#medicare scam

[cleolinda]

Phone scam gothic

So my mom sits down and starts telling me about two weird-ass phone calls she had today—she was returning a missed call, and the woman who answered just… sobbed for a minute. I’m sitting here asking, like, a whole minute? Nothing else, just sobbing? Who did you THINK you were calling back?

“United Healthcare, they have my Medicare plan. They’ve been calling me for weeks without leaving any voicemail.”

(Are you sure it was United Healthcare? “It was the same number that’s on my card, I checked, and that’s who the caller ID said it was.”)

Are you sure it was a whole minute? Did YOU say anything?

“Yes, like sixty seconds while I kept going ‘Hello? Hello?’ It sounded like she was having a nervous breakdown, I kept waiting to see if she’d tell me what was even wrong. Finally I just hung up.”

And then my mom turned right around and called back again, because she was gonna get to the bottom of this.

This time she got a different woman, perfectly calm, who wanted to set up “your in-home direct patient care home health visit.”

At this point (at this point?) I’m staring, because no one here currently has anyone coming to the house to help with any kind of medical care. My mom might honestly be the healthiest member of the household, but even I don’t use any home services, herniated discs and all. “Did they have you… confused with someone else?”

“No, she repeated my full name and phone number back to me.”

This lady then started ARGUING with my mother. Why don’t you want us to come to your house to manage your direct patient care? Don’t you need home health care to be managed? Why don’t you need home health care? Why would you not want home health care? “I JUST KIND OF HAVE HIGH CHOLESTEROL?” But don’t you want us to manage your home health care? “WHY DO YOU NEED TO COME TO MY HOUSE TO MANAGE HEALTH CARE I DON’T USE?”

My mom finally hung up on this lady as well, without giving her any real information.

The more we talked about it, the more things we started to notice:

I was incredibly creeped out by the unsolicited use of the word “manage,” for some reason. Very sinister “write me into your will” vibes for some reason—I don’t know what these people want, but they’re gonna get you to sign something over.

My mom got especially stuck on “WHY DO YOU NEED TO COME TO MY HOUSE?!”

My mom has used home health services before… years ago, before she was on Medicare. But this company wouldn’t know about that. However, if you’re on Medicare, you’re over 65. Having not ever dealt with my mother before, someone calling a Medicare user might be playing the odds that a person over 65 is 1) in frail health and 2) old enough to get easily confused.

Fair play to my mom, she’s the one who thought of number spoofing. I’m so busy not answering the phone ever and arranging all my medical communications to happen through passworded portals that I didn’t think of it.

Hey, are you guys, like… holding someone hostage…?

So at this point, I google “United Healthcare scam.”

The “health insurance counselor”

This fraudster will offer help navigating the health insurance marketplace for a fee, capitalizing on people’s confusion about the state-based health exchanges created through the Affordable Care Act.

What to know

This sort of assistance is indeed available and is legitimate, but the people who offer it – also known as “navigators” – aren’t allowed to charge for their services. Also, remember that people with Medicare coverage don’t need to use the state health exchanges. The exchanges are for people under the age of 65, who are looking to enroll in an individual health plan.

Change “navigate” to “manage,” and I think this is it, although the lady on the phone never mentioned any fees. Either my mom didn’t let her get that far, or this is the point of actually getting into someone’s house: persuading them face-to-face to pay something, and potentially refusing to leave until the scammer has worn their target down.

Medicare does not make unsolicited phone calls.

Okay, so it was a scam no matter what it was about. As far as I’m concerned, my mom should contact Actual United Healthcare about it, and I’m here to spread the good word of Never Believing Anyone on the Phone 2k24. I don’t know what to tell you about the lady having the nervous breakdown though.

[silveryair]

Spent my lunch hour researching insurance policies and loopholes and my conclusion is we need to burn every insurance company building to the ground

[pinolitas]

LMAO answered a spam call theyre so funny they hang up when they realize they cant scam you 😭😭😭😭 sorry im not your target audience i only answered cus im waiting for a job

[thekalpar]

I don't think Americans truly understand how utterly nonsensical privatized healthcare is in our country.

Explanation, I work as a pharmacy tech in a big mail order pharmacy, most of my day is spent making phone calls. It's super boring which is why I never talk about it. This morning I had two phone calls back-to-back about patients who needed insulin.

