The Washington Post Says Prescription Data is Used to Assess Consumers

The Washington Post reports that Milliman, Inc. and Ingenix Inc. compile individual “medical report” profiles on insurance consumers. Amid growing privacy concerns, the Washington Post calls these reports, “health “credit reports” drawn from databases containing prescription drug records on more than 200 million Americans.”

How does it this technology work?

“When an insurer makes an online query about an applicant, Ingenix or Milliman’s servers scour the data and within minutes or less return reports to a central server at the company. The server aggregates the information going back as far as five years, including the drugs and dosages prescribed, dates filled and refilled, the therapeutic class and the name and address of the prescribing doctor.”

Then comes the analysis. The MedPoint data tool, sold by Ingenix Inc., provides insurers a “pharmacy risk score,” or a number that represents an “expected risk” for a group of people. Of course, higher scores imply higher medical costs. Likewise, Milliman Inc.‘s IntelliScript codes pharmaceutical drugs for classification, according to the insurer’s instructions. So called “high-risk” codes could include AIDS cocktail drugs and cancer medications (both Ingenix and Milliman refuse to release their coding standards).

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FTC Decision and Order against Ingenix, Inc. (2008)

On February 6, 2008, the Federal Trade Commission filed a decision and order of their complaint against Ingenix, Inc. (In the Matter of INGENIX, INC., A CORPORATION. DOCKET NO. C-4214).

Consumers should be aware that Ingenix Inc. sells a medical data product called “MedPoint,” which collects and distributes personal medical information to paying corporations.

Ingenix Inc., operates MedPoint, a medical data collection and sales technology. The medical profile generated by MedPoint includes, but is not limited to, 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 specialty medical practice. The medical profile generated by MedPoint analyzes the individual’s prescription drug history, and provides, based on that analysis, potential medical conditions that may be present and predictive scores for the individual.

All consumers can request an annual copy of their MedPoint reports from Ingenix Inc. by calling (888) 206-0335 or writing to: MedPoint Compliance, Ingenix, Inc., 2525 Lake Park Blvd, West Valley City Utah 84120.  Additional contact information can be found at www.ingenix.com/ContactUs/.

The public Federal Trade Commission decision and order against Ingenix, Inc. is reprinted below, in full.

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Take Action – All Consumers are Entitled to Request Annual Medical Reports (FCRA)

If you wouldn’t apply for credit without reviewing your credit report, don’t apply for health and life insurance without checking your medical report.

Health and life insurance corporations have powerful technologies for evaluating and pricing individual insurance applicants: personal “medical report” files. The Washington Post says that these medical reports, which are like credit reports for your health records, have been created for more than 200 million Americans.

Alarmingly, your medical report files may include both medical and non-medical information about you. For instance, personal data collected by the Medical Information Bureau (MIB) may include medical conditions, credit report history, driving records, criminal activity, drug use, sexual orientation, participation in hazardous sports, and personal or family genetic history. Using information from your medical report files, insurance companies can charge higher premiums or terminate coverage. (more…)

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Medical Debt: Is Our Healthcare System Bankrupting Americans?

Most Americans are not familiar with the the role medical debt plays in consumer bankruptcy. One of the most alarming accounts of the role medical debt plays in bankruptcy ccomes from Ms. Aparna Mathur, a scholar from the American Enterprise Institute (AEI). In particular, Mathur concluded “nearly 27 percent of filings are a consequence of primarily medical debt.”

An important new paper on the topic of medical debt now comes from Ms. Melissa Jacoby at the University of North Carolina and Ms. Mirya Holman at Duke University. These legal scholars examined court records and survey responses from the Consumer Bankruptcy Project (CBP). They conclude, “By combining the methods, we find that nearly four out of five respondents had some financial obligation for medical care not covered by insurance in the two years prior to filing, but only about half of the court records contain identifiable medical debt, and of substantially more modest amounts.”

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More Elder Americans forced to File for Medical Bankruptcy

On Tuesday, July 28, the House Judiciary Committee’s Subcommittee on Administrative and Commercial Law held a hearing on the topic of whether the U.S. healthcare system is bankrupting Americans. Among those appearing before the House Judiciary Subcommittee, the hearing centered on testimony from legal experts representing the Consumer Bankruptcy Project (CBP). In his testimony, University of Michigan Law School Professor John Pottow commented,

“Why are the elder filing so much more now for bankruptcy? One important reason appears to be medical bankruptcy.”

