United Healthcare and Fannie and Freddie the Parallels

[Mejappz]

We’re constantly told that technology makes everything better, right? It’s supposed to make things faster, more efficient, and even more fair. But if you look a little closer, it’s clear that sometimes, technology is being used in ways that hurt people and communities.

Take United Healthcare, for example. This huge health insurance company is using artificial intelligence (AI) to handle claims and decide what gets paid out. The problem? Their AI system fails in 90% of cases. That’s a crazy high failure rate, and yet they’re still using it to deny claims and leave people without the coverage they need. So instead of helping people, this technology is making the system more complicated and keeping people from getting the care they deserve.

Then there’s the whole mess with Fannie Mae and Freddie Mac—the big government-backed players in the housing market. These companies are using technology to mess with home prices, making them skyrocket and pushing homeownership out of reach for many. On top of that, their tech-driven systems are shutting small businesses and local developers out of the game, making it even harder for everyday people to get a foot in the door. It’s all about using technology to inflate the market and protect the big players, while small businesses and regular folks are left struggling.

Whether it’s United Healthcare using AI to reject health claims or Fannie and Freddie using tech to jack up housing prices, one thing is clear: big companies are using technology to make more money at the expense of the rest of us. Instead of using tech to make things easier and fairer, they’re using it to cut corners, push people out, and put profits first.

So, what do we do about it? Do we let these companies keep using technology to hurt people, or do we demand a system that’s more transparent and accountable? It’s time to think about how tech can really help, not just make the rich even richer. See JBs article below.

 

[Mejappz]

*** FOR IMMEDIATE RELEASE ***​

ARTIFICIAL INTELLIGENCE GONE WILD – IN HEALTH INSURANCE AND HOUSING

VENTURA, Calif. (Dec. 5, 2024) – The killing of United Healthcare CEO Brian Thompson in Midtown Manhattan this week has unexpectedly illuminated the health insurance industry’s growing use of artificial intelligence to deny claims without review. It should not have taken a murder to expose this disturbing development.

Observers of government-sponsored mortgage giants Fannie Mae and Freddie Mac will recognize a similarly destructive use of artificial intelligence. The twins’ use of AI has helped lead to housing inflation through a feedback loop the companies have single-handedly caused.

In both instances, it’s about the misapplication of AI, or perhaps the inherent flaws of AI itself. The aims are different, but the distortion is similar.

On the health insurance side, three class-action lawsuits were filed late last year and are raising concerns that insurance companies were mindlessly using AI to deny claims without ever examining patient records.

It's difficult to know exactly when insurance companies began using AI tools in the denial of claims. The companies typically don’t share information about such internal processes. Multiple health care and tech leaders told the publication Newsweek that they had begun noticing accelerated claims denials between 2019 and 2020.

Cigna was hit with a class-action lawsuit last year over an algorithm that reportedly rejected more than 300,000 claims in two months—spending about 1.2 seconds on each. A second suit was filed against the company the following month. A similar lawsuit against UnitedHealthcare claimed the insurer deployed an AI tool to deny care to elderly Medicare Advantage beneficiaries. Weeks later, Humana was served papers for allegedly utilizing the same tool, which had a known 90 percent error rate, according to the initial lawsuit.

Parallels can be drawn between the way health insurers have embraced artificial intelligence to increase denials of costly claims for reimbursement and the way Fannie and Freddie have used AI to reduce denials of credit in federally backed mortgages.

Fannie and Freddie together control between 65 to 70 percent of the United States’ mortgage market. The twins’ regulator, a politics-drenched agency known as the Federal Housing Finance Agency, recently announced nearly all mortgages would be eligible for purchase or guarantee by the twins based on AI-generated appraisals.

Barry Colen, appointed by Maryland’s governor to a panel called the Taskforce on Property Appraisal and Valuation Equity, sought to analyze base parameters used by Fannie for its algorithmic property valuation model, along with information about the developers of the tool and general information about ongoing system management. Fannie claimed its automated valuation tool has been tested and found reliable for generating property values. Colen feared otherwise.

He found the organization impenetrable, its employees presumably working from home with no interest in pretending to have even the most basic level of accountability to the people of his state.

He believes Fannie and Freddie are generating unreliable automated appraisals, along the lines of Zillow’s “Zestimates.” He fears these so-called “black-box appraisals” are being manipulated to inflate appraised values in his state. The beneficiary? The commissioned salespeople and bonused executives in the housing industry, a Fannie ally. He worries Fannie's automated appraisals have been gradually inserting risk into Maryland’s economy and making homes there unaffordable.

In 2021, Zillow abruptly shuttered its once-promising Zillow Offers division. Its iBuying business had purchased thousands of homes, aided by its valuation algorithms, for prices higher than it could sell them for. The move sent the company’s stock tumbling and erased hundreds of millions of dollars in investor value overnight.

Colen’s task force was formed by then-Governor Hogan on the premise that the state has an interest in the twins’ activities, since Marylanders would be left with the clean-up costs, impoverished citizenry and urban blight of another 2007-2008-style housing collapse.

The Maryland task force discovered that two risk-analysis products used originally to evaluate appraisals were later repurposed to replace them altogether.

