Video – PBS Interview of Aetna Executive Wendell Potter (Part 2)

Meet Wendell Potter. Bill Moyers interviews former health insurance industry executive Wendell Potter, who left the field after almost 20 years to become a health reform advocate.

Watach Wendell Potters’ experiences inside the health insurance industry, their work fighting a public option, and the insurance companies close ties to Washington. (more…)

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Video – PBS Interview of Former Aetna Executive, Wendell Potter (Part 1)

Meet Wendell Potter. Bill Moyers interviews former health insurance industry executive Wendell Potter, who left the field after almost 20 years to become a health reform advocate.

Watch Wendell Potters’ experiences inside the health insurance industry, their work fighting a public option, and the insurance companies close ties to Washington. (more…)

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Media Resources for Newspapers, Television, Radio, Internet

Contact a local or national media outlet to help educate other consumers about how the insurance industry uses “medical report” files to set prices, hunt for pre-existing conditions, and rescind insurance policies.

Some keywords for the insurance industry are: underwriting, rescission, policy rating, nationwide specialty consumer reporting agencies, medical report files, annual disclosure request. (more…)

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Medical Problems Could Include Identity Theft and Credit Report Complications

Medical identity theft is happening frequently in the United States. The last time federal data on the crime was collected, for a 2007 report, more than 250,000 Americans a year were victims of medical identity theft. That number has almost certainly increased since then, because of the increased use of electronic medical records systems built without extensive safeguards, said Pam Dixon, executive director of the nonprofit World Privacy Forum and author of a report on medical identity theft.

And uncountable, Ms. Dixon said, are the people who do not yet know they are victims. They may not know that their medical information has been tampered with for months or even years until, as in Mr. Sharp’s case, it shows up in collections on a credit report. With medical identity theft, the fraudulent charges can remain unpaid and unresolved for years, permanently damaging your credit rating.
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Resumen de sus Derechos Legales Bajo la Ley de Informes de Credito Justos (Fair Credit Reporting Act)

Se trata de un“Resumen de Sus Derechos Bajo el Fair Credit Reporting Act” (“Informes de Credito Justos“), preparado por la Comisión Federal de Comercio (http://www.annualcreditreport.gov). Conozca sus derechos como consumidor! (more…)

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FTC Decision and Order against Milliman, Inc. (2008) (Fair Credit Reporting Act)

On February 6, 2008, the Federal Trade Commission filed a decision and order of their complaint against Milliman, Inc. (In the Matter of MILLIMAN, INC., A CORPORATION. DOCKET NO. C-4213).

CONSUMERS should be aware that one of Milliman, Inc.’s information exchange products, IntelliScript, is:

“a data aggregation service that provides individual medical profiles, including, but not limited to, prescription drug purchase histories of insurance applicants, to health and life insurance companies. The medical profile generated by IntelliScript includes, but is not limited to: all prescription drugs, including dosage and number of refills filled by the insurance applicant for the previous five years. It also includes, for each drug, the name and address of the dispensing pharmacy, as well as the name and address of the prescribing doctor, including medical specialty. The medical profile generated by IntelliScript analyzes the individual’s prescription drug history and provides a “map” of the risk levels associated with each drug, based on information provided by the insurer.” (Source, FTC complaint)

Furthermore, the Federal Trade Commission avers that Milliman, Inc.’s, in providing medical profiles generated by IntelliScript to insurers, is:

“Now and has been a consumer reporting agency, as that term is defined in Section 603(f) of the Fair Credit Reporting Act, 15 U.S.C. §1681a(f), because it regularly engages in the practice of assembling or evaluating consumer credit information or other information on consumers for the purpose of furnishing consumer reports to third parties for monetary fees, dues, or on a cooperative nonprofit basis. Milliman, Inc. furnishes these consumer reports to third parties through the means or facilities of interstate commerce.”

The public FTC decision and order is reprinted below, in full:

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FTC Complaint against Milliman, Inc. (2008) (Fair Credit Reporting Act)

In 2008, the Federal Trade Commission filed a complaint against Milliman, Inc. (In the Matter of MILLIMAN, INC., A CORPORATION. DOCKET NO. C-4213).

