Processes to Provide Consumer Data for New Insurance Exchanges To Verify Qualifications & Check Your Wages And Other Information Desired

Just before the recent Medicare website update, CMS and the Inspector General were politely duking it out over data on that website.

CMS and Inspector General Duking It Out Over Government Website Data That Helps Consumers Find Health Plans- Just Wait Until the Exchanges Get Going And We Find Those Shortcomings…

Ok so let’s come back to the ACO, we probably have a better idea of what they are now since time has gone by but models and math are all over the place and granted hospitals and doctors are overall putting their best foot forward but until CMS and Medicare gets this impossible inventive issue out of their head and remove some of the complexities, white flags will be showing up all over the place because it’s not worth it with time, money, buying more software and CMS can’t possible create a “fair” incentive system to serve all.  It just is what it is.  Certainly there are some things that can be modeled and evaluated but not with the complex care system we have out there today.  It’s all about context and with that statement watch the video below and see how models and math are created and applied.  See if there’s some Algo Duping going on with way too much dependence on some of the studies and numbers you read.  (If you want to see more scroll down to the footer where I have this video and a few others that help educate on models, math and algorithms.)

I like good data and how it makes me smarter but we have this “building” thing going on here with putting layer after layer after layer of algorithms and analytics on top of each other and it’s going to blow as we might need a better model and eliminate some of the expense.  Half of all analytics purchased will be a waste of investment and that goes for healthcare too.  Let’s get the good half with fewer layers going here and make it easier for doctors and hospitals to tend to their clinical care.  If all of this isn’t bad enough well buy some more software in the form of reinsurance for your expensive ACO.  I wonder if anyone “really” bit on this one?  Gosh knows what the claim process would be to collect (grin)….as one would have to meet all the parameters of their algorithms to collect. 

Worried If your ACO Is Going to Be Too Costly? HCP Offering Accountable Care Reinsurance–Once You Figure Out What Your ACO Model Is…

Data Platforms were supposed to simplify things and make it easier to create meaningful analytics and software but what we are seeing is a lot of the reverse, a bigger market to sell software and analytics and project management has vanished by the way side in a lot of this.  Yes, so if the software and analytics required to participate in an ACO cost too much and requires extensive training,  sure there will be folks dropping out looking for a better way that doesn’t soak them in expenses to potentially not get fined and earn some small incentive payment.  If you watch the video above, you will understand what I am saying completely.  BD


Medicare's most ambitious test of accountable care could lose a substantial number of its participants after the first year.
As many as nine of 32 Pioneer accountable care organizations—the name given to Medicare's first and highest-risk test of the payment model—may exit the program, according to the CMS, and at least four have started to notify providers. At least four of the departing ACOs tentatively say they will join Medicare's lower-risk ACO alternative, the Shared Savings Program, the CMS said.
Pioneers must decide by July 31.

By contrast, ACOs in Medicare's Shared Savings Program may choose an option with no potential for financial penalties for the first three years. The program is larger, with 220 ACOs, and is expected to expand again next year.
Whether all Pioneer ACOs would continue with the initiative has been in doubt since February, when providers challenged proposed benchmarks for quality performance in the second year. CMS agreed to revise the benchmarks, but negotiations between Pioneers and the CMS continued and talks were not limited to the quality debate.

By contrast, ACOs in Medicare's Shared Savings Program may choose an option with no potential for financial penalties for the first three years. The program is larger, with 220 ACOs, and is expected to expand again next year.

http://www.modernhealthcare.com/article/20130628/NEWS/306289944?AllowView=VW8xUmo5Q21TcWJOb1gzb0tNN3RLZ0h0MWg5SVgra3NZRzROR3l0WWRMWGJVdjhKRWxiNUtpQzMyWmV0NVhRWUpiaWw=&utm_source=link-20130628-NEWS-306289944&utm_medium=email&utm_campaign=mp-alert

GE Looking to Shed Consumer CareCredit Healthcare Financing Unit

The targeted consumer here are those who do not have adequate insurance to offer a credit card for short term financing. image The article states it will consider an IPO for GE Capital and I am assuming there could be other divisions rolled in here besides just this one when it all comes out.  This company as a stand alone with relying on consumer financing might be one investors may want to dig in deeper to take a look at.  This brings me to a recent post about SEC Tiered subsidiaries as we are not seeing the big picture any longer with many companies and I don’t know if this is the case with GE but so many are not listing subsidiaries anymore with the SEC, so hard to see the whole picture and I am really beginning to wonder with complexities today what impact this is going to have not only with clients but investors as well.  How much is all this consumer debt worth I guess is the big question, 2 billion?  BD

SEC Rules Ask for Disclosure Only When Subsidiary Operations Are “Significant”-Was The Federal Hub Contract Awarded to QSSI Not Significant When the Company Was Bought By United Health Group?–Subsidiary Watch

NEW YORK (Reuters) - General Electric Co is looking to sell its CareCredit healthcare financing business - a unit within its massive GE Capital financial arm - in a deal that may be valued at about $2 billion, people familiar with the situation told Reuters on Friday.

GE has hired Goldman Sachs Group Inc to oversee the sale process and has attracted buyout interest from a few banks as well as at least one nonbank financial services firm, according to the four sources, who wished to remain anonymous because they are not permitted to speak to the media.

