Mastodawn

Reed Mideke Nov 8, 2023

The insanity of American "healthcare", in one toot:
Blue Cross denies patient doctor-recommend cancer treatment

Patient (a successful lawyer) pays $100K out of pocket, sues

After several years, patient wins. 5th circuit rules treatment should have been approved

Blue Cross now argues it should only have to reimburse the $35K discount rate it *would have paid if it approved*, not the $100K the patient actually paid

https://www.propublica.org/article/blue-cross-proton-therapy-cancer-lawyer-denial

Big Insurance Met Its Match When It Turned Down a Top Trial Lawyer’s Request for Cancer Treatment

Blue Cross and Blue Shield denied payment for the proton therapy Robert “Skeeter” Salim’s doctor ordered to fight his throat cancer. But he was no ordinary patient. He was a celebrated litigator. And he was ready to fight.

ProPublica

Reed Mideke Nov 8, 2023

Blue Cross is also apparently on the hook for $25K of $36K of patient's legal costs (a bro deal from one of patient's lawyer buddies, likely not available to most normal humans)

Original case
https://www.courtlistener.com/docket/14897575/salim-v-louisiana-health-service-indemnity-co/

Appeal
https://www.courtlistener.com/docket/67321092/salim-v-la-health-svc-indemnity/

Reed Mideke Nov 17, 2023

*shocked* to find the invisible hand once again optimizing for profit, not patient outcomes
https://arstechnica.com/health/2023/11/ai-with-90-error-rate-forces-elderly-out-of-rehab-nursing-homes-suit-claims/

UnitedHealth uses AI model with 90% error rate to deny care, lawsuit alleges

For the largest health insurer in the US, AI's error rate is like a feature, not a bug.

Ars Technica

Reed Mideke Nov 21, 2023

Judge in that Blue Cross case wasn't too impressed with their claim they should only have to reimburse their negotiated rate, rather than what patient already paid. Gave them 3 days to cough up the full $95,862.95 plus interest, and they're on the hook for some more legal costs

https://www.courtlistener.com/docket/14897575/salim-v-louisiana-health-service-indemnity-co/#entry-64

Reed Mideke Nov 21, 2023

Which by my count means without even counting their legal costs, they're about $100,000 worse off than they would have been if they'd just approved his treatment ¯\_(ツ)_/¯

Reed Mideke Jan 18, 2024

"private equity buys out a hospital, saddles it with debt, and then reduces operating costs by cutting services and staff—all while investors pocket millions" - The Greatest Heathcare System in the World™

https://arstechnica.com/health/2024/01/hospitals-slash-staff-services-quality-of-care-when-private-equity-takes-over/?utm_brand=arstechnica&utm_social-type=owned&utm_source=mastodon&utm_medium=social

Hospitals owned by private equity are harming patients, reports find

Hospital ratings dive and medical errors rise when private equity firms are in charge.

Ars Technica

Reed Mideke Aug 21, 2024

The World's Greatest Healthcare System™
Steward Health Care System CEO Ralph de la Torre "paid a management consulting firm $30 million a year to "provide executive oversight and overall strategic directive." But, de la Torre was the majority owner of the consulting firm, which also employed other Steward executives"

https://arstechnica.com/science/2024/08/as-hospitals-failed-and-patients-died-ceo-reportedly-netted-250m/

CEO of failing hospital chain got $250M amid patient deaths, layoffs, bankruptcy

Steward Health Care System, run by CEO Ralph de la Torre, filed for bankruptcy in May.

Ars Technica

Reed Mideke Aug 21, 2024

How could a byzantine network of opaque, unaccountable, profit-driven intermediaries not be produce The World's Greatest Healthcare System™?
https://www.nytimes.com/2024/04/07/us/health-insurance-medical-bills.html?unlocked_article_code=1.Ek4.TAmf.DA2yAc5EBdNf&smid=url-share

#GiftArticle #GiftLink #HealthCare #MultiPlan

Insurance Companies Reap Hidden Fees as Patients Get Unexpected Bills

A little-known data firm helps health insurers make more when less of an out-of-network claim gets paid. Patients can be on the hook for the difference.