CONSUMERS should be aware that one of Milliman, Inc.’s information exchange products, IntelliScript, is a

“data aggregation service that provides individual medical profiles, including, but not limited to, prescription drug purchase histories of insurance applicants, to health and life insurance companies. The medical profile generated by IntelliScript includes, but is not limited to: all prescription drugs, including dosage and number of refills filled by the insurance applicant for the previous five years. It also includes, for each drug, the name and address of the dispensing pharmacy, as well as the name and address of the prescribing doctor, including medical specialty. The medical profile generated by IntelliScript analyzes the individual’s prescription drug history and provides a “map” of the risk levels associated with each drug, based on information provided by the insurer.” (Source, FTC complaint)

The Federal Trade Commission avers that Milliman, Inc.’s product, IntelliScript, is purchased and used by, “insurance companies or underwriting or claims review purposes,” and by, “Pharmacy Benefit Managers (“PBMs), which maintain records of individuals’ prescription drug histories.”

The public FTC complaint is reprinted below, in full:

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Pharmaceutical Drug Makers Use Online Quiz RealAge to Secretly Collect Personal Data

More than 27 million people have taken the online test “RealAge” which asks 150 or so questions about lifestyle and family history to assign a “biological age,” how young or old your habits make you. Most consumers are unaware that their answers are being collected by pharmaceutical companies, healthcare corporations, and insurance companies. “Literally millions of people have unknowingly signed up,” said Peter Lurie, the deputy director of the Health Research Group at Public Citizen, a public interest group in Washington.

The test has received widespread publicity because of its affiliation with Dr. Mehmet Oz, a popular author and regular on “The Oprah Winfrey Show.” Dr. Oz — “America’s Doctor,” as he is known on Oprah — is a RealAge spokesman and adviser, and his soothing, simple approach to health is reflected in RealAge’s message: you can change.
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FTC – Summary of Your Rights Under the Fair Credit Reporting Act (FCRA)

This is a “Summary of Your Rights Under the Fair Credit Reporting Act” prepared by the Federal Trade Commission (http://www.annualcreditreport.gov). Know your rights as a consumer!

The Federal Fair Credit Reporting Act (FCRA) promotes the accuracy, fairness, and privacy of information in the files of consumer reporting agencies. There are many types of consumer reporting agencies, including credit bureaus and specialty agencies (such as agencies that sell information about check writing histories, medical records, and rental history records). Here is a summary of your major rights under the Fair Credit Reporting Act (FCRA). (more…)

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New Credit Card Law Will Curb FreeCreditReport.com Ads

The credit card reform bill signed into law by President Obama on May 26, 2009 attempts to put a stop to several unfair practices of the credit card industry — it also targets misleading advertisements for phony “free” credit reports.

The “free credit report” advertised non-stop on cable television, it bears repeating, isn’t free at all.  The law calls for the Federal Trade Commission to issue new rules that will force free credit report advertisers to inform consumers that the only place for a free credit report is AnnualCreditReport.com.

Television and radio ads will also be required to include a pretty deflating statement: “This is not the free credit report provided for by Federal law.” (more…)

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Experian Consumer Direct Settles FTC Charges over Consumerinfo.com & FreeCreditReport.com

On August 16, 2005 , the most prolific marketer of paid credit report services, Experian Consumer Direct, has settled Federal Trade Commission charges that it deceptively marketed “free credit reports” by not adequately disclosing that consumers automatically would be signed up for a credit report monitoring service and charged $79.95 if they didn’t cancel within 30 days, in violation of federal law. The settlement requires Consumerinfo to pay redress to deceived consumers, bars deceptive and misleading claims about “free” offers, requires disclosure of terms and conditions of any “free” offers, and requires the defendant to give up $950,000 in ill-gotten gains.