Patient A

Fancy Insulin: $2700

Generic Insulin: $4

Patient B

Fancy Insulin: $570

Generic Insulin: $100

And I want to emphasize, these patients had the *same* insurance, it wasn't like one had a better insurance company than the other, it was the *same company*.

It makes absolutely no gosh darn sense whatsoever.

[trollprincess]

Me when my mom told me the racist homophobe on the town council told her, “I didn’t know your daughter was *like that*!” about me being bi and that her mom (not her sister) was the one harassing me on FB:

[spinyax]

I hate my job actually

[scottguy]

Article: The Medicare Advantage Trap

The Medicare Advantage Trap

It's a SCAM. They get a fixed amount and thus have nothing but incentive to deny your claims.

Don't choose this! (It may seem cheaper now but will cost your time, money, and possibly your life.)

[exorbitant-interest]

I don't believe you.

[progressivegraffiti]

Take Advantage of Medicare Open Enrollment to Dump a Medicare Advantage Plan

Get real #Medicare during #MedicareOpenEnrollment, instead of a cheap #MedicareAdvantage plan.

Some very smart and knowledgeable people say Medicare Advantage is a scam. If it is, the Advantage scam is heavily supported by the U.S. Government. And now, NPR reports that Advantage plans even drag their feet to pay small, rural hospitals. Put that information in context, with a little background… Medicare is government healthcare. Medicare Advantage is private health insurance.…

[dankxsinatra]

Also, the vatican offered to pay for everything Alfie needed including travel. It wasn't just a cost concern, it was the government flexing it's power to make sure the child died just because they could.

It's interesting how we never look to countries like the Phillipines as examples on how to do things. They seem to have highly affordable but just as advanced medical care. In fact, a lot of Americans that can afford the travel costs will often go to other countries like that for care.

Almost like there are alternatives to bureaucrats or pharmaceutical monopolies deciding on whether we can live or die.

[kitefreecss]

anyone else get this weird T posing video game ad?????

[mostlysignssomeportents]

Epic Systems, a lethal health record monopolist

Epic Systems makes the dominant electronic health record (EHR) system in America; if you're a doctor, chances are you are required to use it, and for every hour a doctor spends with a patient, they have to spend two hours doing clinically useless bureaucratic data-entry on an Epic EHR.

How could a product so manifestly unfit for purpose be the absolute market leader? Simple: as Robert Kuttner describes in an excellent feature in The American Prospect, Epic may be a clinical disaster, but it's a profit-generating miracle:

https://prospect.org/health/2024-10-01-epic-dystopia/

At the core of Epic's value proposition is "upcoding," a form of billing fraud that is beloved of hospital administrators, including the "nonprofit" hospitals that generate vast fortunes that are somehow not characterized as profits. Here's a particularly egregious form of upcoding: back in 2020, the Poudre Valley Hospital in Ft Collins, CO locked all its doors except the ER entrance. Every patient entering the hospital, including those receiving absolutely routine care, was therefore processed as an "emergency."

In April 2020, Caitlin Wells Salerno – a pregnant biologist – drove to Poudre Valley with normal labor pains. She walked herself up to obstetrics, declining the offer of a wheelchair, stopping only to snap a cheeky selfie. Nevertheless, the hospital recorded her normal, uncomplicated birth as a Level 5 emergency – comparable to a major heart-attack – and whacked her with a $2755 bill for emergency care:

https://pluralistic.net/2021/10/27/crossing-a-line/#zero-fucks-given

Upcoding has its origins in the Reagan revolution, when the market-worshipping cultists he'd put in charge of health care created the "Prospective Payment System," which paid a lump sum for care. The idea was to incentivize hospitals to provide efficient care, since they could keep the difference between whatever they spent getting you better and the set PPS amount that Medicare would reimburse them. Hospitals responded by inventing upcoding: a patient with controlled, long-term coronary disease who showed up with a broken leg would get coded for the coronary condition and the cast, and the hospital would pocket both lump sums:

https://pluralistic.net/2024/06/13/a-punch-in-the-guts/#hayek-pilled

The reason hospital administrators love Epic, and pay gigantic sums for systemwide software licenses, is directly connected to the two hours that doctors spent filling in Epic forms for every hour they spend treating patients. Epic collects all that extra information in order to identify potential sources of plausible upcodes, which allows hospitals to bill patients, insurers, and Medicare through the nose for routine care. Epic can automatically recode "diabetes with no complications" from a Hierarchical Condition Category code 19 (worth $894.40) as "diabetes with kidney failure," code 18 and 136, which gooses the reimbursement to $1273.60.