In May, GE CEO Jeff Immelt said the company is considering spinning off parts of GE Capital through an initial public offering as part of its plan to reduce the size of its business. The U.S. conglomerate is seeking to shrink its financial services division from $419 billion in December to $300 billion to $350 billion by end of 2014.

http://ca.news.yahoo.com/exclusive-ge-looking-sell-healthcare-financing-unit-sources-164342420.html

Kaiser Permanente Hit With $4 Million Fine and Cease and Desist For Practices in Violation of State Law Related To Mental Health Care

This is a substantial fine, second only to the $10 millions Blue Cross received a few years ago and Kaiser said they would challenge the dollar amount.  They also said there were changes currently being made to imageprovide better mental health care.  Some of the issues addressed were not seeing patients in a timely manner and not telling patients that long term psychiatric care is not available.  In the article one doctor is quotes as saying that he feels Kaiser has not taken mental illness care as seriously as they have physical illness.  BD


Imposing the second-largest fine in its history, the California Department of Managed Health Care on Tuesday slapped Kaiser health plans with a $4 million penalty for failing to provide mental health treatment in a timely manner.

The department also issued a cease and desist order to Kaiser, forbidding the health plan from continuing practices in violation of state law, which ensures equal care for mental and physical health.

An investigation that started in 2012 found that Kaiser's written description of its mental health services was so complicated and misleading that it "could dissuade an enrollee from pursuing medically necessary care."

Three months ago, the department released a detailed report saying Kaiser needed to see mental health patients more quickly and improve its public disclosures or face penalties.

Managed Health Care officials said advising patients that long-term psychotherapy is unavailable violates the state's mental health parity law. The law says that mental illness must be treated on par with physical illnesses.

Dr. Andris Skuja, a Kaiser psychologist, offered strong words in reaction to the news of the $4 million fine and cease-and-desist order.

"This action confirms what every Kaiser clinician knows," Skuja said. "Kaiser doesn't take mental health care for its patients seriously."

http://www.modbee.com/2013/06/26/2779972/kaiser-mental-health-care-lacking.html

FDA Shuts Down over 1600 Web Sites Selling Counterfeit and SubStandard Drugs

From reading this article, if the website says they are Canadian, there’s imagea good chance they may not be located there, but rather in China, India, Turkey or other countries.  This is a good time to take a look at the 60 minute report and how much money the counterfeit drug companies make.  See how Pfizer has people employed to help catch them. 

Counterfeit Drug Factories Outside the US-60 Minutes Reports (Video)-Solution With Bar Codes for Pharma, FDA, DEA, Medical Devices

Every pharmaceutical company will take pills back and test them for you according to the video.  We all might remember the fake Avastin drugs that made it’s way to the US and the heparin a few years back.  This might be an omen to starting bringing some drug manufacturing back to the US.  BD

Counterfeit Avastin Cancer Drugs Found in the US–Where’s the Bar Codes to Help Identify Authenticity–We Need This!


At some locations, FDA and customs agents use handheld scanners with ultraviolet and infrared radiation to detect suspicious packaging and ingredients. Confirmation of whether a product contains fake ingredients must be done in a laboratory. The scanners are in use at a handful of locations that handle a large volume of imports such as the Los Angeles International Airport.

The FDA said it has shut down 1,677 sites for selling counterfeit or substandard medication, or for selling drugs without appropriate safeguards. Other sites received regulatory warnings. Officials said they also arrested 58 people and seized more than $41 million worth of illegal medicines.

Several sites had sleek interfaces and names that could easily be confused with legitimate pharmacy retailers. For example, the FDA shuttered Walgreens-Store.com; the well-known drugstore chain's website is actually Walgreens.com.

The most common scams advertised popular drugs such as Viagra, Levitra, Celebrex and Avandaryl. The recent crackdown, labeled Pangea VI, involved the cooperation of more than 100 countries, according to Interpol

"The fact of the matter is very few, if any, of these sites are actually based in Canada or (are) Canadian," Catizone said. "In fact, they are located in China, India, Pakistan, around the world."

The National Association of Boards of Pharmacy's website features a list of approved online pharmacies as well as those to avoid.

http://us.cnn.com/2013/06/27/health/online-pharmacies-closed/index.html?sr=sharebar_twitter

Thursday, June 27, 2013

“Redneck Killer Algorithms”, Evidence Backing Digital Illiteracy Connection With Abortions Bills Continues to Grow - Texas Legislature Attempting Manual Altering of Automated Time Stamps To Change Law

UPDATE:  It was a technology issue on the data stamp that made the change as was explained on Wednesday but nobody could answer on the floor as why this occurred.  An algorithm entered a default date as it was called, but again nobody there having a quick response and with the status of the use of technology and data today, everyone speculates:)


This is certainly more proof with this type of action of not understanding automated technology and how it works.  It is actually funny and sad at the same time when you think of this is the mentality of some lawmakers today, to try to cheat.  It’s all documented and again I keep saying that “abortions” are the default fall back topic of those who are not adequately digital literate and this kind of proves it when you have a live broadcast with folks that are digital literate watching for some kind of altering of real time events.  I would call this a  case of “Redneck Killer Algorithms” as they tried to alter a process that was handled by a process smarter than they are.  

