Are Health Insurance Companies Purposely Trying to Cancel Insurance for Grandfathered Plans by Failing to Charge Automatic Payments?

In recent years, concerns have surfaced about whether health insurance companies are intentionally making it difficult for people to keep their grandfathered plans. Specifically, some policyholders have reported that their automatic payments are not being processed, which could lead to the cancellation of their coverage. This article delves into these concerns and explores whether insurance companies might be purposely creating obstacles for people with older, grandfathered insurance plans.

What Are Grandfathered Health Insurance Plans?

Almost 50% of Hospitalized with COVID-19 Had Mild or Asymptomatic Cases

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US hospitals typically spend $2,424/day to provide inpatient care.  Are hospitalizations another federal money grab? 

Hospital Stay Costs by Insurance Type

A new study suggests that almost half of those hospitalized with COVID-19 have mild or asymptomatic cases.

Researchers from Harvard Medical School, Tufts Medical Center, and the Veterans Affairs Healthcare System took on the task of trying to figure out how serious Covid cases were in those hospitalized, and how many people counted as Covid hospitalizations were actually in the hospital for Covid, versus getting a Covid test after being admitted for something else. 

The study "analyzed the electronic records for nearly 50,000 COVID hospital admissions at the more than 100 VA hospitals across the country," The Atlantic wrote. It "checked to see whether each patient required supplemental oxygen or had a blood oxygen level below 94 percent" in order to try and determine if cases met the NIH's threshold for "severe COVID". 

What the study found was that from March 2020 to January 2021, 36% of Covid cases in the hospital were mild or asymptomatic. From January 2021 to June 2021, during the Delta variant's spread, that number rose all the way to 48%. For vaccinated hospital patients, the number rose to a stunning 57%. 

At least 12,000 Americans have already died from COVID-19 this month, as the country inches through its latest surge in cases. But another worrying statistic is often cited to depict the dangers of this moment: The number of patients hospitalized with COVID-19 in the United States right now is as high as it has been since the beginning of February. It’s even worse in certain places: Some states, including Arkansas and Oregon, recently saw their COVID hospitalizations rise to higher levels than at any prior stage of the pandemic. But how much do those latter figures really tell us?

From the start, COVID hospitalizations have served as a vital metric for tracking the risks posed by the disease. Last winter, this magazine described it as “the most reliable pandemic number,” while Vox quoted the cardiologist Eric Topol as saying that it’s “the best indicator of where we are.” On the one hand, death counts offer finality, but they’re a lagging signal and don’t account for people who suffered from significant illness but survived. Case counts, on the other hand, depending on which and how many people happen to get tested. Presumably, hospitalization numbers provide a more stable and reliable gauge of the pandemic’s true toll, in terms of severe disease. But a new, nationwide study of hospitalization records, released as a preprint today (and not yet formally peer-reviewed), suggests that the meaning of this gauge can easily be misinterpreted—and that it has been shifting over time.

If you want to make sense of the number of COVID hospitalizations at any given time, you need to know how sick each patient actually is. Until now, that’s been almost impossible to suss out. The federal government requires hospitals to report every patient who tests positive for COVID, yet the overall tallies of COVID hospitalizations, made available on various state and federal dashboards and widely reported on by the media, do not differentiate based on the severity of illness. Some patients need extensive medical intervention, such as getting intubated. Others require supplemental oxygen or administration of the steroid dexamethasone. But there are many COVID patients in the hospital with fairly mild symptoms, too, who have been admitted for further observation on account of their comorbidities, or because they reported feeling short of breath. Another portion of the patients in this tally are in the hospital for something unrelated to COVID, and discovered that they were infected only because they were tested upon admission. How many patients fall into each category has been a topic of much speculation. In August, researchers from Harvard Medical School, Tufts Medical Center, and the Veterans Affairs Healthcare System decided to find out.

