Private Equity Behaving Badly

[abolt18]

Advertisement - Members don't see this ad

Missouri hospital’s staff lost their health insurance, then their jobs

The U.S. Labor Department investigates Noble Health after former employees of its shuttered Missouri hospitals say the private equity-backed owner took money from their paychecks and then failed to fund

www.stltoday.com

I know this isn't brand new, but don't remember seeing it talked about on here.

 

[jwk]

Scum - not surprising thesedays.

 

[coffeebythelake]

This is actually fraud. They shouldnt get away with this.

 

[abolt18]

Seems like another one of those shell games where they move all the failing businesses to one of their daughter companies, then let it burn itself to the ground, have the daughter company file for bankruptcy and/or sell off whatever they can at any price, big guys keep their hands "clean".

 

[deleted87051]

Seems like another one of those shell games where they move all the failing businesses to one of their daughter companies, then let it burn itself to the ground, have the daughter company file for bankruptcy and/or sell off whatever they can at any price, big guys keep their hands "clean".

Not limited to PE. Blue chip J&J formed a shell company called LTL to assume the liability for all its talcum powder lawsuits. Then almost immediately, LTL filed for bankruptcy.

Recent history has shown that all corporations cheat, lie, and steal to the extent allowed by the government.

 

[deleted1130227]

Not limited to PE. Blue chip J&J formed a shell company called LTL to assume the liability for all its talcum powder lawsuits. Then almost immediately, LTL filed for bankruptcy.

Recent history has shown that all corporations cheat, lie, and steal to the extent allowed by the government.

Corporations are artificial entities that allow PEOPLE to avoid responsibility for their actions.

 

[BLADEMDA]

Our legal system is also corrupt. The worst in the world for destroying companies and lives based on non factual verdicts. Do you all remember the Breast implant fiasco?

J and J is willing to put billions in a fund to compensate supposed "victims" and trial lawyers. The science against J and J is also very weak. The vast majority of people suing J and J aren't victims if they used a product in an unsafe manner and even then, the product didn't contain asbestos. J and J wins most of these cases at huge expense but when they lose it costs billions.

U.S. Court of Appeals Hears Challenge to J&J’s Bankruptcy Plan

A panel of judges will rule on J&J’s tactic that shifted billions of dollars in talc liabilities to a subsidiary, which then filed for bankruptcy.

www.asbestos.com

According to bankruptcy court records, one verdict that covered 22 plaintiffs was worth $2 billion.

______

Anyone can make a false claim against J and J with minimal proof they used the product. All they need to do is simply file a claim and pressure J and J to settle.

Contact Miller & Zois to File a Talcum Powder Lawsuit​

It is NOT too late to file your talcum powder lawsuit. If you used a talcum powder product for a long period and were subsequently diagnosed with ovarian cancer, call our talcum powder lawsuit attorneys at 800-553-8082 or contact us online.

 

[deleted87051]

Our legal system is also corrupt. The worst in the world for destroying companies and lives based on non factual verdicts. Do you all remember the Breast implant fiasco?

J and J is willing to put billions in a fund to compensate supposed "victims" and trial lawyers. The science against J and J is also very weak. The vast majority of people suing J and J aren't victims if they used a product in an unsafe manner and even then, the product didn't contain asbestos. J and J wins most of these cases at huge expense but when they lose it costs billions.

U.S. Court of Appeals Hears Challenge to J&J’s Bankruptcy Plan

A panel of judges will rule on J&J’s tactic that shifted billions of dollars in talc liabilities to a subsidiary, which then filed for bankruptcy.

www.asbestos.com

According to bankruptcy court records, one verdict that covered 22 plaintiffs was worth $2 billion.

______

Anyone can make a false claim against J and J with minimal proof they used the product. All they need to do is simply file a claim and pressure J and J to settle.

Contact Miller & Zois to File a Talcum Powder Lawsuit​

It is NOT too late to file your talcum powder lawsuit. If you used a talcum powder product for a long period and were subsequently diagnosed with ovarian cancer, call our talcum powder lawsuit attorneys at 800-553-8082 or contact us online.

I’m no fan of trial lawyers either. Basically I hate everyone 😉

Have you been getting ads for bair hugger lawsuits too like I have been? And I don’t even have a total joint.

Bair Hugger Warming Blanket Lawsuits: Injuries & Settlements

Thousands of people have filed lawsuits after developing infections following surgeries using Bair Hugger warming devices.

www.drugwatch.com

 

[deleted643396]

How about insurance companies behaving badly? Privatized Medicare defrauding taxpayers out of billions.