According to the FTC complaint, the defendant drove consumers to their www.freecreditreport.com and www.consumerinfo.com Web sites with radio, television, e-mail and Internet ads that promised free credit reports and a bonus – free trials of a credit-monitoring service. Ads made claims such as:

FREE! FREE! FREE! Get Your FREE Credit Report Online in Seconds!!!!
Click here to get a FREE copy of your online Credit Report Instantly!
And that’s not all. . . along with your INSTANT credit report, we’ll give
you 30 FREE days of the Credit Check Monitoring Service at no obligation.

Consumers were required to provide detailed personal information and a valid credit card account number to get their credit report. They were assured that, “Your card will not be charged during the free trial period. However, valid credit card information is required to establish your account.”

According to the FTC’s complaint, Consumerinfo’s advertising and Web sites failed to explain adequately that after the free trial period for the credit monitoring service expired, consumers automatically would be charged a $79.95 annual membership, unless they notified the defendant within 30 days to cancel the service. Consumerinfo billed the credit cards that it had told consumers were “required only to establish your account,” and, in some cases, automatically renewed memberships by re-billing consumers without notice. The FTC charged that the defendant’s failure to adequately disclose the automatic billing and to get consumers’ consent to bill their accounts violated federal law.
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Ingenix Inc. & Milliman Inc. Agree to Comply with Fair Credit Reporting Act

On September 17, 2007, two providers of consumers’ medical profiles used in determining eligibility for life and health insurance agreed to settle Federal Trade Commission charges that, as consumer reporting agencies (CRAs), they failed to provide insurance companies with the Notice to Users of Consumer Reports required by the Fair Credit Reporting Act (FCRA).

“Consumer reporting companies sell information that can play a critical role in the price consumers pay for a variety of products and services – or even whether they’re eligible for them,” said Lydia Parnes, Director of the FTC’s Bureau of Consumer Protection. “These cases make clear that all consumer reporting companies must comply with the laws that protect consumers’ rights.”

The proposed respondents, Ingenix, Inc. and Milliman, Inc., provide individual medical profiles, including prescription drug purchase histories of insurance policy applicants, to insurance companies that use them in making underwriting decisions. With applicants’ consent, Ingenix and Milliman obtain five-year prescription drug histories from Pharmacy Benefit Mangers and create prescription medical profiles. Based on their analysis of the information, they report potential medical conditions that may be present.

According to the Commission, the medical profiles are consumer reports because they include information that bears on an individual’s personal characteristics and are used to determine their eligibility for insurance. Ingenix and Milliman are CRAs because they assemble and evaluate consumer report information for the purpose of furnishing it to third parties.

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FTC Publishes Proposed Breach Notification Rule for Electronic Health Information

The Federal Trade Commission announced on April 16, 2009 that it has approved a Federal Register notice seeking public comment on a proposed rule that would require entities to notify consumers when the security of their electronic health information is breached.

The American Recovery and Reinvestment Act of 2009 (the Recovery Act) includes provisions to advance the use of health information technology and, at the same time, strengthen privacy and security protections for health information. Among other things, the Recovery Act recognizes that there are new types of Web-based entities that collect or handle consumers’ sensitive health information. Some of these entities offer personal health records, which consumers can use as an electronic, individually controlled repository for their medical information. Others provide online applications through which consumers can track and manage different kinds of information in their personal health records. For example, consumers can connect a device such as a pedometer to their computers and upload miles traveled, heart rate, and other data into their personal health records. These innovations have the potential to provide numerous benefits for consumers, which can only be realized if they have confidence that the security and confidentiality of their health information will be maintained.
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Consumer Reporting Agency TALX Corp. Agrees to Settle FTC Charges

On July 9, 2009, the TALX Corporation, a subsidiary of Equifax Inc., agreed to settle Federal Trade Commission charges that it violated federal law by failing to provide certain disclosures to users of their consumer reports and to entities that provide information for consumer reports. The proposed settlement requires TALX to pay a $350,000 civil penalty and bars future violations.