Based on a preliminary review of the data, the Consumer Bankruptcy Project reached the following conclusions about “medical bankruptcies” and elder bankruptcy filers:

  • 39% specifically identified medical problem of the debtor or spouse or another family member as a reason for filing bankruptcy.
  • 32% specifically said medical bills were a reason for bankruptcy.
  • 30% incurred more than $5,000 or 10% of annual household income in out-of-pocket medical bills.
  • 25% incurred more than $5,000 in out-of-pocket medical bills.
  • 11% lost two or more weeks of wages because of lost time from work to deal with a medical problem for themselves or a family member.
  • 4% mortgaged home to pay for medical bills.

Specifically, the hearing focused on the CBP study on medical bankruptcies and contained research on rising elder Americans filing for medical bankruptcy.

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FTC Complaint Against Ingenix Inc., a UnitedHealth Group Company (2008)

In 2008, the Federal Trade Commission filed a complaint against Ingenix, a UnitedHealthGroup, Inc. Company. (In the Matter of INGENIX, INC., A CORPORATION. DOCKET NO. C-4214).

Consumers should be aware that Ingenix Inc. sells a medical data product called “MedPoint,” which collects and distributes personal medical information to paying corporations.

Ingenix Inc., a wholly owned subsidiary of UnitedHealth Group, Inc., has contractual relationships to acquire data from Pharmacy Benefit Managers (“PBM”), which maintain records of individuals’ prescription drug histories. Ingenix Inc., through MedPoint, obtains an insurance applicant’s five-year prescription drug history from the PBMs and creates a prescription medical profile on the applicant for the insurance company. The medical profile generated by MedPoint includes, but is not limited to, 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 specialty medical practice. The medical profile generated by MedPoint analyzes the individual’s prescription drug history, and provides, based on that analysis, potential medical conditions that may be present and predictive scores for the individual.

In its complaint, the Federal Trade Commission avers that Ingenix, Inc., through its product MedPoint, is a consumer reporting agency, and therefore subject to the regulations of the Fair Credit Reporting Act, 15 U.S.C. § 1681a(f), because,

“MedPoint 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. Ingenix, Inc. furnishes these consumer reports to third parties through the means or facilities of interstate commerce.”

You can request a copy of your MedPoint report from Ingenix Inc. by calling (888) 206-0335 or writing to: MedPoint Compliance, Ingenix, Inc., 2525 Lake Park Blvd, West Valley City Utah 84120. Additional contact information can be found at www.ingenix.com/ContactUs/.

The public Federal Trade Commission complaint against Ingenix, Inc. is reprinted below, in full. (more…)

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Personal Prescription Data is Bought and Sold by Insurers and Pharmaceutical Companies

Prescriptions, and all the information on them — including not only the name and dosage of the drug and the name and address of the doctor, but also the patient’s address and Social Security number — are a commodity bought and sold in a murky marketplace, often without the patients’ knowledge or permission.

If enforced, the federal stimulus law enacted by the Obama administration in February 2009 prohibits in most cases the sale of personal health information, with a few exceptions for research and public health measures like tracking flu epidemics.  The new provisions also tighten rules for telling patients when hackers or health care workers have stolen their Social Security numbers or medical information, as happened to Britney Spears, Maria Shriver and Farrah Fawcett before she passed away in June 2009.
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Prescription Analytics: Corporate Databases Track What’s In Your Medicine Cabinet

Insurance Applicant and Policyholder Screening RescissionHealth and genetic information is regarded as the most private of information. People desire to keep their medical and health care records private for many reasons, including personal privacy, avoiding stigmas associated with certain diseases or conditions, and preventing job and economic discrimination.

When the New York Times reported on pharmacy marketing and advertising databases for sale, the Internet was generally outraged.  However, there seems to be less or concern (or a general unawareness), regarding the prescription analytics that corporations are now utilizing to construct massive medical and prescription databases.

According to a BusinessWeek Special Report from 2008, health care providers and insurers work with medical data brokers to compile records of your prescription activity.  Based on this data, insurers and health care providers charge consumers more for coverage, deny pay-outs, or rescind coverage altogether.