Researchers have tried to get at similar questions before. For two separate studies published in May, doctors in California read through several hundred charts of pediatric patients, one by one, to figure out why, exactly, each COVID-positive child had been admitted to the hospital. Did they need treatment for COVID, or was there some other reason for admission, like cancer treatment or a psychiatric episode, and the COVID diagnosis was merely incidental? According to the researchers, 40 to 45 percent of the hospitalizations that they examined were for patients in the latter group.

The authors of the paper out this week took a different tack to answer a similar question, this time for adults. Instead of meticulously looking at why a few hundred patients were admitted to a pair of hospitals, they analyzed the electronic records for nearly 50,000 COVID hospital admissions at the more than 100 VA hospitals across the country. Then they checked to see whether each patient required supplemental oxygen or had a blood oxygen level below 94 percent. (The latter criterion is based on the National Institutes of Health definition of “severe COVID.”) If either of these conditions was met, the authors classified that patient as having moderate to severe disease; otherwise, the case was considered mild or asymptomatic.

The study found that from March 2020 through early January 2021—before vaccination was widespread, and before the Delta variant had arrived—the proportion of patients with mild or asymptomatic disease was 36 percent. From mid-January through the end of June 2021, however, that number rose to 48 percent. In other words, the study suggests that roughly half of all the hospitalized patients showing up on COVID-data dashboards in 2021 may have been admitted for another reason entirely, or had only a mild presentation of the disease.

This increase was even bigger for vaccinated hospital patients, of whom 57 percent had mild or asymptomatic disease. But unvaccinated patients have also been showing up with less severe symptoms, on average, than earlier in the pandemic: The study found that 45 percent of their cases were mild or asymptomatic since January 21. According to Shira Doron, an infectious-disease physician and hospital epidemiologist at Tufts Medical Center, in Boston, and one of the study’s co-authors, the latter finding may be explained by the fact that unvaccinated patients in the vaccine era tend to be a younger cohort who are less vulnerable to COVID and may be more likely to have been infected in the past.

Among the limitations of the study is that patients in the VA system are not representative of the U.S. population as a whole, as they include few women and no children. (Still, the new findings echo those from the two pediatric-admissions studies.) Also, like many medical centers, the VA has the policy to test every inpatient for COVID, but this is not a universal practice. Lastly, most of the data—even from the patients admitted in 2021—derived from the phase of the pandemic before Delta became widespread, and it’s possible that the ratios have changed in recent months. The study did run through June 30, however, when the Delta wave was about to break, and it did not find that the proportion of patients with moderate to severe respiratory distress was trending upward at the end of the observation period.

The idea behind the study and what it investigates is important, says Graham Snyder, the medical director of infection prevention and hospital epidemiology at the University of Pittsburgh Medical Center, though he told me that it would benefit from a little more detail and nuance beyond oxygenation status. But Daniel Griffin, an infectious disease specialist at Columbia University, told me that using other metrics for the severity of illness, such as intensive-care admissions, presents different limitations. For one thing, different hospitals use different criteria for admitting patients to the ICU.

One of the important implications of the study, these experts say, is that the introduction of vaccines strongly correlates with a greater share of COVID hospital patients having mild or asymptomatic disease. “It’s underreported how well the vaccine makes your life better, how much less sick you are likely to be, and less sick even if hospitalized,” Snyder said. “That’s the gem in this study.”

“People ask me, ‘Why am I getting vaccinated if I just end up in the hospital anyway?’” Griffin said. “But I say, ‘You’ll end up leaving the hospital.’” He explained that some COVID patients are in for “soft” hospitalizations, where they need only minimal treatment and leave relatively quickly; others may be on the antiviral drug remdesivir for five days, or with a tube down their throat. One of the values of this study, he said, is that it helps the public understand this distinction—and the fact that not all COVID hospitalizations are the same.