The proposed settlement requires TALX to provide the required notices to users and furnishers. If TALX provides the notices electronically, it must follow certain specifications to make the notices “clear and prominent.” Specifically, the notices must be unavoidable, of a size and shade and on the screen for a duration sufficient for an ordinary consumer to read and comprehend them, easily printable, and presented on the principal screen or landing page where the disclosure is relevant. These requirements are designed to ensure that the notices will be effective in communicating the information online.

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No ‘Free’ Lunch on Credit Report Sites

From the Consumers Union Webwatch, a research study citing the problematic use of ‘Free’ in advertising creates confusion over rights to consumer credit data.

“”Web sites aggressively advertising “free” credit reports are charging consumers for services they are unlikely to need, while drawing attention away from the site created by law to provide consumers with free credit data every year, says a Consumer Reports WebWatch study.

The report notes that the proliferation of Web sites offering “free” credit reports may confuse consumers. Some of those sites even appear to disparage the information on offer from annualcreditreport.com.

“It seems disingenuous for the same credit reporting companies who were required by the federal government to provide free credit reports to be so heavily engaged in selling these reports to consumers bundled with other credit-related services,” says Robert Mayer, professor of consumer studies at the University of Utah, author of the report.

Of the 24 sites analyzed, nine were owned by or closely connected to TransUnion and eight were owned by or otherwise closely connected to Experian, the largest advertiser on the Web. This concentrated market structure has potentially negative consequences for competition and aspects of market performance (e.g., price, quality, choice, and innovation), the report’s author concludes.The Fair and Accurate Credit Transaction Act of 2003 (FACTA) entitles consumers to obtain, once a year, a free copy of their credit reports from each of the three major credit reporting bureaus–Equifax, Experian, and TransUnion. The site set up to deliver those reports is www.annualcreditreport.com.

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Merck and Schering-Plough Settle Drug Claims on Vytorin and Zetia

American pharmaceutical corporations Merck & Co. and Schering-Plough Corp. announced on July 15, 2009 that they will pay $5.4 million to settle civil claims that the companies covered up test results that cast doubt on the effectiveness of two blockbuster cholesterol drugs.

The companies settled with attorneys general from 35 states and the District of Columbia. The investigation centered on claims the companies kept the results from unfavorable studies quiet, violating consumer protection laws. Merck, Whitehouse Station, N.J., and Schering-Plough, Kenilworth, N.J., will pay back the costs of the investigation, but don’t have to make other payments or admit wrongdoing or liability.

In January 2008, the companies released studies showing Vytorin and Zetia, sold by the Merck/Schering-Plough Pharmaceuticals joint venture, were not more effective than an older drug at reducing plaque buildup in the blood vessels of the neck. The testing was finished in 2006 and the companies faced criticism for not releasing the results sooner.

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UnitedHealth Takes On Microsoft, Google With Online Health Venture

In February 2008, UnitedHealth Group launched its own Web site for people to store their personal health information. The website competitor’s include Microsoft and Google.

The service, at myoptumhealth.com lets people create their own digital-health records, putting the health insurer into direct competition with Microsoft’s HealthVault and Google Health. Microsoft launched its site in 2007, ahead of Google, which went live with its offering in 2008. All three sites provide their service free of charge.

Like other health-portals, such as WebMD, UnitedHealth’s new site is open to all comers — not just clients of the insurer — and features information about medical conditions and diseases. The insurer also plans to market its products, such as medical, dental and vision insurance through the site. Rivals insurers, such as Aetna and WellPoint already offer digital-health records through their sites, but to a narrower group of consumers: health-plan members and employees of large corporate clients, the Wall Street Journal writes.
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FTC Facts for Businesses: What Insurers Need to Know about Consumer Reports

Facts for Businesses: What Insurers Need to Know about Consumer Reports

[Informtion Provided by the FEDERAL TRADE COMMISSION]

As an insurer, you may use consumer reports to underwrite insurance policies and to screen high-risk applicants—as long as you comply with the Fair Credit Reporting Act (FCRA).

The Act
The FCRA is designed to protect the privacy of consumer report information and to guarantee that the information supplied by credit reporting agencies (CRAs) is as accurate as possible. Consumer reports may include information on an applicant’s credit history, medical conditions, driving record, criminal activity, and hazardous sports. Amendments to the FCRA, which went into effect September 30, 1997, increase the legal obligations of insurers who use consumer reports.

