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posted by chromas on Sunday July 21 2019, @10:01AM   Printer-friendly
from the ever-wonder-why-health-care-is-so-expensive dept.

Ever since her 14-year marriage imploded in financial chaos and a protective order, Amy Lankford had kept a wary eye on her ex, David Williams.

Williams, then 51, with the beefy body of a former wrestler gone slightly to seed, was always working the angles, looking for shortcuts to success and mostly stumbling. During their marriage, Lankford had been forced to work overtime as a physical therapist when his personal training business couldn't pay his share of the bills.

So, when Williams gave their three kids iPad Minis for Christmas in 2013, she was immediately suspicious. Where did he get that kind of money? Then one day on her son's iPad, she noticed numbers next to the green iMessage icon indicating that new text messages were waiting. She clicked.

What she saw next made her heart pound. Somehow the iPad had become linked to her ex-husband's personal Apple device and the messages were for him.

Most of the texts were from people setting up workouts through his personal training business, Get Fit With Dave, which he ran out of his home in Mansfield, Texas, a suburb of Fort Worth. But, oddly, they were also providing their birthdates and the group number of their health insurance plans. The people had health benefits administered by industry giants, including Aetna, Cigna and UnitedHealthcare. They were pleased to hear their health plans would now pay for their fitness workouts.

Lankford's mind raced as she scrolled through the messages. It appeared her ex-husband was getting insurance companies to pay for his personal training services. But how could that be possible? Insurance companies pay for care that's medically necessary, not sessions of dumbbell curls and lunges.

Insurance companies also only pay for care provided by licensed medical providers, like doctors or nurses. Williams called himself "Dr. Dave" because he had a Ph.D. in kinesiology. But he didn't have a medical license. He wasn't qualified to bill insurance companies. But, Lankford could see, he was doing it anyway.

As Lankford would learn, "Dr. Dave" had wrongfully obtained, with breathtaking ease, federal identification numbers that allowed him to fraudulently bill insurers as a physician for services to about 1,000 people. Then he battered the system with the bluntest of ploys: submit a deluge of out-of-network claims, confident that insurers would blindly approve a healthy percentage of them. Then, if the insurers did object, he gambled that they had scant appetite for a fight.

By the time the authorities stopped Williams, three years had passed since Lankford had discovered the text messages. In total, records show, he ran the scheme for more than four years, fraudulently billing several of the nation's top insurance companies — United, Aetna and Cigna — for $25 million and reaping about $4 million in cash.

Read the rest at ProPublica.


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  • (Score: 5, Insightful) by Rosco P. Coltrane on Sunday July 21 2019, @11:31AM (27 children)

    by Rosco P. Coltrane (4757) on Sunday July 21 2019, @11:31AM (#869597)

    You get to enjoy the quality of care you see today because "unabashed raging capitalism" dumps money by the truckload into medical research and development.

    That's so naive it's almost cute...

    The pharma industry dumps monye into whatever yields the best returns. So for instance, for cancer, malaria, AIDS or kidney failure, their priority is developing expensive meds that keep the patient alive but don't actually cure them - else the lucrative source of income would dry up. That's why your private pharma corps still havent come up with a malaria or AIDS vaccine. It takes a publicly-funded lab to pursue such unprofitable ventures.

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  • (Score: 3, Insightful) by The Mighty Buzzard on Sunday July 21 2019, @12:09PM (25 children)

    That's so naive it's almost cute...

    Check your medical history over the past hundred years or so. The majority of all significant advances are examples of US badassitude.

    --
    My rights don't end where your fear begins.
    • (Score: 1, Insightful) by Anonymous Coward on Sunday July 21 2019, @12:16PM (3 children)

      by Anonymous Coward on Sunday July 21 2019, @12:16PM (#869609)

      The majority of all significant advances are examples of US badassitude.

      Yup, that sure looks like one true setup for a Scotsman joke.

      • (Score: 2) by The Mighty Buzzard on Sunday July 21 2019, @12:42PM

        Oh we're leading in insignificant advances as well, it's just less absurd to count only the things that make a major difference in the medical care you can receive rather than lumping zit creams and PET scans together.

        --
        My rights don't end where your fear begins.
      • (Score: 3, Insightful) by aristarchus on Sunday July 21 2019, @07:40PM (1 child)

        by aristarchus (2645) on Sunday July 21 2019, @07:40PM (#869707) Journal

        The Buzzard just want to make America Great again, and is willing to "No True Scotsman" do make it so. As a bird of carrion, he has a lot in common with Big Pharma, and the Capitalist death-feeding industry.

        • (Score: 2) by c0lo on Monday July 22 2019, @04:53AM

          by c0lo (156) Subscriber Badge on Monday July 22 2019, @04:53AM (#869837) Journal

          The Buzzard just want to make America Great again

          Naaah, he just want to fish.
          He's hoping that someone will MAGA, 'cause he heard promises.