‘The Cash Monster Was Insatiable’: How Insurers Exploited Medicare for Billions (Published 2022)

By next year, half of Medicare beneficiaries will have a private Medicare Advantage plan. Most large insurers in the program have been accused in court of fraud.

www.nytimes.com

archive.ph

 

[coffeebythelake]

I’m no fan of trial lawyers either. Basically I hate everyone 😉

Have you been getting ads for bair hugger lawsuits too like I have been? And I don’t even have a total joint.

Bair Hugger Warming Blanket Lawsuits: Injuries & Settlements

Thousands of people have filed lawsuits after developing infections following surgeries using Bair Hugger warming devices.

www.drugwatch.com

The whole bairhugger debacle is very interesting and could make for a Netflix documentary

 

[abolt18]

How about insurance companies behaving badly? Privatized Medicare defrauding taxpayers out of billions.

‘The Cash Monster Was Insatiable’: How Insurers Exploited Medicare for Billions (Published 2022)

By next year, half of Medicare beneficiaries will have a private Medicare Advantage plan. Most large insurers in the program have been accused in court of fraud.

www.nytimes.com

archive.ph

Okay that archive link is clutch! Gotta use that in the future!

 

[VA Hopeful Dr]

How about insurance companies behaving badly? Privatized Medicare defrauding taxpayers out of billions.

‘The Cash Monster Was Insatiable’: How Insurers Exploited Medicare for Billions (Published 2022)

By next year, half of Medicare beneficiaries will have a private Medicare Advantage plan. Most large insurers in the program have been accused in court of fraud.

www.nytimes.com

archive.ph

This is very common and is a quality measures for us PCPs.

 

[aneftp]

The real lesson when a hospital filed bankruptcy is be super careful to put money into 457b plans.

You can lose your 457b money in any non government run plan

So if it’s a state 457b. It’s safe. But if it’s hospital 457b be super careful

 

[abolt18]

The real lesson when a hospital filed bankruptcy is be super careful to put money into 457b plans.

You can lose your 457b money in any non government run plan

So if it’s a state 457b. It’s safe. But if it’s hospital 457b be super careful

A scary prospect, no doubt!

 

[deleted643396]

This is very common and is a quality measures for us PCPs.

What is the quality measure and who is measuring it?

When I was an IM resident and hospitalist, I used to get notes from a “chart fairy” suggesting changes to how notes were worded and suggesting diagnoses. The whole thing seemed very suspicious to me even as a naive and idealistic new doctor.

 

[deleted643396]

The real lesson when a hospital filed bankruptcy is be super careful to put money into 457b plans.

You can lose your 457b money in any non government run plan

So if it’s a state 457b. It’s safe. But if it’s hospital 457b be super careful

I would never use a 457b unless you are a state employee.

 

[IMGASMD]

What is the quality measure and who is measuring it?

When I was an IM resident and hospitalist, I used to get notes from a “chart fairy” suggesting changes to how notes were worded and suggesting diagnoses. The whole thing seemed very suspicious to me even as a naive and idealistic new doctor.

Can you clarify this diagnosis?
Is the CHF compensated or not compensated?
Is it a diastolic failure?

Fuk if I know. Go ask the attendings, why are you hassling the intern/resident?!

 

[VA Hopeful Dr]

What is the quality measure and who is measuring it?

When I was an IM resident and hospitalist, I used to get notes from a “chart fairy” suggesting changes to how notes were worded and suggesting diagnoses. The whole thing seemed very suspicious to me even as a naive and idealistic new doctor.

For this year we just have to document every diagnosis the leads to increased Medicare money.

Next year the average complexity score (HCC being the official term) of our patient population is a multiplier for our year end bonus.

Epic monitors all of this.

 

[deleted1130227]

I would never use a 457b unless you are a state employee.

I would never use a 457b unless you are a state employee.

The only hope is that the administrative leadership has money in the 457b and has it under an entity of the system that is not going to go bankrupt. Similar to what J and J did as described in an earlier post. I would be surprised if that were not the case.

 

[deleted87051]

For this year we just have to document every diagnosis the leads to increased Medicare money.

Next year the average complexity score (HCC being the official term) of our patient population is a multiplier for our year end bonus.

Epic monitors all of this.