War on Women In US Continues in Texas, Digital Illiteracy With Lawmakers the Contributing Factor For the Insanity With Continued Legislative “Carnival” Session Called During NBA Playoff Game…

It’s bad enough to attempt this and much less when the whole world is watching and someone is going to catch it and they did!  No wonder Algo Duping survives with political lobbying issues.  I do wonder who was the non literate “brain child” that thought this would fly?  It makes all of them appear to look like a bunch of old angry men on a mission to “control something”.

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Anyway I first made note of this phenomena two years ago with where the focus was with all of this.  In my personal opinion, I have never seen so many lawmakers that detest and avoid education with technology and I guess more proof as such not to mention embarrassment of exposure like this is needed?  Have we not seen enough?  This is a big duh!  You might say the Texas legislature was attacked by their own Killer Algorithms they tried to institute.

Digital Illiteracy Still Plagues Law Makers–Severe Focus on Abortion Rights Proves It–Is This Where Our Lawmaking Knowledge Leaves Off or Even Begins? Scary…

In Washington too, they could use some help and it’s time once more to plug the Sunlight Foundation and their cause to restore the Office of Technology Assessment to help and educate those making laws, and hopefully eliminate further showings such as this one that occurred in Texas, aka “Redneck Killer Algorithms”.  I’m not the only one out there watching by any means, and a public exposure of such is pretty scary and who knows what legal ramifications may come out of this but again this is the OMG abortion group at their best and if this is the best, I shudder to see what the worst is.  Visit the Algo Duping page for some real educational videos from some people who are a lot smarter than me to read up on how math, modeling, (modeling for inequality) and steroid marketing is shaping and attacking those who are not informed and see how easy it can be to get sucked in to models and reports that lie and are generated for profit only.  BD

Congress Needs a Bigger Brain–Restore the Office of Technology Assessment And Truly Assess What is Useful And Remove The Algo Duping Permeating In Government–Fantasy Perceptions That Are Not Real Can Be A Dangerous Thing

In a desperate effort to pass a controversial bill that would shutter abortion clinics in Texas, a slew of Twitter sleuths, including Circa's Anthony De Rosa and former Reuters social media editor Matthew Keys, discovered that the state legislature altered official state documents to show that the vote was passed before the midnight deadline.

In actuality, the Texas state senate did not pass the bill, SB 5, in time—thanks to defeaning cheers from the gallery from supporters of State Senator Wendy Davis, who spent more than 10 hours filibustering a vote.

"Over 170,000 of us watched the Texas GOP [on YouTube] *Break the Senate rules*, and mainstream media is ignoring that fact," writer Wil Wheaton tweeted.

http://www.dailydot.com/politics/texas-senate-alter-timestamp-sb5/

Wednesday, June 26, 2013

SEC Rules Ask for Disclosure Only When Subsidiary Operations Are “Significant”-Was The Federal Hub Contract Awarded to QSSI Not Significant When the Company Was Bought By United Health Group?–Subsidiary Watch

I think we need a new meaning to the word “significant” as it may not be significant today but it could be tomorrow.  There are others besides Untied Healthcare doing this as mentioned in the title like Google.  But I have read on the web about many others asking why all the secrecy with the Federal Exchange Data Hub?  There was also the scuttlebutt about how the contract was awarded and how 2 weeks later it was bought by the United Group conglomeration. 

I have said this many times that the daisy chains of subsidiaries is important as the dollar value may not be there to qualify as a “significant operation” but the data does.  I read articles to where HHS reported this to the SEC after the presidential election and others to where United said they were not required to report the purchase to the SEC and it looks like they were right under the current explanation of “significant operations”.  As I look at this having the contract to develop the Federal Data Hub that all state exchanges will connect with, as well as the IRS, Social Security, Immigration and more is a “significant operation” especially when the Inspector General is all over them for having the same issues that Booz Allen had in the news with USB drive security.  A contract is awarded and 2 weeks later the company, QSSI is sold to United. 

QSSI, Subsidiary of United Healthcare Building Federal Data Hub Gets Busted by the Inspector General Regarding USB Security And Compliance With Federal Requirements

I was reading another great blog, mathbabe and Cathy was good enough to point out this article about the SEC rules and what is also important here along with not knowing the tools that are working under the hood is the fact that this issue also is the crux of what allows companies to stash money overseas and avoid taxes.  Cathy made a very good point on who being the winner as far as trying to stay off the radar, it’s not individuals, it’s corporations, the very companies that create some of the data to catch everyone they can who’s on the radar:)   So what does the NSA do about that?  Not much it appears if they are collecting and analyzing all the data they say they do on foreign interests. 

So again here at the Quack being insurance companies have turned into such huge conglomerates that are involved in all kinds of businessesimage by owning subsidiaries, I try to keep that up front so you know which big conglomerate profits at the bottom line when you do business with one of their subsidiaries. 

This has evolved into more than just a shell game and especially when it comes to data.  A few years ago I read an article where a bunch of VCs said of their portfolio companies that they were going to query and manage data from different industries (meaning the companies they manage) and really come up with some powerful business intelligence and then the by product that comes along here too with data or so called analytics to sell.  Don’t get me completely wrong as there’s good stuff out there too but if you follow the money you can kind of figure the direction of where the next big money making queries will be written.  We don’t k know if big conglomerates are sharing and querying data to have an edge for one example over a competitor or to write a shabby mocked up non linear report to justify something they want to do to make money that nobody checks. 