          --
          https://www.youtube.com/watch?v=aoFiw2jMy-0 https://soylentnews.org/~MichaelDavidCrawford
    • (Score: 0) by Anonymous Coward on Sunday July 21 2019, @03:47PM

      by Anonymous Coward on Sunday July 21 2019, @03:47PM (#869644)

      There really have not been many advances since the 1950s, and most of those are by "crackpots" like Kary Mullis and Raymond Damadian.

    • (Score: 3, Insightful) by HiThere on Sunday July 21 2019, @03:59PM (9 children)

      by HiThere (866) Subscriber Badge on Sunday July 21 2019, @03:59PM (#869648) Journal

      While you've got a bit of a point, it's worth noting that a lot of their "improvements" are the US patent office recognizing things as improvements which are trivially better than what was being done elsewhere. It *is* a benefit, in that it acts as a screening mechanism, because a whole lot of "what was being done elsewhere" is true shit, but it's not the kind of improvement you are thinking it is, and they add a whole bunch of costs.

      Additionally, they *do* have a strong preference for things that are treatments rather than cures, for obvious financial reasons. So they don't fork out the kind of money for "human trials" for things that would cure diseases as they do for things that promise recurring payments. (Just consider the efforts they put into Viagra.)

      So. You're partially right. But a different system is still needed. I would personally prefer that research be separated from marketing totally, but designing a workable system is not something I've convinced myself I could do. (I'm not talking about getting it implemented, just a flow-chart level design at the top level.) Saying "That other system was worse than our system" isn't much of a defense. For one thing, the Russians weren't really interested in broadly based medical care, beyond the basics, so your "proof" isn't a valid argument, but more specifically, there's more than two ways of organizing things. State supported academia, for instance, should not have been allowed to have partial ownership in pharmaceutical companies. Just how that law should have been written is not, however, clear. We do want to encourage state sponsorship of academia for multiple valid reasons.

      --
      Javascript is what you use to allow unknown third parties to run software you have no idea about on your computer.
      • (Score: 1) by fustakrakich on Sunday July 21 2019, @05:59PM (6 children)

        by fustakrakich (6150) on Sunday July 21 2019, @05:59PM (#869683) Journal

        We have to put the government (taxpayer funding) in competition, not cahoots with the industry.

        --
        La politica e i criminali sono la stessa cosa..
        • (Score: 2) by The Mighty Buzzard on Monday July 22 2019, @10:33AM (5 children)

          Only works if one side of the competition doesn't get to use its bottomless pockets to put the others out of business by eating a loss longer than they can. That's got to be dealt with any time the government is allowed to compete in the private sector or there is no more private sector very soon.

          --
          My rights don't end where your fear begins.
          • (Score: 2, Insightful) by fustakrakich on Monday July 22 2019, @07:22PM (4 children)

            by fustakrakich (6150) on Monday July 22 2019, @07:22PM (#870042) Journal

            It's our pockets, we can use them however we want. That's what voting is about, to determine how our tax dollars are spent. The government is our voice, and wallet. So if we want to compete, we have that right.

            And it won't put honest people out of business, only the scammers will feel the pressure.

            --
            La politica e i criminali sono la stessa cosa..
            • (Score: 2) by The Mighty Buzzard on Tuesday July 23 2019, @04:45AM (3 children)

              The government is our voice, and wallet.

              In an ideal world, yes. Not in this one though.

              --
              My rights don't end where your fear begins.
              • (Score: 1) by fustakrakich on Tuesday July 23 2019, @05:00AM (2 children)

                by fustakrakich (6150) on Tuesday July 23 2019, @05:00AM (#870224) Journal

                Yes, in this one, right here, right now.

                --
                La politica e i criminali sono la stessa cosa..
                • (Score: 2) by The Mighty Buzzard on Tuesday July 23 2019, @09:55AM (1 child)

                  You probably want to seek psychological help. Specifically, have them check you for schizophrenia. That's a pretty severe departure from reality.

                  --
                  My rights don't end where your fear begins.
                  • (Score: 1) by fustakrakich on Tuesday July 23 2019, @06:22PM

                    by fustakrakich (6150) on Tuesday July 23 2019, @06:22PM (#870420) Journal

                    The world is a bit bigger than your view through the pinhole.

                    Your denials of what is in front of you are the real issue.

                    --
                    La politica e i criminali sono la stessa cosa..
      • (Score: 2) by driverless on Monday July 22 2019, @01:43AM (1 child)

        by driverless (4770) on Monday July 22 2019, @01:43AM (#869793)

        While you've got a bit of a point, it's worth noting that a lot of their "improvements" are the US patent office recognizing things as improvements which are trivially better than what was being done elsewhere. It *is* a benefit, in that it acts as a screening mechanism

        It's not a benefit, unless you're referring to a financial benefit for the pharma companies. By continuously applying trivial tweaks to standard medicines, they make sure they never go off patent and become generics, which would affect their bottom line. They're not trivially better "improvements", they're trivially different patentable variations.

