• null@piefed.nullspace.lol
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    20 hours ago

    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.

              • null@piefed.nullspace.lol
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                17 hours ago

                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?

                • SpaceNoodle@lemmy.world
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                  17 hours ago

                  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.

                  • null@piefed.nullspace.lol
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                    17 hours ago

                    They use those tactics to avoid shelling out money that they’re supposed to.

                    But how?

                    a = Premiums
                    b = Healthcare spend
                    c = Rebates
                    d = Revenue
                    
                    b + c = (a x 0.8)
                    
                    d = a - (b + c)
                    d = a - (a x 0.8)
                    d = a x 0.2
                    

                    Therefore, no matter how much you drop b, d is still always going to be 20% of a.

                    Where does the extra amount in d come from?