Epic snitches on doctors to their bosses, giving them a dashboard to track doctors' compliance with upcoding suggestions. One of Kuttner's doctor sources says her supervisor contacts her with questions like, "That appointment was a 2. Don’t you think it might be a 3?"

Robert Kuttner is the perfect journalist to unravel the Epic scam. As a journalist who wrote for The New England Journal of Medicine, he's got an insider's knowledge of the health industry, and plenty of sources among health professionals. As he tells it, Epic is a cultlike, insular company that employs 12.500 people in its hometown of Verona, WI.

The EHR industry's origins start with a GW Bush-era law called the HITECH Act, which was later folded into Obama's Recovery Act in 2009. Obama provided $27b to hospitals that installed EHR systems. These systems had to more than track patient outcomes – they also provided the data for pay-for-performance incentives. EHRs were already trying to do something very complicated – track health outcomes – but now they were also meant to underpin a cockamamie "incentives" program that was supposed to provide a carrot to the health industry so it would stop killing people and ripping off Medicare. EHRs devolved into obscenely complex spaghetti systems that doctors and nurses loathed on sight.

But there was one group that loved EHRs: hospital administrators and the private companies offering Medicare Advantage plans (which also benefited from upcoding patients in order to soak Uncle Sucker):

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8649706/

The spread of EHRs neatly tracks with a spike in upcharging: "from 2014 through 2019, the number of hospital stays billed at the highest severity level increased almost 20 percent…the number of stays billed at each of the other severity levels decreased":

https://oig.hhs.gov/oei/reports/OEI-02-18-00380.pdf

The purpose of a system is what it does. Epic's industry-dominating EHR is great at price-gouging, but it sucks as a clinical tool – it takes 18 keystrokes just to enter a prescription:

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2729481

Doctors need to see patients, but their bosses demand that they satisfy Epic's endless red tape. Doctors now routinely stay late after work and show up hours early, just to do paperwork. It's not enough. According to another one of Kuttner's sources, doctors routinely copy-and-paste earlier entries into the current one, a practice that generates rampant errors. Some just make up random numbers to fulfill Epic's nonsensical requirements: the same source told Kuttner that when prompted to enter a pain score for his TB patients, he just enters "zero."

Don't worry, Epic has a solution: AI. They've rolled out an "ambient listening" tool that attempts to transcribe everything the doctor and patient say during an exam and then bash it into a visit report. Not only is this prone to the customary mistakes that make AI unsuited to high-stakes, error-sensitive applications, it also represents a profound misunderstanding of the purpose of clinical notes.

The very exercise of organizing your thoughts and reflections about an event – such as a medical exam – into a coherent report makes you apply rigor and perspective to events that otherwise arrive as a series of fleeting impressions and reactions. That's why blogging is such an effective practice:

https://pluralistic.net/2021/05/09/the-memex-method/

The answer to doctors not having time to reflect and organize good notes is to give them more time – not more AI. As another doctor told Kuttner: "Ambient listening is a solution to a self-created problem of requiring too much data entry by clinicians."

EHRs are one of those especially hellish public-private partnerships. Health care doctrine from Reagan to Obama insisted that the system just needed to be exposed to market forces and incentives. EHRs are designed to allow hospitals to win as many of these incentives as possible. Epic's clinical care modules do this by bombarding doctors with low-quality diagnostic suggestions with "little to do with a patient’s actual condition and risks," leading to "alert fatigue," so doctors miss the important alerts in the storm of nonsense elbow-jostling:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5058605/

Clinicians who actually want to improve the quality of care in their facilities end up recording data manually and keying it into spreadsheets, because they can't get Epic to give them the data they need. Meanwhile, an army of high-priced consultants stand ready to give clinicians advise on getting Epic to do what they need, but can't seem to deliver.

Ironically, one of the benefits that Epic touts is its interoperability: hospitals that buy Epic systems can interconnect those with other Epic systems, and there's a large ecosystem of aftermarket add-ons that work with Epic. But Epic is a product, not a protocol, so its much-touted interop exists entirely on its terms, and at its sufferance. If Epic chooses, a doctor using its products can send files to a doctor using a rival product. But Epic can also veto that activity – and its veto extends to deciding whether a hospital can export their patient records to a competing service and get off Epic altogether.