So this is how we end up with 40 item problem lists on Epic! Every problem they’ve ever had since 1951.

 

[wholeheartedly]

from today

Your anesthesiologist may work for a private-equity firm

A few months after a private-equity-owned firm took over one Nevada hospital's anesthesia services, “it became obvious they were understaffing,” said the hospital's chief executive.

www.nbcnews.com

 

[VA Hopeful Dr]

So this is how we end up with 40 item problem lists on Epic! Every problem they’ve ever had since 1951.

No that's just laziness most of the time in cleaning up problem lists. My sickest patient only has maybe 8-10 codes that count towards HCC scores. Its the stuff you want on there: cancer, CHF, COPD, diabetes and its complications/status, CKD with stage, amputations/ostomies, significant mental illness (bipolar, schizophrenia, major depression), hyperparathyroid, autoimmune diseases, and other significant illnesses.

You don't see stuff like thyroid disease, osteoarthritis, 99% of symptom diagnoses, hypertension, cholesterol, CAD, allergies, asthma, 99% of skin diseases,

 

[deleted87051]

No that's just laziness most of the time in cleaning up problem lists. My sickest patient only has maybe 8-10 codes that count towards HCC scores. Its the stuff you want on there: cancer, CHF, COPD, diabetes and its complications/status, CKD with stage, amputations/ostomies, significant mental illness (bipolar, schizophrenia, major depression), hyperparathyroid, autoimmune diseases, and other significant illnesses.

You don't see stuff like thyroid disease, osteoarthritis, 99% of symptom diagnoses, hypertension, cholesterol, CAD, allergies, asthma, 99% of skin diseases,

What about lateral epicondylitis? 😉

 

[VA Hopeful Dr]

What about lateral epicondylitis? 😉

https://www.cms.gov/files/document/updated-2022-benefit-year-final-hhs-risk-adjustment-model-coefficients-clean-version-508.pdf

 

[deleted87051]

https://www.cms.gov/files/document/updated-2022-benefit-year-final-hhs-risk-adjustment-model-coefficients-clean-version-508.pdf

Interesting. You get a larger bonus if you have a panel full of hemophilia, transplant, and VADs patients?

 

[VA Hopeful Dr]

Interesting. You get a larger bonus if you have a panel full of hemophilia, transplant, and VADs patients?

Very much so. But as a family doctor its going to be a mix of healthy and sick. An HCC score for primary care averaged across all Medicare patients is supposed to be 1.00. That's nationwide. I'm sitting around 0.96 or so last I checked.

 

[Hoya11]

How about insurance companies behaving badly? Privatized Medicare defrauding taxpayers out of billions.

‘The Cash Monster Was Insatiable’: How Insurers Exploited Medicare for Billions (Published 2022)

By next year, half of Medicare beneficiaries will have a private Medicare Advantage plan. Most large insurers in the program have been accused in court of fraud.

www.nytimes.com

archive.ph

this article from the NYT goes on to bash private insurance companies as the cause of many US healthcare problems...

never mentions that CMS pays 1/5 of the private market rate and medicare/medicaid couldnt support providers without private insurance to offset their government slave wages...

 

[deleted643396]

this article from the NYT goes on to bash private insurance companies as the cause of many US healthcare problems...

never mentions that CMS pays 1/5 of the private market rate and medicare/medicaid couldnt support providers without private insurance to offset their government slave wages...

…For our niche world of anesthesia. That seems to be beyond the scope of the article. Trying to tackle all that is wrong in healthcare in one article would be an impossibility. You would need volumes of books to even scratch the surface of the absolute disaster that is American healthcare. CMS is very lucrative for hospitals and insurance companies, as stated in this article. Hospitals have entire staffs of people who’s sole existence is to maximize the payments from Medicare/Medicaid. Do you think hospitals would hire teams of chart and billing optimizers if it was pennies they were going after?