The New York Times

Reed Mideke Sep 12, 2024

Steward Health Care System CEO Ralph de la Torre, previously seen in this thread paying his own consulting company millions while bankrupting Steward, has decided to fuck around with the United States Senate. Let's see how that works out for him https://arstechnica.com/science/2024/09/ceo-of-health-care-terrorists-faces-contempt-charges-after-senate-no-show/?utm_brand=arstechnica&utm_social-type=owned&utm_source=mastodon&utm_medium=social

CEO of “health care terrorists” faces contempt charges after Senate no-show

Senators are pursuing both civil and criminal contempt charges.

Ars Technica

Reed Mideke Sep 21, 2024

Bipartisanship isn't completely dead: The Senate Health, Education, Labor, and Pensions committee voted 20-0 that Steward Health Care System CEO Ralph de la Torre should move on to the Find Out phase
https://arstechnica.com/science/2024/09/rich-ceo-of-failed-hospitals-could-face-prison-time-as-contempt-charges-advance/

Senate panel votes 20–0 for holding CEO of “health care terrorists” in contempt

After he rejected subpoena, contempt charges against de la Torre go before Senate.

Ars Technica

Reed Mideke Sep 27, 2024

The full Senate voted unanimously (!) that that Steward Health Care System CEO Ralph de la Torre should Find Out

https://arstechnica.com/science/2024/09/senate-holds-rich-ceo-of-third-world-medicine-hospitals-in-contempt/

Senate holds rich CEO of “third-world medicine” hospitals in contempt

Ralph de la Torre, CEO of Steward, faces up to 12 months in prison if convicted.

Ars Technica

de la Torre's lawyers "argued that testifying at the hearing would have violated his Fifth Amendment rights" - which appears to be essentially the same argument that landed Bannon and Navarro in prison ¯\_(ツ)_/¯

As they learned the hard way, you can take the 5th or claim other immunity in congressional testimony, but you have to actually show up and take it on each question

Reed Mideke Sep 30, 2024

Steward Health Care System CEO Ralph de la Torre doubles down on his fuck around strategy. I would suspect a delaying tactic in hopes it would go away in the new term, except that (unlike a subpoena) the referral belongs to the DOJ now and won't expire, and also, the referral was *unanimous* so it's vanishingly unlikely a new senate would be more friendly https://arstechnica.com/science/2024/09/ceo-of-health-care-terrorists-sues-senators-after-contempt-of-congress-charges/?utm_brand=arstechnica&utm_social-type=owned&utm_source=mastodon&utm_medium=social

CEO of “health care terrorists” sues senators after contempt of Congress charges

Suing an entire Senate panel is seen as a "Hail Mary play" unlikely to succeed.

Ars Technica

Reed Mideke Oct 19, 2024

Sure, they bankrupt dozens of hospitals and killed many patients in the process, but "Cerberus has said it made roughly $800 million on its investment in Steward, more than tripling its original investment, even as the hospitals themselves were hemorrhaging cash" so who can really say what was right or wrong?

https://wapo.st/3BQrdRv

#GiftArticle #GiftLink #HealthCare #PrivateEquity #Cerberus

Senate report: How private equity ‘gutted’ dozens of U.S. hospitals

Thanks to modern tricks of financial engineering, investors can prosper even when the underlying business is failing.

The Washington Post

Reed Mideke Oct 19, 2024

Senate report, which make make your blood boil https://www.markey.senate.gov/imo/media/doc/the_steward_health_care_report.pdf

Reed Mideke Nov 14, 2024

'Jillian Watkins, a center manager in Huntington, West Virginia, repeatedly alerted supervisors that Lincare was improperly billing for equipment that patients weren’t using. Lincare blocked her from firing a subordinate who’d falsified documents supporting the charges, then fired Watkins, citing “inadequate direction and leadership.”' and subsequently tried to blame her for the overbilling
https://www.propublica.org/article/lincare-medicare-lawsuit-settlements-oxygen-equipment?utm_source=mastodon&utm_medium=social&utm_campaign=mastodon-post

Lincare Made Billions While Repeatedly Defrauding Medicare. Feds Did Little To Rein It In.