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Nobody Knows the Medical Information Bureau (MIB) (Secrecy and Privacy)

The Medical Information Bureau Inc. (MIB Inc.) (a/k/a, MIB Group, Inc., a/k/a, MIB, Inc., a/k/a, MIB Solutions, Inc.) has been the subject of ongoing controversy since the 1970’s, when its existence first became generally known. Even today, the Medical Information is an unknown entity; most consumers, doctors, and even politicians, remain unaware of its existence.

The Medical Information Bureau has a penchant for secrecy. For many years, insurance agencies consulted MIB without telling applicants about the files. MIB even had an unlisted phone number. Today, the secret continues, if to a lesser extent: MIB won’t publish its list of corporate members or release the list of codes it uses. More importantly, the MIB refuses to provide a centralized, secure, online source for consumers to request, review, and dispute their medical report files.

The following article, “Nobody Knows the MIB” by, Simson Garfinkel is excerpted from Database Nation: The Death of Privacy in the 21st Century (2000):

“… As part of his Ph.D. thesis at Harvard Business School on privacy policies in corporate America, Jeff Smith surveyed more than a thousand people on a variety of privacy issues, and conducted in-depth interviews with several dozen. One of the key questions he asked was whether people had ever heard of a company called the Medical Information Bureau (MIB). What he found wasn’t terribly surprising: they hadn’t… I asked my wife if she knew what the Medical Information Bureau was. She said she didn’t. (more…)

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Medical Information Bureau (MIB) Fact Sheet is Current (from 1990)

The Medical Information Bureau (a/k/a, MIB Group, Inc., a/k/a, MIB, Inc., a/k/a, MIB Solutions, Inc.) is the nation’s largest insurance reporting agency. Under Federal law, every consumer is entitled to a free annual copy of their medical report file.

MIB’s basic purpose was (and continues to be) to detect and deter fraud and misrepresentation in connection with the underwriting of life and health insurance and claims. MIB helps “keep the cost of insurance down for insurance companies and for consumers by preventing losses that would occur due to fraud or omissions,” says Neil Day, MIB’s president.

For many years, insurance agencies consulted MIB without telling applicants about the files. MIB even had an unlisted phone number. Today, the secret continues, if to a lesser extent: MIB won’t establish a secure website for consumers to request, review, and dispute their MIB medical reports.

In the past the Medical Information Bureau (MIB) reported codes in consumers’ files for such non-medical information as “sexual deviance” and “sloppy appearance.” MIB, Inc. President Neil Day disagrees, but since the Medical Information Bureau (MIB) won’t release the list of conditions for which it has created codes, there is really no way to know for sure. There have also been disagreements over the accuracy of MIB’s files.

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Medical Information Privacy: The American Medical Association Judicial Council Rules (AMA)

Health and genetic information is regarded as the most private of information. People desire to keep their medical and health care records private for many reasons, including personal privacy, avoiding stigmas associated with certain diseases or conditions, and preventing job and economic discrimination.

In the medical field, the confidentiality of medical information is protected, at the most basic level, by the ethical and professional rules of the American Medical Association (AMA). Specifically, the American Medical Association (AMA) issued the following professional rule in the “Current Opinions of the Judicial Council of the American Medical Association Canon 5.05”

“The information disclosed to a physician during the course of the relationship between physician and patient is confidential to the greatest possible degree…The physician should not reveal confidential communications or information without the express consent of the patient, unless required to do so by law.”

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Confidentiality of Medical Information: The Oath and Law of Hippocrates (American Medical Association AMA)

Health and genetic information is regarded as the most private of information. People desire to keep their medical and health care records private for many reasons, including personal privacy, avoiding stigmas associated with certain diseases or conditions, and preventing job and economic discrimination.

In the medical field, the confidentiality of medical information is protected, at the most basic level, by the ethical rules of the “Oath and Law of Hippocrates,” which was established circa 400 B.C.  Here is the Oath and Law of Hippocrates:

“Whatever, in connection with my professional service, or not in connection with it, I see or hear, in the life of men, which ought not to be spoken of abroad, I will not divulge, as reckoning that all such should be kept secret.”

The modern health care system is complex and personal medical data is disclosed as a matter of operating procedure. Medical data is disclosed to doctors, nurses, and other professional staff. In addition, patient-level medical and care data is widely circulated among insurers, hospitals, employers, government agencies, health care information brokers, pharmacy benefit managers, and the American Medical Association.

