I don’t know if you have followed the Tri-Care bidding processes or not but his has been ongoing with bids, protests, rebids and so on since 2009. There are 3 areas of the country to where carriers can bid, the northeast, southeast and the west and one carrier cannot have more than one area awarded in a big. Untied has been 
very active in all of them and in the southeast won the contract, Human filed a protest and got it back. So the next move it appears was to focus on the western US and again with hiring the former US Assistant Attorney General from Minnesota I guess they must have covered all the legal ends as you can read the link below to see where United filed suit against the government over the Tri-Care contracts.
Update: UnitedHealthcare Sues Department of Defense Over Tri-Care Contracts–They Said They Would Do This – Is This A Case Of My Algorithms Are Better Than Yours?
As I read this story it will take a year to wind down and March of 2013 is when the official date is for assuming all the services. This is a lot of data and medical record information to transfer, as is everything today. You can read the back link below too and see more about the United protest filed against Humana which was successful in maintaining the contract for the south. 
UnitedHealth Loses Tri-Care Protest Again With Contract Awarded to Humana in the South-Now Protesting Contracts Awarded In Both the South and the Western States
Here we go again with a whistle blower incident with Tri-West and it’s kind of funny as you read that United’s complaint was based on the fact that they felt that Tri-West forced the DOD to focus on costs and not quality of care…well you can read enough here and talk to many primary MDs and find that opinion from many of them as United has actively cut reimbursements and is very aggressive in this area so is the pot calling the kettle black? HealthNet filed a protest against the award in the northeast and they were able to keep the contract that was awarded to United back in 2010 and HealthNet, not being as large as a conglomerate until the decision was reversed had to sell part of it’s other commercial coverage in northeast to Untied. 
Humana Keeps Tricare In The South And Back in May of 2010 HealthNet Was Able to Keep the Northeast-Both Companies Filed Appeals
United owns enough companies to pretty much get a cut of the action anywhere they go today to include buying up physicians groups as well and in the OC the activity has been huge with lawsuits here as well with Blue Shield filing one based on issues of causing patients and doctors problems that are in their network. This even get more interesting as TriWest awarded a 5 year contract to Blue Health Intelligence in September for data analytics and saving money.
Nobody has been in the game as analytics as long as United who for years through subsidiaries has sold analytics services and software even to other insurance carriers. We all became aware of this with the big class action lawsuit over the use of the old Ingenix analytics for out of network payments where most carriers subscribed to the data base and formulas created by United. Here’s where the case of the formulas and algorithms created by United ran up against Andrew Cuomo and lead to the big class action lawsuit with low balling payments to MDs and patients.
AMA Announced Settlement of Class Action Suit of $350 Million with Ingenix (United Healthcare)
Other lawsuits are still floating around out there on the use of the Ingenix data base which is now Optum and they created it and other insurers licensed and use it.
Ingenix Data Base Has Some Long Reaching Legal Tentacles with Aetna, Blue Cross, Blue Shield, Humana
Here’s a little bit of recent action in the OC with United and/or subsidiaries owning/controlling two of the biggest physician’s groups in southern California.
United Healthcare Subsidiary MemorialCare Medical Foundation Acquires Nautilus Healthcare Management Who Manages Greater Newport Physicians-MDs Become Part of MemorialCare System–Subsidiary Watch
With all the emphasis on ACOs today, look what’s happening here as well..mixing everyone up and who’s really going to contract with who and what subsidiaries of 
insurers are involved? Good questions to ask as now the data for use is caught in the middle, as are doctors and patients.
Health Insurance Contracts at the OC Corral–Lawsuits, an ACO and A Lot of Mixed Up and Confused Patients As Data Disruption and Patient Care Move Center Stage…
If you haven’t quite figured this out yet, it’s all about money and care comes in here secondary as the money drives who patients can see, what’s approved for medications and so forth so based on lawsuits and contracts this is not doing much in the way of “real” care being in the forefront as it appears to me and more focus seems to be with providing dividends to shareholders, who on day might wake up to the fact that they to be insured by some health insurance company too so this is where the stock goes and just something again shareholders should take note of as far as their personal involvement as this roller coaster ride speeds up.
United Healthcare Acquisition of Monarch Healthcare HMO Already Causing Confusion and Access Problems for Blue Shield Patients in Orange County
The sometimes scary part too about United is there huge number of subsidiaries so if they lose on one count, there’s a subsidiary they can send in to work on another angle, again all to put more profit to their bottom line. Below I discussed this a little as they own 3 companies that provide electronic medical records so as a quick example if a doctor needs an EMR to gain stimulus funds as their insurer reimbursements gets cut, does this happen to where 3 potential solution companies that are subsidiaries rush in for that sale?
Subsidiary Watch-Corporate Conglomerate Insurers Reduce Compensation Contracts Using One Subsidiary Then Market Same MDs With Another Subsidiary in Health IT
In healthcare and in the financial areas today this all getting to be a game of money and Algorithms for either desired or accurate results and they should be the same but they are not always. I have a series in which I discussed “The Attack of the Killer Algorithms” where I have connected dots on flawed data, and so forth on how this works to sell more software sometimes and how the consumer gets hurt. What do you do when you can’t see, talk to or touch those algos that are making life impacting decisions about you on servers 24/7? The link below also has an excellent video that’s an eye opener too on how all analytics are not 100% factual and how marketing spins numbers and moves public opinions based on such and how we get suckered in every day. 