But the study also demonstrates that hospitalization rates for COVID, as cited by journalists and policymakers, can be misleading, if not considered carefully. Clearly many patients right now are seriously ill. We also know that overcrowding of hospitals by COVID patients with even mild illness can have negative implications for patients in need of other care. At the same time, this study suggests that COVID hospitalization tallies can’t be taken as a simple measure of the prevalence of severe or even moderate disease, because they might inflate the true numbers by a factor of two. “As we look to shift from cases to hospitalizations as a metric to drive policy and assess the level of risk to a community or state or country,” Doron told me, referring to decisions about school closures, business restrictions, mask requirements, and so on, “we should refine the definition of hospitalization. Those patients who are there with rather than from COVID don’t belong in the metric.”

Among the limitations of the study is that patients in the VA system are not representative of the U.S. population as a whole, as they include few women and no children. (Still, the new findings echo those from the two pediatric-admissions studies.) Also, like many medical centers, the VA has a policy to test every inpatient for COVID, but this is not a universal practice. Lastly, most of the data—even from the patients admitted in 2021—derive from the phase of the pandemic before Delta became widespread, and it’s possible that the ratios have changed in recent months. The study did run through June 30, however, when the Delta wave was about to break, and it did not find that the proportion of patients with moderate to severe respiratory distress was trending upward at the end of the observation period.

Read the article. 

How Big Pharma is Extorting Governments Around The World

An excellent independent news report from WION points out the extortion Pfizer is conducting in order to leverage their own financial interests in various countries around the globe. As outlined in the expose’, The U.S. pharma company is asking for military bases and sovereign assets as guarantees for vaccines delivery.

We have noted how the U.S. government has moved to merge ideological interests with Big Tech to control information. In this report about Pfizer, you see the same merging of government and the pharmaceutical industry to advance their collective interests. There is word for government and corporations working together to control society…

BIG PICTURE – While the specifics of this report focus on multinational corporation Pfizer and the control over the COVID vaccine, it is worth remembering the same type of influence operation happens in other industries.  That is an outcome of the world being driven by government and multinational corporations working together.

What Big Pharma is to global medicines, specifically vaccines, Big Agriculture is to global food production, in every sector.

What Pfizer is doing to extort nations to maximize their profit, so too is Monsanto or Cargill operating on the same premise.  A lemon costs you .89 cents because they want it to cost you .89 cents; not because a ‘free market’ prices it at .89 cents.   The multinationals have long passed the place where ‘free markets’ exist.  Everything is now a controlled market

Beware of COVID-19 Laboratory Testing Scams

Coronavirus Fraud Takes Many Forms as Federal and Local Officials Continue to Pursue Widespread Cases of Clinical Laboratory Testing Scams

Federal investigators have been actively searching for trends of fraud in Medicare claims data for COVID-19 clinical laboratory research since the pandemic started.

According to media studies, dating back to at least March, fraudulent actors offering fake SARS-CoV-2 tests have preyed on vulnerable Americans in a wide range of ways during the public health emergency. In return for swab collections and fake testing, the New York Times reported, some scam operators have gone into nursing homes and long-term care facilities to raise money from unsuspected elders.

The federal Centers for Medicare and Medicaid Programs (CMS) no longer needs a laboratory test requirement signed by a treating physician or other provider for COVID-19 testing after the declaration of the public health emergency in the US. "The high demand for and restricted availability of SARS-CoV-2 samples, along with the decision by CMS to loosen rules during the pandemic for some test orders, makes the situation a potentially ripe one for fraud," said Modern Healthcare.

Moreover, a lack of clarification about the medical necessity of COVID-19 tests might increase the risk of liability for clinical laboratories that are law-abiding. All of these variables make COVID-19 fraud testing a possible bombshell for clinical laboratories performing coronavirus testing that could get caught up in federal research.

Feds Increasing Enforcement

The FBI, the Better Business Bureau (BBB), the FDA, the Federal Department of Health and Human Services ( HHS), and other federal and local authorities have repeatedly alerted physicians, hospitals, and healthcare customers about the potential for fraud by unscrupulous firms pretending to deliver COVID-19 legitimate clinical laboratory tests shortly after the pandemic arrived in the US. "Scammers are selling fraudulent and/or unapproved COVID-19 antibody tests, potentially providing false results," a June 26 FBI press release said.