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Patients Have to Beg Doctors to Opt-Out of Medical Data Collection (American Medical Association)

For the past 60 years, the American Medical Association has made the AMA Physician Masterfile available for sale to corporations and other medical entities. Currently, purchasers of the AMA Physician Masterfile database include pharmaceutical companies, consultants, market research firms, insurance companies, hospitals, medical schools, medical equipment and supply companies, health data brokers, and commercial organizations.

AS A PATIENT, information about your medical care is included in the American Medical Association’s collection of physicians’ practice-level data. All doctors are automatically enrolled to have their practice-level information recorded, UNLESS the doctor affirmatively acts to opt-out. It is NOT the choice of the patient, but the choice of the doctor as to whether the patient’s information will be sold.

The American Medical Association does not grant any doctor or patient the opportunity to prevent information about their medical care from being collected in the Physician Masterfile Database. However, the AMA has been willing to give doctors the choice to opt-out of mailing solicitations and sales calls from pharmaceutical representatives. Specifically, the American Medical Association has two options for doctors wishing to “opt-out” of the sale of their patients’ medical information: (1) the Do Not Contact (DNC) restriction and (2) the Do Not Release (DNR) restriction.

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American Medical Assoc. Senior VP tells how your Medical Data is Identified

Dr. Robert Musacchio, PhD, is the Senior Vice President of Publishing and Business Services for the American Medical Association (AMA). In this role, Dr. Musacchio is in charge of the AMA’s Department of Database Licensing, which sells access to the AMA Physician Masterfile Database. In 2002, sales of licenses to the American Medical Association’s (AMA) Physician Masterfile generated $20 million in revenue for the organization. By 2007, sales of the AMA Physician Masterfile had reached $40 million per year.

Although the AMA claims information in its Physician Masterfile has been “de-identified,” it is a fact that merging the AMA Physician Masterfile with just one other commercially available database of patient medical info, such as IntelliScript or MedPoint, will cause private patient information to be identifiable.

From Dr. Musacchio directly, here is how the pharmaceutical companies utilize the AMA’s Physician Masterfile database:

“[Pharmaceutical corporations] take our data as well as [data from] several dozen other databases and combine them together with information that they receive from pharmacies, and they put together a picture of physicians’ prescribing habits — by zip code, by specialty, by individual physician — and they use it for their planning and marketing purposes(more…)

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American Medical Students Association SCHOOLS the regular American Medical Association

In July 2007, protests at the American Medical Association (AMA) annual meeting in Chicago brought to the forefront the fact that the AMA has begun disclosing information in its Physician Masterfile, or physician database, to pharmaceutical companies. The American Medical Student Association (AMSA) are protesting the “sales” of these data for pharmaceutical marketing purposes.

In defense, the AMA calls the financial arrangement “licensure” and notes that physicians have the right to opt-out of sharing their personal information (although not its collection.) Likewise, the AMA opt-out options do not limit the AMA’s ability to store this medical data indefinitely into the future; physician information collected by the AMA is never deleted from the Masterfile, even after the physician’s death. Since the AMA began compiling physician data in 1906, the Masterfile is now more than a century old and includes approximately 900,000 physicians, about two thirds of whom are not AMA members.

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Your Doctor Probably Doesn’t Know She’s Selling Your Medical Care Info

The American Medical Association closely tracks the activities of physicians from medical school to death. In its Physician Masterfile, the AMA merges all of the information it has ever collected about physicians and the medical care they provide.

The AMA began compiling physician data in 1906—the Physician Masterfile is now more than a century old and includes records for approximately 900,000 physicians, about two thirds of whom are not AMA members. Physician records are never removed from the AMA Physician Masterfile, even in the case of a physician’s death.

The results of a Kaiser Family Foundation research study showed that only 60% of physicians were aware that the American Medical Association is selling their information through the AMA Physician Masterfile Database, but 74% of physicians were opposed to the practice once they were so informed.

Even worse, doctors were less informed about their ability to opt-out of having their practice-level data sold, according to an American Medical Association survey in January 2007, only about 10% to 15% of physicians were aware of the AMA’s Physician Data Restriction Program (PDRP); a second survey in late May showed that physician awareness had increased to 33%.

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Which IT Vendors does the American Medical Association (AMA) License to Sell your Medical Data?