        • (Score: 2) by HiThere on Monday July 22 2019, @09:12PM

          by HiThere (866) Subscriber Badge on Monday July 22 2019, @09:12PM (#870079) Journal

          What you're talking about happens, but isn't what I was talking about. Generally the drugs that they tweak for new patents are their own drugs, not someone else's. I was thinking more of things like the way they took tea-tree oil, which had been used as a medicine in India since the Vedas were written, and got it patented in the US.

          There's a reasonable argument that what you were talking about is a larger problem, but it didn't fit as directly into the discussion.

          --
          Javascript is what you use to allow unknown third parties to run software you have no idea about on your computer.
    • (Score: 2, Insightful) by fustakrakich on Sunday July 21 2019, @06:09PM

      by fustakrakich (6150) on Sunday July 21 2019, @06:09PM (#869690) Journal

      No, THIS is the best example of US badassitude [brightspotcdn.com]

      Hopefully, some day, This will be US badassitude [wp.com]

      Capitalism: Wherever abuse the market collective will bear...

      --
      La politica e i criminali sono la stessa cosa..
    • (Score: 4, Informative) by PartTimeZombie on Sunday July 21 2019, @08:55PM (8 children)

      by PartTimeZombie (4827) on Sunday July 21 2019, @08:55PM (#869717)

      Right, like Germ Theory (European)

      Antibiotics (European),

      X-Rays (European)

      Magnetic resonance imaging (European)

      To name just a few. What the US health system is really good for is monetizing those inventions.

      • (Score: 0) by Anonymous Coward on Monday July 22 2019, @12:05AM (3 children)

        by Anonymous Coward on Monday July 22 2019, @12:05AM (#869774)

        I didn't check the others but at least MRI is wrong:

        Raymond Vahan Damadian (born March 16, 1936) is an American physician, medical practitioner, and Mb>inventor of the first MR (Magnetic Resonance) Scanning Machine.

        https://en.wikipedia.org/wiki/Raymond_Damadian [wikipedia.org]

        • (Score: 2) by PartTimeZombie on Monday July 22 2019, @12:19AM (2 children)

          by PartTimeZombie (4827) on Monday July 22 2019, @12:19AM (#869779)

          It is not really wrong.

          Peter Mansfield had something to do with it too. [wikipedia.org]

          Peter Mansfield of the University of Nottingham in the United Kingdom took Lauterbur's initial work another step further, replacing the slow (and prone to artefacts) projection-reconstruction method used by Lautebur's original technique with a method that used frequency and phase encoding by spatial gradients of magnetic field. Owing to Larmor precession, a mathematical technique called a Fourier transformation could then be used to recover the desired image, greatly speeding up the imaging process.

          Also:

          John Francis Bovell was the first person to have an MRI scan in the UK in Southampton General Hospital.

          • (Score: 0) by Anonymous Coward on Monday July 22 2019, @01:05AM (1 child)

            by Anonymous Coward on Monday July 22 2019, @01:05AM (#869785)

            If minor minor tweaks count as inventing something then good luck attributing anything to one country.

            • (Score: 2) by PartTimeZombie on Monday July 22 2019, @01:32AM

              by PartTimeZombie (4827) on Monday July 22 2019, @01:32AM (#869790)

              If making the first practical MRI scanner counts as a "minor tweak" then sure, OK.

              Not that you're wrong though. Lots of people had a hand in that invention.

      • (Score: 2) by The Mighty Buzzard on Monday July 22 2019, @10:37AM (3 children)

        Those are three good ones, yes. Three. Out of a whole lot more than three.

        Also, it's a nit-pick but you don't get to claim all antibiotics by inventing the first.

        --
        My rights don't end where your fear begins.
        • (Score: 2) by PartTimeZombie on Monday July 22 2019, @08:09PM (2 children)

          by PartTimeZombie (4827) on Monday July 22 2019, @08:09PM (#870063)

          You're right, it is a nit-pick.

          I am still wondering what fundamental discoveries the mighty US capitalist medical industry made?

          I can't think of any, except maybe $3,000 ambulance rides.

          • (Score: 2) by The Mighty Buzzard on Tuesday July 23 2019, @04:48AM (1 child)

            The majority, not plurality but majority, of medical advances in the past century or so were made in the US. If you can't even think of one, then you're actively blocking reality from entering your memory to keep it from upsetting your worldview.

            --
            My rights don't end where your fear begins.
  • (Score: 3, Informative) by Runaway1956 on Sunday July 21 2019, @06:02PM

    by Runaway1956 (2926) Subscriber Badge on Sunday July 21 2019, @06:02PM (#869686) Journal

    So, what you appear to be saying is, no one in the world has a publicly funded lab to pursue the vaccine for malaria? No one? None of the wealthiest countries in Africa? None of the wealthiest countries in Asia? None of the countries in the Pacific, or South America? Seriously?

    I think that you have inadvertently made a case for capitalism. No one else can afford to chase after the medical advances that an unabashedly capitalistic country can explore.

    And, remember, I'm not the greatest fan of capitalism. Capitalism is the worst form of economics and government on earth, except for all the rest.