Ok so back to QSSI, not “significant operations” as the SEC rules stand now?  Their project may not have the money impact but it sure has the data and security impact to be significant.    imageRules need to change for more reasons than one as I for one would like to be able to look at an SEC filing and see all the subsidiaries and their “daisy chains” of companies (aka tiered subsidiaries) owned by the subsidiary as well as what’s directly a subsidiary of the parent company.  I think investors would like to see this too.  You may never see the “sub of a sub” on some listings.  Sure, investors may ask more questions as they should as to what’s being done with their money and what’s the board doing? 

Bottom line here is the lack of transparency as either as a policy holder or as an investor there should be a listing with the SEC that shows every subsidiary and the subsidiaries of their subsidiaries.  We are getting less and less information about what corporations do today and especially less of what they are doing with their data. 

The secrecy of the Federal Data Hub being built by a health insurance subsidiary sounds like a good place to start, again as others all over the web are asking the same questions, why all the secrecy.  BD


The vanishing subsidiaries don't stem from asset sales or corporate restructuring. Companies across industries say they are taking advantage of Securities and Exchange Commission rules that demand disclosure only when subsidiary operations are "significant."

One result of the change is that the companies limit information about offshore operations, in particular units operating in countries regarded as tax havens.

For many investors, even small disclosures matter. Information about a company's subsidiaries provides a gauge of whether its operations have grown or shrunk, how complex the company may be and how it may be generating or shifting income around the globe. The lists of subsidiaries are the most easily accessible and reliable source for such information and are often used as a starting point for researchers studying how a company has structured itself to minimize its tax burden.

In its 2009 annual report, Google reported more than 100 subsidiaries, including 81 overseas in places like Bermuda, Hong Kong and the Netherlands Antilles. Over the past three years, the number dropped to two units—both based in Ireland. A Google spokesperson said the company is in compliance with SEC rules regarding the disclosure of subsidiaries

http://ducknetweb.blogspot.com/2013/06/qssi-subsidiary-of-united-healthcare.html

FDA Approves Two New Cigarette Brands

This was a bit of news to me but as the article states the FDA has the final approval process to make sure there’s no new products on the market that could cause any additional health concerns.  They have imagearound 4000 applications for products that claim to be equivalent to other products already on the market.  Some companies have been waiting for over 2 years for an approval. 

As I read this we are talking about products introduced between 2007 and 2011 to be ok and sold pending a review by the FDA, so I would guess any product that was on the market prior to 2007 is grandfathered in essence.  500 new products have been submitted since 2011 and they can’t be sold until they have FDA approval.  I guess this is a good thing and perhaps with all the new products, etc. that appear today maybe this is a good idea to make sure something odd doesn’t get out there for consumers so now all the ingredients appear to be verified.   BD


The Food and Drug Administration on Tuesday began using one of the key powers Congress gave it under the landmark 2009 tobacco-control law: Final say over which new tobacco products can be marketed and sold to consumers.

The Family Smoking Prevention and Tobacco Control Act gave the FDA broad authority to regulate everything from cigarettes to smokeless tobacco. Before its passage, companies could introduce new products without the blessing of any federal regulator.

The FDA said it had approved applications for two types of non-menthol cigarettes made by Lorillard after determining that the cigarettes, while slightly different than previous products, wouldn’t pose new public health worries.

“This is an historic step forward,” said Mitch Zeller, director of the FDA’s Center for Tobacco Products. “Today is the first day that a regulatory agency anywhere in the world has made a science-based determination, on a pre-market basis, that a product either can or cannot be marketed.”

http://www.washingtonpost.com/national/health-science/fda-approves-two-new-cigarette-brands/2013/06/25/24f45308-ddc4-11e2-948c-d644453cf169_story.html

WellPoint Initiates New Employer Health Cost Tool With Capping Services–3rd Party Castlight To See Additional Revenues as They Will Train The Insured On How To Use the Their Software

Yes indeed things are becoming  more complex with insurance and in this case WellPoint is capping what they will pay on some services and procedures. Again this is a data creation windfall for Castlight, the 3rd party consultant who  creates the models and algorithms that will be used by employeesimage to search and find the providers who are within the range of the caps.  If employees do not learn how to use the software then phone service will be provided.  More and more in order to save money it is dependent on the use of software. The new insurance exchanges are the same with millions in grants being put out to fund “navigators’, which again is basically learning how to use the software and how filters work to make a selection for health insurance

Of course a simpler answer would be to have the same caps on all services everywhere in the US and not as many insurance plans to choose from but that would put some of the third party consultants out of business who do well with both hospitals and insurance companies to design software and consulting solutions so the middle man cut seems it’s here to stay as complexities continue to grow.  It’s an education process in order to have and use health insurance.  Sometimes though today as business models are changed so frequently, the minute you have one website or software service down pat, it’s time to learn another one.  We see that all the time. 

Folks at the top of all this, like lawmakers don’t have to worry about learning software though as they have a staff that does what they need so they remain kind of bliss and non participating for the most part which leaves them without the hands on experience the rest of us get.  There will always be bumps in the road to see if this works and basically how far it can be extended I think.  Hips and knees seems to do well but when it is done on a bigger basis remains to be seen. 