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Jeremy Bagott is a real estate appraiser and former newspaperman. His most recent book, “The Ichthyologist’s Guide to the Subprime Meltdown,” is a concise almanac that distills the cataclysmic financial crisis of 2007-2008 to its essence. This pithy guide to the upheaval includes essays, chronologies, roundups and key lists, weaving together the stories of the politics-infused Freddie and Fannie; the doomed Wall Street investment banks Lehman and Bear Stearns; the dereliction of duty by the Big Three credit-rating services; the mayhem caused by the shadowy nonbank lenders; and the massive government bailouts. It provides a rapid-fire succession of “ah-hah” moments as it lays out the meltdown, convulsion by convulsion.

# # #​

 

[TerryRohrer]

Beware the Dial. A little tweaking can pay all the bonuses for the Christmas season! A little turn'll do ya (shareholder) or do ya in (patient).

‘Not medically necessary’: Inside the company helping America’s biggest health insurers deny coverage for care | CNN

Every day, patients across America crack open envelopes with bad news. Yet another health insurer has decided not to pay for a treatment that their doctor has recommended. Sometimes it’s a no for an MRI for a high school wrestler with a strained back. Sometimes for a cancer procedure that will...

amp.cnn.com

 

[djd09]

Australian Medical Icon Breaks Down in Tears During Debate with Government Officials Over COVID-19 Vaccine Catastrophe: “The Most Uncontrolled Experimentation Ever on Humankind”​

https://twitter.com/x/status/1864944493486621015

Australian Medical Icon Breaks Down in Tears During Debate with Government Officials Over COVID-19 Vaccine Catastrophe: "The Most Uncontrolled Experimentation Ever on Humankind" | The Gateway Pundit | by Jim Hᴏft

The Pilbara’s Town of Port Hedland passed a significant motion on October 11th, demanding that the Prime Minister, the Premier, and their respective Health Ministers acknowledge and address the concerns raised by the Federal Member for Monash, The Honourable Russell Broadbent MP, through...

www.thegatewaypundit.com

they are letting the mortgage brokers estimate value...what could go wrong

 

[Mejappz]

These CEOs are popping in their pants.

The ‘Chilling’ Fatal Shooting of a C.E.O. Has Business Leaders on Edge

A Fortune 500 pharmaceutical company raised its drug prices, and then board members and executives received phone calls threatening violence.

dnyuz.com

 

[Mejappz]

Beware the Dial. A little tweaking can pay all the bonuses for the Christmas season! A little turn'll do ya (shareholder) or do ya in (patient).

‘Not medically necessary’: Inside the company helping America’s biggest health insurers deny coverage for care | CNN

Every day, patients across America crack open envelopes with bad news. Yet another health insurer has decided not to pay for a treatment that their doctor has recommended. Sometimes it’s a no for an MRI for a high school wrestler with a strained back. Sometimes for a cancer procedure that will...

amp.cnn.com

Very similar to CU and ACE.

This is where tweaking the dial comes in. EviCore can adjust the algorithm to increase the number of requests sent for review, according to five former employees. The more reviews, the higher the chance of denials.

Here’s how it works, the former employees said: The algorithm reviews a request and gives it a score. For example, it may judge one request to have a 75% chance of approval, while another to have a 95% chance. If EviCore wants more denials, it can send on for review anything that scores lower than a 95%. If it wants fewer, it can set the threshold for reviews at scores lower than 75%.

 

[TerryRohrer]

Very similar to CU and ACE.

This is where tweaking the dial comes in. EviCore can adjust the algorithm to increase the number of requests sent for review, according to five former employees. The more reviews, the higher the chance of denials.

Here’s how it works, the former employees said: The algorithm reviews a request and gives it a score. For example, it may judge one request to have a 75% chance of approval, while another to have a 95% chance. If EviCore wants more denials, it can send on for review anything that scores lower than a 95%. If it wants fewer, it can set the threshold for reviews at scores lower than 75%.

What moron would create an AVM without the same functionality? It is not like anyone will find it, even in the unlikely event anyone looks!

 

[chad hampton]

I know it's not a great look that this week, a handful of other HI companies suddenly decided to change some of their policies they had enacted over the years that screwed over policy holders. Sort of like admitting you've been gouging for all these years. Maybe this is a wake up call to the corporations that a new day is dawning. I'm sure there are discussions going on at a lot of these large corporations today.

 

[Dublin ohio]

Just to throw this out there. I wonder how many of those refusals are on Medicare add on plans. Because Medicare controls most of what happens with those plans

 

[Mejappz]

I know it's not a great look that this week, a handful of other HI companies suddenly decided to change some of their policies they had enacted over the years that screwed over policy holders. Sort of like admitting you've been gouging for all these years. Maybe this is a wake up call to the corporations that a new day is dawning. I'm sure there are discussions going on at a lot of these large corporations today.

I think unfortunately it will take a few more scalps for them to get the message finally. And not just the in insurance industry.

'It seemed unbelievable': Anthem Blue Cross Blue Shield reverses decision on anesthesia coverage time limits

Anthem Blue Cross Blue Shield has reversed course on a controversial plan to no longer cover anesthesia for the full length of certain surgeries in New York.

www.wkbw.com