Lincare, the nation’s largest distributor of home oxygen equipment, has repeatedly violated Medicare rules and probation agreements, victimizing ailing patients and costing taxpayers huge sums. The federal government has done little to stop it.

ProPublica

Reed Mideke Nov 26, 2024

DOJ hasn't obviously acted on Steward Health Care System CEO Ralph de la Torre's contempt referral yet, but apparently they have bigger fish to fry "The execution of a search warrant last week is a clear sign that a sprawling federal corruption and fraud investigation against Steward and de la Torre is escalating" https://arstechnica.com/health/2024/11/things-arent-looking-good-for-infamous-ceo-of-health-care-terrorists/?utm_brand=arstechnica&utm_social-type=owned&utm_source=mastodon&utm_medium=social

Things aren’t looking good for infamous CEO of “health care terrorists”

Former Steward CEO Ralph de la Torre faces wide-ranging fraud and corruption probes.

Ars Technica

Reed Mideke Jan 9, 2025

🚩 "in 1995, Perwaiz was indicted in a federal tax fraud case for “falsely claiming a Ferrari luxury sports car as an ultrasound machine so that he could write it off as a business expense,” among other charges"

https://wapo.st/3Wej9RU

#GiftArticle #GiftLink

Virginia hospital indicted over unnecessary surgeries on women

Chesapeake Regional Healthcare billed about $18.5 million in questionable procedures performed by Javaid Perwaiz, who was convicted in 2020, prosecutors say.

The Washington Post

Reed Mideke Mar 16, 2025

"Her case accuses Lincare of putting profits ahead of patient care by failing to make sure that her son got a replacement BiPAP quickly and refusing to provide “loaner equipment” in the meantime, because the company didn’t believe it could bill for it" - The Greatest Healthcare System in the World™ https://www.propublica.org/article/lincare-wrongful-death-lawsuit-sleep-apnea-oxygen

What a Wrongful Death Lawsuit Reveals About America’s Largest Oxygen Provider

When an at-risk sleep apnea patient needed his breathing machine replaced, Lincare, a $2.4 billion behemoth with a decadeslong history of regulatory and legal problems, acted slowly. The result was disastrous.

ProPublica

Reed Mideke Apr 14, 2025

Blue Cross of Louisiana, featured at the start of this thread denying coverage to a cancer patient*, found liable for systematically stiffing a cancer treatment center and ordered to pay $421 million https://www.propublica.org/article/blue-cross-blue-shield-louisiana-insurance-lawsuit-breast-cancer-doctors

* https://mastodon.social/@reedmideke/111372756548391007

“Slow Pay, Low Pay or No Pay”

Blue Cross authorized mastectomies and breast reconstructions for women with cancer but refused to pay the full doctors’ bills. A jury called it fraud and awarded the practice $421 million.

ProPublica

Reed Mideke Apr 14, 2025

Don't know what the odds are of it surviving appeal, but the whole case sure paints a portrait of the Greatest Healthcare System in the World™
https://www.propublica.org/article/blue-cross-blue-shield-louisiana-insurance-lawsuit-breast-cancer-doctors

“Slow Pay, Low Pay or No Pay”

Blue Cross authorized mastectomies and breast reconstructions for women with cancer but refused to pay the full doctors’ bills. A jury called it fraud and awarded the practice $421 million.

ProPublica

Reed Mideke Sep 24, 2025

"Patient death rates increased in the emergency departments of U.S. hospitals acquired by private equity firms compared to similar hospitals not acquired by private equity" - I'm for one am *shocked* to find this happening in the Greatest Healthcare System in the World™

https://hms.harvard.edu/news/deaths-rose-emergency-rooms-after-hospitals-were-acquired-private-equity-firms

Pardon Our Interruption