Some of the fraudsters behind these scams have operated online and through social media and email. While others have conducted these scams in person or over the phone, noted the press release. And yet, the scams and news stories about them have continued to propagate during the COVID-19 pandemic, despite the warnings.

How Do The Fraudsters Work?

Fraudsters aim to collect personal information from customers in many of these scams, including names, birth dates, and social security numbers, as well as other types of personal health information, such as data from Medicare or private health insurance, the FBI said. Scammers can use the data in fraud schemes for medical insurance or to commit identity theft, the agency said.

In addition, any fraudulent or incorrect COVID-19 tests or assays not approved to be used by the FDA may give false results to physicians, potentially creating a dangerous situation for patients. 

The New York Times (NYT) recently announced that a notice "about scammers selling fake COVID-19 antibody tests as a way to access personal information that can be used for identity theft or medical insurance fraud" was released by the FBI.

The BBB added an alert to its website three days after the FBI released its warning about the COVID-19 antibody testing scam:' BBB Scam Alert: Want a COVID-19 test? "There is a scam for that." BBB also provided customers with advice about how to stop scam checking. 

The FDA announced on June 17 that it had given warning letters to three firms for the sale of adulterated and misbranded COVID-19 antibody tests, an FDA news release said. Warning letters have been sent by the department to:

• Medakit Ltd. of Sheung Wan, Hong Kong;
• Antibodiescheck.com and Yama Group;
• Dr. Jason Korkus, DDS, and Sonrisa Family Dental d/b/a My COVID19 Club of Chicago.

Other scams

The New York Times reported on April 17 that a special agent with the HHS OIG noted that impostors requesting information from Medicare or Medicaid posed as physicians or laboratory technicians in nursing homes and assisted living facilities to deliver fake tests.

The Texas Tribune reported earlier in April that the owner of a freestanding emergency room in Laredo, Texas, spent $500,000 on buying 20,000 COVID-19 rapid tests for patients suspected of having COVID-19. In Laredo, health officials decided to set up a drive-through testing site and then conduct tests to detect active infections from a manufacturer in China. City health officials learned they were ineffective and unusable after attempting to verify the samples.

An April 9 article from the AARP (American Association of Retired Persons) news department reported that in several states, including Alabama, Arizona, Florida, Georgia, Kentucky, New York, and Washington state, federal officials have found fake coronavirus testing sites. 

According to AARP, the FBI investigated several fake test sites in Louisville, Ky., after a city official confirmed the collection of biological specimens from residents by individuals in personal protective equipment ( PPE). In order to prove their identity, those requesting tests were advised to pay $240 in cash or have their Medicare, Medicaid, or Social Security cards.

The AARP confirmed that fake drive-up testing sites were confirmed over a four-day period at gas stations and other locations in Louisville. 

On April 2, WRGB TV in Albany, N.Y., announced that in return for bogus coronavirus tests, scammers claiming to be from the New York State Department of Health (NYSDOH) were taking money and insurance details from individuals. One woman told police that she had a fake test in a Little League parking lot at a drive-up spot.

North Greenbush police said the scammers described themselves as being with NYSDOH and obtained information from several individuals about money and insurance. Police and state officials said that in the parking lot, the DOH had no connection to the collection site.

Lessons for Laboratories

The message from these stories is to be vigilant of strangers providing COVID-19 testing for clinical laboratory directors and all clinical laboratory scientists, while also making sure to post information on the legitimacy of your laboratory's rapid molecular and serological tests to customers. Doing so could entail presenting evidence that the FDA has approved the coronavirus to be used for your studies.

Medical laboratories should also ensure that proper identification is demonstrated by all workers collecting specimens in public places.