One major selling point for Epic is its capacity to export "anonymized" data for medical research. Very large patient data-sets like Epic's are reasonably believed to contain many potential medical insights, so medical researchers are very excited at the prospect of interrogating that data.

But Epic's approach – anonymizing files containing the most sensitive information imaginable, about millions of people, and then releasing them to third parties – is a nightmare. "De-identified" data-sets are notoriously vulnerable to "re-identification" and the threat of re-identification only increases every time there's another release or breach, which can used to reveal the identities of people in anonymized records. For example, if you have a database of all the prescribing at a given hospital – a numeric identifier representing the patient, and the time and date when they saw a doctor and got a scrip. At any time in the future, a big location-data breach – say, from Uber or a transit system – can show you which people went back and forth to the hospital at the times that line up with those doctor's appointments, unmasking the person who got abortion meds, cancer meds, psychiatric meds or other sensitive prescriptions.

The fact that anonymized data can – will! – be re-identified doesn't mean we have to give up on the prospect of gleaning insight from medical records. In the UK, the eminent doctor Ben Goldacre and colleagues built an incredible effective, privacy-preserving "trusted research environment" (TRE) to operate on millions of NHS records across a decentralized system of hospitals and trusts without ever moving the data off their own servers:

https://pluralistic.net/2024/03/08/the-fire-of-orodruin/#are-we-the-baddies

The TRE is an open source, transparent server that accepts complex research questions in the form of database queries. These queries are posted to a public server for peer-review and revision, and when they're ready, the TRE sends them to each of the databases where the records are held. Those databases transmit responses to the TRE, which then publishes them. This has been unimaginably successful: the prototype of the TRE launched during the lockdown generated sixty papers in Nature in a matter of months.

Monopolies are inefficient, and Epic's outmoded and dangerous approach to research, along with the roadblocks it puts in the way of clinical excellence, epitomizes the problems with monopoly. America's health care industry is a dumpster fire from top to bottom – from Medicare Advantage to hospital cartels – and allowing Epic to dominate the EHR market has somehow, incredibly, made that system even worse.

Naturally, Kuttner finishes out his article with some antitrust analysis, sketching out how the Sherman Act could be brought to bear on Epic. Something has to be done. Epic's software is one of the many reasons that MDs are leaving the medical profession in droves.

Epic epitomizes the long-standing class war between doctors who want to take care of their patients and hospital executives who want to make a buck off of those patients.

Tor Books as just published two new, free LITTLE BROTHER stories: VIGILANT, about creepy surveillance in distance education; and SPILL, about oil pipelines and indigenous landback.

If you'd like an essay-formatted version of this post to read or share, here's a link to it on pluralistic.net, my surveillance-free, ad-free, tracker-free blog:

https://pluralistic.net/2024/10/02/upcoded-to-death/#thanks-obama

Image: Flying Logos (modified) https://commons.wikimedia.org/wiki/File:Over_$1,000,000_dollars_in_USD_$100_bill_stacks.png

CC BY-SA 4.0 https://creativecommons.org/licenses/by-sa/4.0/deed.en

[thejewishlink]

Biden Administration Proposes Crackdown On Scam Medicare Ads

Biden Administration Proposes Crackdown On Scam Medicare Ads

WASHINGTON (AP) — The Biden administration on Wednesday proposed a ban on misleading ads for Medicare Advantage plans that have targeted older Americans and, in some cases, convinced them to sign up for plans that don’t cover their doctors or prescriptions. The rule, proposed by the Centers for Medicare and Medicaid Services, would ban ads that market Medicare Advantage plans with confusing…

[dragonpyre]

Scam caller: Hi, I'm here to talk to you about your medicare plan

Me: *meows like a cat*

Scam caller: *hangs up*

Me: quitter

[soberscientistlife]

American insurance is a scam. We need Medicare for all

[memingursa]

Company with 70 Billion dollars of profits demands you listen to fake ai medicare scams, Mr Beast scams, healthcare scams, Thinly veiled Deep fake AI porn maker ads, Hero Wars fetish videos, Prager U Fascist propaganda, General fascist propaganda, Full length Episodes of youtube shows or podcasts you never have seen and never want to watch, Music videos somebody paid to force you to watch, “ha ha want to skip this” ass ads or whatever fucking else.