Doctor Wins 3.8 Million Dollar Law Suit Against Anthem Blue Cross In California–He Was Turned Away for Challenging Denial of Patient Claims

The “quality” information provided is just that, data and some of this is good but price is going to be the big call here.  All providers, imaging services, labs are not created equal and that’s been the entire issue with coming up with some kind of ranking service and the current rating/information sites are losing viewers anyway as most sites imageare there just to promote some kind of advertising anymore and the files are dated.  If you read here often enough you know that story.  Yes indeed it would be a lot nicer to have one set of numbers to work with instead of having to shop doctors, labs and imaging centers.  It’s a royal pain and of course you are always on your own dime doing so.  So here we go, more money for the middle companies and consumers need to learn more software techniques to filter and shop from the employer provided insurance side. 

One last thought…does software and 3rd party training expenses fall under the MLR as being part of a claims process?  Thought just kicked through my head after writing this post.  So if consumers don’t learn how to use the software to find those who are within the capped price, they might be paying more for every dollar that exceeds the amount will be out of their pocket.    Blue Cross is also buying up your Visa and Master Card purchase records, as they say they are mining to see if you are buying clothes that are a size larger.  I guess with these records and if you use a debit or credit card they will also be able to see what you pay above and beyond the capped amounts too?  Only the query masters know for sure.  BD

Insurance Companies Are Buying Up Consumer Spending Data-Time is Here to License and Tax the Data Sellers-As Insurers Sell Tons of Data, Gets Flawed Data When Data Buyers Uses Out of Context Too


As companies seek ways to curb health-care spending, insurer WellPoint Inc. WLP +0.40% is rolling out a program that lets employers pay only a set amount for a medical service, asking workers who select costlier care to pay the difference.

The idea has been tested for years by a limited number of large employers. But the new option from the second-biggest U.S. insurer, which will be available for coverage that kicks off next January, will be offered broadly to any client with at least 100 employees.

The new approach "encourages a member or employee to shop and become a smarter health-care consumer," said Ken Goulet, chief executive of WellPoint's commercial business unit, who said the company has seen "strong interest" from employers.

WellPoint said its program can include more than 900 different services. The vast majority are routine things like lab tests, but the list also includes some more complex procedures like hip and knee replacements and bariatric surgeries.

Cigna Corp. CI +0.99% said it has been piloting the approach with a big client since 2011, but has seen mixed results, and is considering whether to launch more pilots. The Cigna test found that employees ended up paying around $600 on average out of their pockets for imaging scans, signaling that they may not have been shopping around as the program intended. "We do not want to roll out solutions that will be riddled with consumer gotchas," said Wendy Sherry, vice president for product development at Cigna.

WellPoint is working with Castlight Health Inc., which has an online tool that gives pricing and other information about health-care providers. The companies will offer Web and printed materials and a call-in line for employees, and Castlight will send people to employers' work locations to train workers on how to use the service. WellPoint and Castlight said workers would get quality information about providers drawn from multiple sources.

http://online.wsj.com/article/SB10001424127887323998604578567982013011300.html

Specialty Medical Supply Founder Held Hostage in Chinese Factory By His Own Employees Over Compensation Disputes

The company, Specialty Medical is located in Florida and was in the process of shifting some of the manufacturing from China to India. image The employees at the China factory claim they have not been paid, blocked the doors and have locked him in until they can negotiate.  This happened last Friday and he’s been barricaded since then.  The Chinese government is pretty much hands off and it’s not unusual in the country for employees to take this into their own hands.  Gee could this catch on over here (grin)?

Lancets and insulin syringes are manufactured at the plant.  30 employees from the injection molding division were laid off at the plant and given severance packages and the remainder of the employees want the same when their jobs go.  Chip Starnes is the founder and president of the company.  He can move throughout the factory and you can see the folks filming all of this with cameras in the videos so it’s very peaceful and no violence at all.  It’s not unusual for companies to flee China and not pay employees so this could be left over fears too from some past employee experiences.  The plant in China outside of Beijing has been in operation for around 10 years.  Some workers have been making a lot of noise to deprive him of sleep but he’s been fed and food is not a problem. 

Officers so far with the government are siding with the workers.  There was little the US embassy could do as well.  You do kind of wonder why a portion of the business was being moved to India, perhaps to save money?  If we see more activities as such the US might not look so bad as far as reinvesting in the US labor market.  BD 

BEIJING — An American business executive being held hostage by employees at his medical supply plant on the outskirts of the capital spent a fifth day on Tuesday in a surreal standoff that has highlighted the dearth of legal protections in China for foreign investors and workers.

The dispute, which has drawn a throng of police officers, Chinese reporters and American diplomats to the factory, began when the company, which is based in Coral Springs, Fla., closed its injection molding division and gave roughly 30 employees what Mr. Starnes described in a telephone interview on Tuesday night as a generous severance package.

The division, which manufactured medical goods like lancets and insulin syringes, is being moved to India. But rumors soon spread that Mr. Starnes was planning to close the entire plant and flee without paying the rest of the workers, which happens often in China.

Although he explained that the remaining workers were not being laid off, about 100 employees barricaded the exits on Friday and stopped him from leaving until he agreed to give them compensation identical to that given to the laid-off employees, a sum he contends would bankrupt the company.

