The company says it is protecting nursing home residents by curbing unnecessary hospital transfers. Whistleblowers allege cost-cutting tactics have endangered the elderly
          • null@piefed.nullspace.lolEnglish
            12·
            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
              2·
              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.lolEnglish
                12·
                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?