In 2002, sales of licenses to the American Medical Association’s (AMA) Physician Masterfile generated $20 million in revenue for the organization. By 2007, sales of the AMA Physician Masterfile had reached $40 million per year. What is the American Medical Association Physician Masterfile? And why is it so profitable for the AMA?

The American Medical Association closely tracks the activities of physicians from medical school to death. In its Physician Masterfile, the AMA merges all of the information it has ever collected about physicians and the medical care they provide. The AMA began compiling physician data in 1906—the Physician Masterfile is now more than a century old and includes records for approximately 900,000 physicians, about two thirds of whom are not AMA members. Physician records are never removed from the AMA Physician Masterfile, even in the case of a physician’s death.

For the past 60 years, the American Medical Association has made the AMA Physician Masterfile available to the health care community; today, the AMA has contractual arrangements with Database Licensees (e.g., vendor companies) who specialize in a variety of health-related marketing services and research activities. Purchasers of the AMA Physician Masterfile database include pharmaceutical companies, consultants, market research firms, insurance companies, hospitals, medical schools, medical equipment and supply companies, health data brokers, and commercial organizations.

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What is the American Medical Association’s Masterfile Physician Database?

In 2002, sales of licenses to the American Medical Association’s (AMA) Physician Masterfile generated $20 million in revenue for the organization. By 2007, sales of the AMA Physician Masterfile had reached $40 million per year.

“As a physician, I have no knowledge or control over data about me that is sold in the AMA Physician Masterfile,” said Michael Mendoza, MD, MPH, a clinical assistant professor of family medicine at the Pritzker School of Medicine, University of Chicago in Illinois.

What is the American Medical Association Physician Masterfile database? And why is it so profitable for the AMA?

The American Medical Association (AMA), founded in 1847 and incorporated 1897, is the largest association of physicians and medical students in the United States. Throughout its history, the AMA has been actively involved in a variety of medical policy issues, from Medicare and HMOs to public health, and climate change.

The American Medical Association closely tracks the activities of physicians from medical school to death. In its Physician Masterfile, the AMA merges all of the information it has ever collected about physicians and the medical care they provide. The AMA began compiling physician data in 1906—the Physician Masterfile is now more than a century old and includes records for approximately 900,000 physicians, about two thirds of whom are not AMA members. Physician records are never removed from the AMA Physician Masterfile, even in the case of a physician’s death.

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Former Healthcare Exec Blows the Whistle on Media Tactics

Wendell Potter, the former Chief Spokesman of Cigna, returned to the Bill Moyers Journal on PBS on July 31, 2009. Potter continued to blow the whistle on the “slash and burn” PR tactics of the health and insurance industry lobbying and trade groups.

“All it takes is one illness or accident among employees at a small business to prompt an insurance company to hike the next year’s premiums so high that the employer has to cut benefits, shop for another carrier or stop offering coverage altogether, leaving workers uninsured,” Wendell Potter, who retired as Cigna’s chief spokesman last year, said in testimony to the Senate Commerce, Science and Transportation Committee.

Health insurers, including Cigna, purge such accounts through “intentionally unrealistic rate increases,” Potter testified, adding that the number of small businesses offering coverage to their employees has declined significantly over 15 years.

Wendell Potter, the former Chief Spokesman of Cigna, returned to the Bill Moyers Journal on PBS on July 31, 2009. The full transcript from Moyer’s interview with Wendell Potter is below:

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Cigna Chief PR Spokesman Quits to Blow the Whistle

Wendell Potter, the former Chief Spokesman of Cigna Corporation, appeared on the Bill Moyers Journal on PBS on July 10, 2009.

After a 20-year career as a corporate public relations executive, Wendell Potter left last year he left his job as head of communications for Cigna, one of the nation’s largest health insurers, to try his hand at helping socially responsible organizations — including those advocating for meaningful health care reform — achieve their goals. Before his switch, Potter held a variety of positions at CIGNA Corporation over 15 years, serving most recently as head of corporate communications and as the company’s chief corporate spokesman.

Potter also speaks out on both the need for a fundamental overhaul of the American health care system and on the dangers to American democracy and society of the decline of the media as watchdog, which has contributed to the growing and increasingly unchecked influence of corporate PR. Prior to joining CIGNA, Potter headed communications at Humana Inc., another large for-profit health insurer and was director of public relations and advertising for The Baptist Health System of East Tennessee.

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