In February, a factory owner in south China’s Guangxi Autonomous Region was kidnapped from a hotel by two contractors who claimed that he owed them $618,000. A month earlier, a migrant worker in Shandong Province stabbed the relatives of a construction contractor, killing the man’s 5-year-old nephew, over what news reports said was a $245 debt. In December, 14 women died in a fire at a bra factory in Guangzhou, which the police determined had been set by a worker upset over $490 in unpaid wages.

http://www.nytimes.com/2013/06/26/world/asia/standoff-drags-on-for-us-businessman-held-hostage-by-employees-in-china.html

SEC Files Lawsuit Against Imaging3 Inc.–Accusing CEO and Founder of False Statements About FDA Approval Process

If you read the third paragraph here it sounds like the FDA was not satisfied with the device overheating and stated the images were uselessimage in 2010.  If you visit the website the company filed for Chapter 11 in May of this year.  The SEC is looking for financial penalties and wants to bar the CEO from serving an an officer of a public company. The product in question was a 3-D dimensional scanner.  Perhaps if they work on the technology it could at some point be perfected but the SEC due to the false FDA statements does not feel like it should be under the leadership of the current CEO.  BD


The Securities and Exchange Commission accused a Burbank medical imaging device company and its chief executive of fraud for allegedly misleading investors about the Food and Drug Administration’s views of one of its products.

In a lawsuit filed Tuesday in federal court in Los Angeles, the SEC said Imaging3 Inc. and its founder and chief executive, Dean Janes, made false statements about the company’s chances of gaining FDA approval of a three-dimensional scanner used in medical diagnosis.

After the FDA denied approval of the device in 2010, Janes told investors that the FDA’s issues were “not substantive” and largely “administrative,” the SEC said. Janes failed to mention that in an October 2010 letter, the FDA said the device had a potential for overheating and that sample images appeared “scientifically invalid and useless.”

http://www.latimes.com/business/money/la-fi-mo-sec-accuses-burbank-company-of-misleading-investors-20130626,0,1459304.story

Tuesday, June 25, 2013

Blackstone is Not The Only Corporation Involved in Housing-UnitedHealth Group New Mexico Investment Wants A Rent Check –Subsidiary Watch

I wrote about this a couple years ago when the project was announced and as you can read from the article they have a partner named imageEnterprise Community Investment and the two worked together on this to build and provide medium to to income housing, rentals.  We see Blackstone in a much bigger way buying up vacant homes in Arizona and Nevada.  Housing market is not back for the middle class, it’s the investors with cash.  So when you end up filing bankruptcy as your health insurance doesn't cover what you need, well United Health Group wants to be there to help collect some rent after you lose your home.  I don’t know if this is an ALEC deal or not but United is listed as a big player in the group. 

United Healthcare Gets in The Low Income Housing Business With Partnership to Finance Housing Projects in New Mexico

From the Enterprise website, what investors like United can expect: (tax credits) and projects in 20 States and Washington DC.

“As a leading syndicator of LIHTC equity, Enterprise is committed to guiding investments in affordable housing and serving the interests of investors, developers and residents.

Enterprise raised $673.5 million in LIHTC equity and invested $753.3 million  for the creation or rehabilitation of 5,410 affordable homes”

In addition United has their own Optum Bank and this is from a post from a couple years ago so how much beyond a billion is on deposit I don’t know.

UnitedHealth Group Owns a Bank With Deposits Surpassing a Billion – OptumHealth Bank FDIC Insured

From the website:

“OptumHealth Bank, Member FDIC, is dedicated to health care banking. It is a leading administrator of health savings accounts (HSAs) for individuals and families, with more than 500,000 accounts. OptumHealth Bank also offers credit programs to individual account holders to help them pay for out-of-pocket medical expenses.

Hmmmm…$22 million could pay a ton of medical claims.  No word yet on whether or not United will be participating in the New Mexico health insurance exchange as they are one of the states who opted to build their own but so far in what I have covered on the web, I have not seen them listed yet but there’s more information to come.  Here’s another related insurance story that has links to SEC subsidiary listings…it’s a big of a daisy chain as United has subsidiaries of subsidiaries so I don’t know if all there there entirely. 

United has done well shifting focus from HHS to contracts with the DOD, and even suing them to get one of the contracts with Tri-Care imageso their focus for income appears to be focused heavily on both employer and especially government contracts as are a few others, but none are as large as United.  As of a couple weeks ago, New Mexico was still looking to find  someone to hire as an Insurance Regulator , and as of next month, insurance regulation will no longer be part of the Public Regulation Commission so looks like a bit of open game with a lot of unknowns with the insurance side.  In the meantime United is one more investor interested in collecting consumer rent checks. 

One more reminder let’s not forget that United subsidiary QSSI is the government contractor building our new Federal Data hub connecting to state exchanges, Social Security, Immigration, and more.  In normal format, it’s secretive and everyone on the web can’t find anything about it.  Wonder what kind of security clearance they have from NSA to build this with all the access they have and need to create the project?  They just got busted by CMS on the same problem Booz Allen had with Snowden with USB drives…security…hmmmm…BD


Community leaders and project partners are celebrating the official grand opening of two rental housing developments in Santa Fe and Las Cruces this week.

