Dawn Cornelis on LinkedIn: Lawsuits take aim at use of AI tool by health insurance companies to… (2024)

19.5% rate increase!https://lnkd.in/gEx_NzXc

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An audit by the U.S. Department of Health and Human Services inspector general’s office found California had been using an outdated calculation method to determine how much federal reimbursem*nts to claim between Oct. 2018 and June 2019. This calculation did not account for the services given to noncitizens, which must be funded by the state, according to the report.https://lnkd.in/gbUX8Ah4

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I preach from the mountaintops that every Employer should consider RosenHealth™ model that is committed to transparency, data-driven decision-making, and fighting for what’s right for patients. By controlling their own destiny, they’ve achieved significant savings (or shall I say, they refuse to feed the beast) while prioritizing the well-being of their associates and the community. If you want to learn more about this program, reach out to me.

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This propublica piece is heartfelt message about Marshall Allen, aka: "Titan of Truth," resonates deeply. Marshall's tireless dedication to exposing injustices in the healthcare system has made a significant impact, and it's heartwarming to read about the 100s if not thousands he has helped both directly and indirectly. Im proud to play my part in assisting to help the young family facing bankruptcy where they faced a $898k hospital bill of which we had appealed over and over until we had exhausted all appeal procedures. I was so angry, so I called Marshall Allen and said "I have a story for you" and we need to expose this bad behaviour of this hospital system that refused to pay for neonatal hospital care of a premature neonate case. This is one of many stories that highlights the Titan of TRUTH advocacy and transparency work. When Marshall confronted the hospital system about the astronomical bill for the premature baby's care, their rapid response demonstrates the influence he wields. It's a testament to the importance of holding institutions accountable and fighting for fair treatment.As we read Marshall's memorial piece, let's also consider supporting his family during this difficult time. Donating to to support his wife and 3 sons. It is a small but meaningful gesture—a way to honor Marshall's legacy and express our gratitude for his unwavering commitment.I give thanks and gratitude that our paths crossed and we will continue your work with passion and integrity. Together, we can all strive for a more just and compassionate healthcare system. 🙏❤️https://lnkd.in/ggfNhUDx

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This tragic news is absolutely devastating . Please consider donating in support of Marshall's family. Marshall Allen the "Titan of TRUTH"!

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Mirza was one of four people arrested and charged in June 2022 [see “Four arrested for alleged Amtrak health-care fraud,” Trains News Wire, June 24, 2022]. According to court documents or statements made in court, Mirza and co-conspirators, between April 2017 and June 2022, were involved in a scheme to bill Amtrak’s health-care plan for services that were either never provided or were medically unnecessary. They would recruit Amtrak employees to participate by paying them to allow those involved in the scheme to use their patient and insurance information to submit false and fraudulent claims. Those involved submitted claims that cost Amtrak at least $1.3 million.

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Update: Patient Advocacy Battlefront- Brother Tom and wife LindaYesterday, our sweet sister Linda was informed by Anthem her lifesaving Ibrance medication is not covered and that her refill due on Monday will not be re- filled. Through her tears she described a day long marathon of calls to Anrhem, PBM, Oncology Dept, pleading to talk to anyone who would listen. Finally, a cancer advocacy group stepped in and was able to get coverage for this months treatment. While this is a short term fix, their is a battle looming with this County Employer group health plan and Third Party Administrator Anthem.I spent over an hour discussing these new challemges they are faced with. I understand their frustration, and I’m sorry to hear about the challenges my family is facing during this vulnerable time. It’s disheartening when essential treatments like Ibrance are denied, especially after diligently meeting financial obligations and insurance requirements. Interesting enough, I discovered a class action lawsuit was filed against Anthem for the denial of Ibrance. Transparency serves as a catalyst for creating a work environment that valtues openness and honesty, promotes accountability and responsibility, and supports continuous learning and improvement. When health data, including clinical outcomes and performance metrics, is made accessible, it enables healthcare providers to identify areas for improvement. By sharing my sister-in-law’s experience, I will continue to highlight the importance of transparency and accountability within healthcare systems.Let this story resonate, and remember that advocating for transparency benefits not only for patients but also the entire healthcare ecosystem. As a plan administrator, staying vigilant and responsive is crucial. This battle is just beggining! in her words: "I'm human, I want to live, I want to spend time with family while I still have time! Do they know the harm that they have caused?"

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Insurance proceeds from urine testing accounted for three-quarters of the clinic's revenue.Dr. William Lawrence Siefert, 70, of Dayton, Ohio, was sentenced to 1.5 years in prison and ordered to pay $1,968,763.10 in restitution. Dr. Timothy Ehn, 51, of Union, Kentucky, was sentenced to 2.5 years and ordered to pay $3,773,569.30.https://lnkd.in/g9D2-5PV

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