 

[Hoya11]

…For our niche world of anesthesia. That seems to be beyond the scope of the article. Trying to tackle all that is wrong in healthcare in one article would be an impossibility. You would need volumes of books to even scratch the surface of the absolute disaster that is American healthcare. CMS is very lucrative for hospitals and insurance companies, as stated in this article. Hospitals have entire staffs of people who’s sole existence is to maximize the payments from Medicare/Medicaid. Do you think hospitals would hire teams of chart and billing optimizers if it was pennies they were going after?

i think CMS is cheap for everyone across the board.. i dont think healthcare could stand on government payments alone.. not saying the private sector is without its problems. but the article is villainizing the entities that are paying, and victimizing the one that are collapsing our practices. if medicare/medicaid was so lucrative you wouldnt see these hospitals closing down, practices folding, etc..

if you look at which health care entities are thriving, i would certainly bet it goes hand in hand with a higher payer mix of private payers. and if you look at the ones that are failing, i would be you see a higher payer mix of CMS

 

[deleted1130227]

i think CMS is cheap for everyone across the board.. i dont think healthcare could stand on government payments alone.. not saying the private sector is without its problems. but the article is villainizing the entities that are paying, and victimizing the one that are collapsing our practices. if medicare/medicaid was so lucrative you wouldnt see these hospitals closing down, practices folding, etc..

if you look at which health care entities are thriving, i would certainly bet it goes hand in hand with a higher payer mix of private payers. and if you look at the ones that are failing, i would be you see a higher payer mix of CMS

Don’t underestimate the ability of local politics to allow grossly incompetent and corrupt individuals to make incredibly bad eight, nine, and ten figure mistakes.
All of which contribute to failing systems.

 

[Neopolymath]

So this is how we end up with 40 item problem lists on Epic! Every problem they’ve ever had since 1951.

Please remember the EMR is 99% about billing and 1% about record keeping and 0.001% about patient care. Thanks!

 

[deleted643396]

i think CMS is cheap for everyone across the board.. i dont think healthcare could stand on government payments alone.. not saying the private sector is without its problems. but the article is villainizing the entities that are paying, and victimizing the one that are collapsing our practices. if medicare/medicaid was so lucrative you wouldnt see these hospitals closing down, practices folding, etc..

if you look at which health care entities are thriving, i would certainly bet it goes hand in hand with a higher payer mix of private payers. and if you look at the ones that are failing, i would be you see a higher payer mix of CMS

Did you read it? That article is talking about fraud. It’s not a discussion about the fairness of payments or even “villainizing” private insurers. The article is about insurance companies committing fraud and encouraging physicians to commit fraud. If you are looking for a discussion about the fairness of CMS payments, perhaps this is not the article for that. I’m not sure why you keep trying to shoehorn a discussion about the viability of CMS payments onto an article about a very specific subset of privatized Medicare and the fraudulent system that has developed around it.

 

[Hoya11]

Did you read it? That article is talking about fraud. It’s not a discussion about the fairness of payments or even “villainizing” private insurers. The article is about insurance companies committing fraud and encouraging physicians to commit fraud. If you are looking for a discussion about the fairness of CMS payments, perhaps this is not the article for that. I’m not sure why you keep trying to shoehorn a discussion about the viability of CMS payments onto an article about a very specific subset of privatized Medicare and the fraudulent system that has developed around it.

I did read it. I get that its about fraud and thats wrong. Check out the comments section. Its the unsaid implication of the article that this is yet another F up of private insurance and as long as we have private insurance these things will happen. And this is the NYT readers opinions, educated informed people, no idea of the actual workings of the medicare for all they are preaching ..

 

[deleted643396]

I did read it. I get that its about fraud and thats wrong. Check out the comments section. Its the unsaid implication of the article that this is yet another F up of private insurance and as long as we have private insurance these things will happen. And this is the NYT readers opinions, educated informed people, no idea of the actual workings of the medicare for all they are preaching ..

One of my philosophies of life is to avoid comments sections.

Maybe the real story is how the government keeps passing laws that continues to enrich these powerful insurance companies? Between privatized Medicare and No Surprise Acts, insurance companies have been racking up a lot of wins lately.

 

[vector2]

One of my philosophies of life is to avoid comments sections.

Maybe the real story is how the government keeps passing laws that continues to enrich these powerful insurance companies? Between privatized Medicare and No Surprise Acts, insurance companies have been racking up a lot of wins lately.

The problem is pure free market capitalistic healthcare is a libertarian nightmare wherein we leave old and poor people to die in the gutter, and every mention of single-payer healthcare is met with cries of stalinistic death panels, so we're left in this hellish in-between where all we have is literally the worst mishmash of both systems.

 

[chessknt]

The problem is pure free market capitalistic healthcare is a libertarian nightmare wherein we leave old and poor people to die in the gutter, and every mention of single-payer healthcare is met with cries of stalinistic death panels, so we're left in this hellish in-between where all we have is literally the worst mishmash of both systems.