The new residential communities, along with an additional housing development in Deming, were made possible by a $22 million investment by UnitedHealth Group (UNH) through a partnership with Enterprise Community Investment, Inc. (Enterprise). The collaboration brought together one of the nation’s top health and well-being companies and one of the nation’s leading advocates for affordable housing to provide critical equity to build the developments through Low Income Housing Tax Credits (LIHTC).

The three New Mexico projects – Stage Coach Apartments in Santa Fe, Robledo Ridge Apartments in Las Cruces and Mountain View Apartments in Deming – are creating an additional 179 affordable-housing units. Each provides housing opportunities and onsite social services for low-income families, seniors, and people with special needs and who are at risk of becoming homeless. The developments also created nearly 300 construction and permanent jobs in the state.

http://finance.yahoo.com/news/22-million-unitedhealth-group-investment-190000905.html

Monday, June 24, 2013

When You Have ALEC, Who Needs Lobbyists…Teaching State Law Makers How To Cash in on Models for Profit With Private Industry…Update from Bill Moyer

With ALEC you can change the world without ever having to go to Washington, find out what this is all about if you have not seen this before. image This is a quote from the video and there’s a big focus on Wisconsin here and their influence in the state and with Scott Walker.  The Koch brothers were the largest investors behind his campaign. 

This is the secret “wine and dine” lobby bill if you will.  The governors of Arizona and Wisconsin are big ALEC members.  Watch the video and see how all of this works.  You can find big representation from the NRA here.  Many companies in the last couple of years have left their memberships in ALEC.  ALEC continues to find new friends.  Arizona introduced an ALEC accountability bill.  This is also how many insurers have gained power at state levels.  This is all done in secrecy.  With all the recent NSA controversy I think ALEC controversies will continue to arise. 

ALEC still calls for privatizing Medicare.  Wendell Potter is referenced here to his shock at the information and politics being used and he was on the other side for years and had no idea how deep this is.  United Healthcare has a big presence with ALEC and guess what, their subsidiary company, QSSI is build the new federal data hub that will connect at first insurance exchanges to the IRS, Immigration, Social Security and more.  Two weeks after HHS awards the contract Untied buys the company, ALEC related?  Now almost all the big commercial insurers are not even going to participate in the state health insurance exchanges, planned? 

States Slowly Getting Insurance Exchanges Set Up as Federal Exchange Hub Built By United Health Group Subsidiary. QSSI Still Remains a Mystery

And they seem to have the same USB drive problem that Booz Allen is having relative to NSA matters with Snowden and his access as a system administrator.

QSSI, Subsidiary of United Healthcare Building Federal Data Hub Gets Busted by the Inspector General Regarding USB Security And Compliance With Federal Requirements

On a side note here it was in the news that Nancy Pelosi was “booed” at her speech when she mentioned Snowden and I like her, but hence imageshe did not know her audience in San Jose of very high intellectual people who build technologies, some like what gets sold to the government and of course they were offended as the technologists don’t get the credit a lot of times for their intelligence and what they know and how they created models and algorithms that control money.  ALEC as you can see by watching the Bill Moyer video is right in there, teaching modeling for profit and the feds end up once again on the short end of the stick and it comes down to money and digital illiteracy. 

Sorry Nancy, but next time assess the crowd you are addressing and the high level of intelligence that functions beyond the walls of Congress and that message can go to all of them both parties.  Time to wake up.  Do yourselves a favor and get educated and restore the Office of Technology Assessment so you are better informed on how technology is shaping the world and how Algo Duping with models that lie or are not accurate fleece all of us.  Corporations model and model and model and ALEC appears to be right in there and again nobody is asking any questions as to the validity or accuracy of such.  BD 

Here’s some additional links on ALEC….

http://www.sourcewatch.org/index.php/ALEC_Corporations

http://www.alecexposed.org/wiki/ALEC_Exposed

 

A national consortium of state politicians and powerful corporations, ALEC — the American Legislative Exchange Council — presents itself as a “nonpartisan public-private partnership”. But behind that mantra lies a vast network of corporate lobbying and political action aimed to increase corporate profits at public expense without public knowledge.image

In state houses around the country, hundreds of pieces of boilerplate ALEC legislation are proposed or enacted that would, among other things, dilute collective bargaining rights, make it harder for some Americans to vote, and limit corporate liability for harm caused to consumers — each accomplished without the public ever knowing who’s behind it. Using interviews, documents, and field reporting, the episode explores ALEC’s self-serving machine at work, acting in a way one Wisconsin politician describes as “a corporate dating service for lonely legislators and corporate special interests.”

http://billmoyers.com/episode/full-show-united-states-of-alec-a-follow-up/

Tenet Healthcare Buys Vanguard Health for $1.8 Billion Cash and Assumes $2.5 Billion in Debt

Not too long ago, Community Health was trying to take over Tenet and that didn’t work and they were pretty aggressive and ended up giving up their efforts.  It was hot news for a while and ended up with Tenet filing a lawsuit against Community stating they were inflating hospital admissions in 2011.

Community Health Offers $3.3 Billion With A Non Solicited Bid for Tenet Healthcare
Tenet Tells Community Health Thanks But No Thanks in Response to Their Submission of 10 Nominees for Tenet’s Board of Directors

Now Tenet is in the drivers seat per se with buying Vanguard Health Systems.  They are assuming twice the amount of debt than what is indicated in the purchase amount.   Tenet themselves lost money in the first quarter of this year due to a lower number of admissions.  A few years ago Vanguard sold some of their hospitals to Prime Healthcare here in Orange County.  La Palma and Huntington Beach hospitals were two of the medical centers sold.

