How AI Algorithms Routinely Reject Medicare Advantage Claims: Just something else that the intellectually-incurious John Carney will never read:
The STAT investigation found artificial intelligence is increasingly driving denials by health insurance companies for medical claims in Medicare Advantage.
As health insurance companies expand their use of algorithms to predict a patient’s health care journey and outcome, the growing list of denials that follow cause conflict between physicians and insurers, putting treatment, sometimes for critically ill patients, in limbo.
The cost of the tussle between AI-based assessment versus doctor-based assessments can put the lives of nursing home residents in jeopardy, notes the STAT article.
“While the firms say [the algorithm] is suggestive, it ends up being a hard-and-fast rule that the plan or the care management firms really try to follow,” said David Lipschutz, associate director of the Center for Medicare Advocacy, a nonprofit group that has reviewed such denials for over two years. “There’s no deviation from it, no accounting for changes in condition, no accounting for situations in which a person could use more care.
Moreover, Medicare Advantage plans, though popular for their lower premiums and prescription drug coverage, also give insurers more leeway in denying and limiting services.
When will Carney and his minions stop lying about Medicare Advantage?
Where Did Rethug Rep. Bury $$’s He Raised For ‘Children’s Burial Garden’? No, not ‘George Santos’:
What did Tennessee Congressman Andy Ogles do with tens of thousands of dollars meant for a children’s burial garden?
It’s a story that goes far beyond questions about Ogles’ inflated resume. It’s a story that stems from a personal tragedy — the stillborn death of a child whose photo Ogles sometimes posts on his political social media — and a GoFundMe that allowed Ogles to rake in tens of thousands of dollars for what was supposed to be a children’s burial garden.
Yet, what makes it a story is the fact that there is no burial garden, no one knows where their donations went, and Ogles refuses to say what he did with the money.
He ‘promised a “burial garden” that would “create a place for Lincoln’s new play friends,” “a life-size statue of Jesus watching over the children,” along with “benches for families to sit while surrounded by flowers.”
No burial garden, no life-size Jesus, no benches. Just $25K that has disappeared. Ogles is not talking.
The Conservative Partnership Institute, as the nonprofit is known, now controls four commercial properties along a single Pennsylvania Avenue block, three adjoining rowhouses around the corner, and a garage and carriage house in the rear alley. CPI’s aim, as expressed in its annual report, is to transform the swath of prime real estate into a campus it calls“Patriots’ Row.”
Anyone Believe That Insider Trading Isn’t A Thing? Perhaps this piece will disabuse you of that notion:
ProPublica analyzed millions of those trades, isolated those by corporate executives trading in companies related to their own, then identified transactions that were anomalous — either because of the size of the bets or because individuals were trading a particular stock for the first time or using high-risk, high-return options for the first time.
The records give no indication as to why executives made particular trades or what information they possessed; they may have simply been relying on years of broad industry knowledge to make astute bets at fortuitous moments. Still, the records show many instances where the executives bought and sold with exquisite timing.
Such trading records have never been publicly available. Even the SEC itself doesn’t have such a comprehensive database. The records provide an unprecedented glimpse into how the titans of American industry make themselves even wealthier in the stock market.
U.S. securities law bars “insider trading” — buying or selling stocks based on access to nonpublic information not available to other investors — under certain circumstances. Historically, insider trading prosecutions and SEC enforcement have both focused on corporate employees, and those close to them, trading in the stock of their own companies.
‘No More Drilling On Federal Lands, Period.’ Strike the ‘No’ from Biden’s statement:
There are more than 600 million barrels of oil available to be dislodged by ConocoPhillips over the next 30 years, effectively adding the emissions of the entire country of Belgium, via just one project, to further heat the atmosphere.
The scale of Willow is vast, with more than 200 oil wells, several new pipelines, a central processing plant, an airport, and a gravel mine set to enable the extraction of oil long beyond the time scientists say that wealthy countries should have kicked the habit in order to avoid disastrous global heating.
But the approval of the project is consistent with an administration that has approved nearly 100 more oil and gas drilling leases than Donald Trump had at the same point in his presidency, federal data shows. Biden may have promised “no more drilling on federal lands, period” during his presidential campaign, but the reality has been very different—not only have the hydrocarbons continued to flow, they are in a sort of boom, with both oil and gas production forecast to hit record levels year.
He, at best, is America’s Occasional Environmental President.
What do you want to talk about?