It truly is the worst. I have had the pleasure of finally getting to interface with my healthcare plan this year for a medical issue on one of my kids and it has been beyond infuriating. I even know their stupid lexicon and still can't manage to overcome the mountain of nonsense they erect on their "in-network" providers. I had a phone rep outright like to me, another who didn't know two letter state abbreviations, hours on the phone with these people with essentially no alternative recourse. Just to get more denied claims in the end and it all starts over again. The whole time I'm thinking--what is the point of all this? Why is Dr a in network but Dr b isn't when both are charging the same rate. Why is the deductibe 4x more depending on in or out of network? Why are there so many legions of low level incompetent roadblocks who serve no purpose other than to waste my time?

 

[doctalaughs]

How about insurance companies behaving badly? Privatized Medicare defrauding taxpayers out of billions.

‘The Cash Monster Was Insatiable’: How Insurers Exploited Medicare for Billions (Published 2022)

By next year, half of Medicare beneficiaries will have a private Medicare Advantage plan. Most large insurers in the program have been accused in court of fraud.

www.nytimes.com

archive.ph

The result of this article is 100% predictable. Of course mega-companies are going to look at the rules and try to game the system to maximize profits- 100% predictable if you pay more for “sicker” patients then these companies will do everything possible to document their insured are sicker. Now it sounds like some committed fraud, which is illegal— but that doesn’t mean in the future they won’t push the limit as much as possible if it makes money.

Why don’t lawmakers stop creating a mountain of increasingly complex rules and payment systems, “metrics” and billing rules that will continue to be gamed by the companies that hire the most MBAs and lawyers to interpret those artificial rules?

 

[deleted1130227]

It truly is the worst. I have had the pleasure of finally getting to interface with my healthcare plan this year for a medical issue on one of my kids and it has been beyond infuriating. I even know their stupid lexicon and still can't manage to overcome the mountain of nonsense they erect on their "in-network" providers. I had a phone rep outright like to me, another who didn't know two letter state abbreviations, hours on the phone with these people with essentially no alternative recourse. Just to get more denied claims in the end and it all starts over again. The whole time I'm thinking--what is the point of all this? Why is Dr a in network but Dr b isn't when both are charging the same rate. Why is the deductibe 4x more depending on in or out of network? Why are there so many legions of low level incompetent roadblocks who serve no purpose other than to waste my time?

Rationing by inconvenience.

 

[deleted87051]

Rationing by inconvenience.

Appealing denials of care is a normal part of the process. Doctors and patients are used to it now.

One of our orthopedists makes a point of calling the “peer to peer” reviewer at 4:55pm because he knows the reviewer is clueless and wants to stop working at 5 so they will fold quickly.

What a waste of time and resources.

 

[chessknt]

Appealing denials of care is a normal part of the process. Doctors and patients are used to it now.

One of our orthopedists makes a point of calling the “peer to peer” reviewer at 4:55pm because he knows the reviewer is clueless and wants to stop working at 5 so they will fold quickly.

What a waste of time and resources.

Each insurance company also has their own made up criteria. I have an ALS patient who struggles to breathe while supine, tried to get him a ventilator but he didn't meet criteria because he didn't have awake hypercapnia or pfts showing severe restriction. Now he has to complete a sleep study to qualify. It sefies comprehension.

 

[abolt18]

Each insurance company also has their own made up criteria. I have an ALS patient who struggles to breathe while supine, tried to get him a ventilator but he didn't meet criteria because he didn't have awake hypercapnia or pfts showing severe restriction. Now he has to complete a sleep study to qualify. It sefies comprehension.

What about supine and vertical PFTs to compare? That should be able to demonstrate significant change in volumes when supine.

 

[chessknt]

What about supine and vertical PFTs to compare? That should be able to demonstrate significant change in volumes when supine.

The insurance company only has hypercapnia or fvc as qualifying criteria couldn't care less about his mip of 10%

 

[abolt18]

The insurance company only has hypercapnia or fvc as qualifying criteria couldn't care less about his mip of 10%

Sad 🙁

Intern year on my pulmonology rotation we got consulted for an old guy with a new O2 requirement despite normal CT chest/CTPE, and effectively normal PFT. Our attending suggested a repeat of his spirogram but supine, which demonstrated severe restrictive disease. Immediate neurology consult -> -> ALS. Turns out that new foot drop his PCP had attributed to his diabetes and neuropathy was actually something more nefarious going on.

We sent him home with a ventilator (Trilogy).