Attack of the Killer Algorithms–Digest & Links for All Chapters–See How the Math and Crafty Formulas Today Running on Servers 24/7 Make Life Impacting Decisions About You
United with their various subsidiaries to include a bank with over a billion on deposit is showing up in all types of industries…even low income housing. Recent subsidiaries include a clearinghouse business and in Florida, the purchase of two more HMO companies.
United Healthcare Gets in The Low Income Housing Business With Partnership to Finance Housing Projects in New Mexico
United Healthcare Buys Two HMOs in Florida–More Cheap or Free Hearing Aids for Seniors Perhaps–Subsidiary Watch
With all these varied subsidiaries, no wonder they hired former US Attorney General in Minnesota for their general counsel as I too sometimes wonder when the “conflicts of interests” or those of a monopoly of business sector questions will arise. They are also duking it out in Kansas and Nebraska for state and employee managed care contracts. In Kansas, Blue Cross who is the largest in that state decided not to even bid, and again when up against the mighty subsidiary powers United has been able to bring in profit dollars from so many different areas from introducing a drug to the FDA all the way down to physician reimbursement, I do wonder how they compete not to mention the draw of the crowd for those cheap hearing aides in some areas. 
In addition a few weeks ago this story was big all over the web with United offering their new Cloud services and going to sell and give away apps…what do they not do?
UnitedHealthCare Launching Cloud Platform Via Optum Subsidiary Will Sell Apps Like the Apple Store But They Won’t Be As Much Fun And Solicit Hospitals for Record Storage
Again if you have been asleep at the wheel, folks in the US don’t normally like to discuss math and algorithms and it works in the background while we get distracted over women’s health issues and abortions that make the news mostly due to the digitally illiterate folks we have in office and they don’t do math either. All of this and lack of focus has allowed United to grow behind the scenes and acquire such a huge network of subsidiaries and make lots of money in the intangibles and they have a lot of it and also make million selling our data along the way as well.
“Numbers Don’t Lie, But People Do”–Radio Interview from Charles Siefe–Journalists Take Note, He Addresses How Marketing And Bogus Statistics Are Sources of Problems That Mislead the Public & Government
So as a company when they feel they have all the math and formulas to run everything this certainly seems to present a case for protests and so forth to government entities that are pretty much blind to how business in the background works today and while our folks in government maintain full levels of distraction and with the media keeping the public tied into the emotional turmoil that they really have no control over, big conglomerates such as United continue to grow and add to their profits and one day someone will wake up and say “how did all this happen”. Again it’s all about government and consumers being naïve and gullible over a number of years that has allowed this to take place with nobody minding “the intelligence shop” . 
The company via subsidiaries can even introduce a drug to the FDA and has subsidiaries to consult all the way down to MD reimbursements if a perfect contract solution were given where each step was awarded to one of their subsidiaries…kind of scary isn't it but that’s what has been built in the background is now coming to forefront…again mostly due to folks being asleep at the wheel and living in technical denial. Below are a couple other subsidiaries you may not be aware of as well…good reading if you want to stay on top of what is controlling everything today…servers and algorithms that makes billions in profits while the general public and lawmakers run from the math and corporations thrive. BD
United Healthcare (Optum) Owns A Consulting Firm for FDA Drug and Device Approvals, Clinical Trials–CanReg - Subsidiary Watch
UnitedHealth subsidiary (Ingenix Subsidiary I3) Acquires ChinaGate – Working to Sell Chinese Products Globally
PHOENIX (AP) — Phoenix-based TriWest Healthcare Alliance has lost a $20.5 billion contract to manage health benefits for U.S. military families, and company officials say 1,000 jobs in Arizona are now at risk.
The U.S. Department of Defense announced Friday that it chose UnitedHealth Group over TriWest to serve military family members across 20 western states.
“We are disappointed,” TriWest chief executive David McIntyre said. “We do this work well by every measure. We do it very efficiently for the government.”
TriWest representatives plan to meet with department officials next week to learn why the company did not win the contract, the Arizona Republic reported.McIntyre said TriWest will file a protest if the company discovers a legitimate reason to do so after meeting with department officials. Otherwise, he said operations will start to wind down after TriWest’s contract with the department ends in March 2013.
In July 2009, the federal government awarded the western region contract to TriWest. It reopened bidding in April 2011 based on UnitedHealth Group’s protest of the contract award. At the time, UnitedHealth Group said the Department of Defense forced contractors to focus on low costs instead of quality care.
In September, TriWest agreed to pay the federal government $10 million to settle whistle-blower claims that the company had failed to pass along discounted rates to the government.
TriWest had been accused of overbilling the federal government for medical services provided to military personnel and their families. From 2004 to 2010, TriWest reportedly submitted claims from health care providers at rates that were more expensive than discounted rates the insurer had negotiated.
http://www.mohavedailynews.com/articles/2012/03/18/news/business/doc4f6597ba5e448967025190.txt
0 comments:
Post a Comment