The Adverse Action Notice
The following disclosure requirement applies to new applicants as well as current policy holders. When an adverse action is taken—such as a decision to deny insurance, increase rates, or terminate a policy—and it is based solely or partly on information in a consumer report, Section 615(a) of the FCRA requires you to provide a notice of the adverse action to the consumer. The notice must include:

  • the name, address, and telephone number of the CRA that supplied the consumer report, including the toll-free telephone number for credit bureaus that maintain files nationwide;
  • a statement that the CRA that supplied the report did not make the decision to take the adverse action and cannot give the specific reasons for it; and a notice of the individual’s right to dispute the accuracy or completeness of any information the CRA furnished, and the consumer’s right to a free report from the CRA upon request within 60 days. Disclosure of this information is important because some consumer reports may contain errors. The adverse action notice is required even if information in the consumer report was not the main reason for the denial or rate increase. Even if the information in the report played only a small part in the overall decision, the applicant still must be notified.

While written adverse action notices are not required, many insurers provide them and keep copies for two years to show compliance with the FCRA.
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US Senate Commerce Committee Report Criticizes Insurers’ Use of Ingenix Inc. Database

Senate report criticizes plans’ use of Ingenix database- The findings are similar to what New York’s attorney general found in his investigation, which resulted in insurers promising to create a new system.

An investigation by the U.S. Senate Committee on Commerce, Science and Transportation has found that the same controversial system for setting “usual, customary and reasonable” pay that was criticized in New York also underpaid patients across the rest of the country.

The report, released June 24, 2009, details the way insurers for the last decade have used Ingenix’s information to set out-of-network pay rates.

A lengthy investigation by New York Attorney General Andrew Cuomo and a series of lawsuits against health plans already had outlined the problems with the industry’s use of a database owned and operated by UnitedHealth Group subsidiary Ingenix. The Senate report reiteratedwhat the New York attorney general and the American Medical Association have said before — that the use of the Ingenix database resulted in underpayments to patients and physicians everywhere in the United States. Committee Chair Jay Rockefeller (D, W.Va.) condemned insurers’ use of the Ingenix data.

The report also gave ammunition to critics of the health insurance industry at a time when health plans are trying to have a major role in crafting health system reform. It found that plans using the data also were contributing to it, allowing insurers to feed charges into the database that were skewed downward.

More than 2 million federal employees and military service members were enrolled in plans that used the Ingenix database to set out-of-network pay, potentially reducing reimbursements for out-of-network care.

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MIB, Inc. Pays IBM Corporation for New Technology (IBM’s DataPower)

IBM Corporation (NYSE: IBM) announced on February 13, 2008, that MIB, Inc., the largest provider of fraud detection services to the North American life and health insurance industries, is building a service oriented architecture (SOA) using IBM technology to better serve its clients.

MIB, Inc. is moving towards an SOA so its members can more easily integrate the services they need from MIB with their own business systems. At the same time, SOA is allowing MIB to reuse its existing software in new ways that allow the company to better serve its 500 member life and health insurance companies. IBM’s DataPower SOA security appliance gives MIB the functionality it needs to meet its architectural goals. By combining IBM DataPower SOA security appliances with Web 2.0 capabilities and rich Internet applications, customers are assured of secure data exchanges and presentation of information in a familiar interface that takes advantage of the latest Web innovations.

“As a central clearinghouse for information significant to risk selection, one of MIB’s competitive differentiators is our ability to offer accurate, timely information that prevents insurance fraud and is easily integrated with our members’ automated business processes,” said Alexander Klevitsky, director of Architecture and Enterprise Software, MIB, Inc. “IBM’s sophisticated WebSphere integration software, DB2 database and REST Web services are enabling us to maintain our leadership position by building a secure and powerful SOA on our zSeries enterprise server, thereby protecting our existing investments in technology while building a foundation for the future.”
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