Tenet Healthcare Loses $88 Million First Quarter 2013–Admissions Drop, Algorithmic Models Of Insurers Transferring Risk to Patients and Providers Not Working, Why? No Money

Blackstone is a money winner here as the largest single investor.  Vanguard did an IPO a couple years ago and remained a “controlled” company.  In addition Tent also recently announced opening a regional office in Atlanta so perhaps this was preparing for the acquisition.  BD


Tenet Healthcare said on Monday that it had agreed to acquire Vanguard Health Systems for roughly $1.8 billion in a deal that will put Tenet into new markets.

Tenet’s offer of $21 in cash for every Vanguard share represents a premium of 70 percent over Vanguard’s closing stock price on Friday. Tenet will also assume $2.5 billion in Vanguard debt.  A big winner in the deal is the Blackstone Group, which owns 37.9 percent of Vanguard as of the end of March. The biggest shareholder of Tenet is the hedge fund manager Larry Robbins’ Glenview Capital, which owns a 9.51 percent stake, after selling some four million shares as May 14

Based in Nashville, Vanguard owns and operates 28 acute care hospitals with 7,081 licensed beds in San Antonio, Harlingen and Brownsville in Texas; metropolitan Detroit; metropolitan Phoenix; metropolitan Chicago; and in Massachusetts. The company also owns managed health plans in Chicago; Detroit; Harlingen, Tex.; and Phoenix, and it has two surgery centers in Orange County in California.

Tenet, based in Dallas, has 49 hospitals with a total of 13,180 licensed beds and 122 outpatient centers. It also owns Conifer Health Solutions.

http://dealbook.nytimes.com/2013/06/24/tenet-to-acquire-vanguard-health-systems-for-1-8-billion/?_r=0

Sunday, June 23, 2013

Anthem Blue Cross to Pay $6 Million in Fines for Illegally Dropping Policy Holders–Fixing the Policy Dropping Algorithm Parameters…

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 hereimage 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. 

Med Solutions and Blue Cross Caught On the Stress Test Denial Algorithm (video)

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

“Algo Duping” – PLOS One Journal Publication Explains Why The Fear of Math Plays a Big Role As One Underlying Reason We All Get Duped And Those Who Don’t Fear Math Take All the Money, Gradually, Using “Mathematical Formulas & Algorithms”

READ ALGO DUPING 101 (there’s also a link to Algo Duping 101 at the top links here)


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.

http://www.sfgate.com/news/medical/article/LA-settles-health-insurance-lawsuit-for-6M-4612963.php

CalPERS Reimbursement Caps Seem to Be Working As More Hospitals in California Reduce Prices for Some Surgical Procedures

Recently CalPERS has been in the news for their new bidding process to split up the insurers offering coverage for their health insurance.  imageThey have opening admitted they don’t  know if any money will be saved but in working with Blue Cross on some of this they are making some headway with what they will pay for certain surgical procedures.  Hospitals don’t want to lose patients so if they are too far out of the ball park, and consumers have to pick up the rest of the bill they look else where. 

CalPERS Announces Results of Health Insurance Bids and Blue Shield Loses It’s Monopoly & No Clue If Any Money Will Be Saved

On the other side of the coin too we had situations like this at Stanford to where they eventually made up but Blue Cross patients had to go elsewhere.

Stanford Hospitals and Clinics No Longer Accepting Blue Cross Health Insurance–Contract Expire-Patients Have to Go Elsewhere While the Cost Algorithms Churn With Contract Negotiations

Now even hospitals like Cedars have lowered costs and are included on the list where patients can go and have the procedure covered for knee and hip replacements and CalPERS may entertain capping even more procedures.  When compared with other insurance data, there were no better or worse outcomes.  There have been employers who have also negotiated with hospitals like Lowes and the Cleveland Clinic for one example with domestic medical tourism to save money. BD


When the California Public Employees’ Retirement System told its Anthem Blue Cross members it would pay only up to $30,000 for a knee or hip replacement surgery, some patients shopped around for a cheaper hospital.

What may be more surprising is that about 40 higher-priced hospitals in the state cut their surgery prices significantly to avoid losing patients. That response accounted for about 85% of the $5.5 million CalPERS saved over two years, researchers at UC Berkeley found, with the rest of the savings coming from patients opting for lower-cost hospitals.

The average charge among the more-expensive hospitals fell 37% from $43,308 in 2010 to $27,149 last year for these common joint replacements. The average price for CalPERS members at the less-expensive hospitals was $24,528, down just 3% since 2010.

CalPERS, the nation’s third-largest purchaser of health benefits, said it pursued this idea because its hospital bills for hip and knee surgeries ranged from $15,000 to $110,000. Now the giant pension fund said it will look at expanding this approach to other procedures.

To assist workers, CalPERS and Anthem gave members a list of 46 hospitals that were judged to be both higher quality and lower cost. This group, which has grown to 54 facilities, includes hospitals such as Cedars-Sinai Medical Center.

http://www.latimes.com/business/money/la-fi-mo-calpers-hospital-surgery-prices-20130623,0,6571991.story