The company says it is protecting nursing home residents by curbing unnecessary hospital transfers. Whistleblowers allege cost-cutting tactics have endangered the elderly
There is only a rebate if the government can prove they spent less than 80% or payments and more than 20% on management. They will still deny coverage so they make more money.
The claim is that they use the DDD tactic to legally game the system and make more money. You’re making a claim about fraud. These are vastly different topics.
No, for denying, defending, or delaying claims being inherently fraudulent acts, under the law.
I’m just curious if you even have any though. It’s okay if you don’t, we can just grant you that for the sake of the discussion and move on to the actual question:
How does that type of fraud change the math for* revenue with respect to premiums premiums vs healthcare spend?
There is only a rebate if the government can prove they spent less than 80% or payments and more than 20% on management. They will still deny coverage so they make more money.
The claim is that they use the DDD tactic to legally game the system and make more money. You’re making a claim about fraud. These are vastly different topics.
DDD is also fraud.
Not in the legal sense.
It’s not legal, it’s just set up so it’s nearly impossible to prove.
Source?
You want sources for malpractice, practicing medicine without a license, and breach of contract?
No, for denying, defending, or delaying claims being inherently fraudulent acts, under the law.
I’m just curious if you even have any though. It’s okay if you don’t, we can just grant you that for the sake of the discussion and move on to the actual question:
How does that type of fraud change the math for* revenue with respect to premiums premiums vs healthcare spend?
It doesn’t, it’s just fraud. Go ahead and look up the relevant laws for the illegal actions I listed.
They use those tactics to avoid shelling out money that they’re supposed to.
I can only assume that you’re just being obtuse at this point.