Aetna Insurance:  Will the "Cavitat" Case Take The Company Down?...

Opinion by Consumer Advocate Tim Bolen

Wednesday, April 20th, 2005

 

The American medical system is broken.  And, it isn't worth fixing.  Americans know that, and perhaps, without conscious thought, are abandoning it for "alternatives," in droves.

The National Science Foundation, a few years ago, issued a report that shocked the medical industry.  It said, simply, that 88% of adult Americans believed in, and used, some form of "alternative" to medicine.  As early as 1998 reports showed that half of the total US health dollar was being spent on "alternatives."  Even more shocking to industry was the fact that, not only were Americans using those "alternatives," but they were paying for them out-of pocket - because neither insurance, nor Medicare, would pay for them.  Americans bought them anyway.

Obviously, there is a paradigm shift happening.  Thank God for that.

 

What's wrong with the American medical system?  A lot.

We know that the American hospital system is the number one killer of Americans, with the families of 793,000 unnecessary death victims, each year, trying to clean up the mess, and sort through the shock and disbelief that occurs after they realized that the system they trusted betrayed them.  One industry critic says that the number of "injuries" caused by the hospital system is twenty (20) times the death rate.

We also know that the worldwide pharmaceutical industry (Big Pharma) has little, or no, interest in health - but is centered on generating huge numbers on the bottom line.  The Merck Vioxx scandal says it all.  The lawsuits springing up in every locale say even more.  The UK House of Commons report on the influence of the Pharmaceutical industry is the death knell.

The American Dental System is buried in 100 year old technologies, won't accept anything new, and is fighting a losing battle over their promotion of deadly poisonous mercury amalgam (they call them "silver") fillings, and ultra-dangerous, but highly profitable "Root Canals."

The American Health Regulatory system - simply isn't...

The health insurance industry, perhaps typified by industry giant Aetna's policies, is struggling to find focus in the turmoil.  And, not doing it well.  They simply "can't find the forest for the trees." 

Ziff-Davis's publication "Baseline" last February 1st, 2005, ran an article titled "The Aetna Cure," I highly recommend.  It explains, dear readers, how a health insurance giant thinks.  It also says to me that Aetna, and other insurers, are standing astride a trend, trying to block it, rather than riding with it.  They just don't get it.

But they will...

Aetna, just a few years ago, according to Baseline, "was losing about  $1 million dollars a day..."  Then John W. Rowe was brought aboard as CEO.  Rowe made big changes to stop the hemorrhaging.  The biggest thing was implementation of a new system labeled Executive Management Information System (EMIS) designed to replace an old system that Rowe said was "using stale information to make actuarial assumptions about what was happening in health care.

Again, Baseline says "This performance management system helped Aetna understand where it was losing money and what it would have to change to reverse that trend. Initially, Aetna returned to profitability by raising its rates and deliberately driving away unprofitable customers. But over the past couple of years, it has continued to increase profits by whittling away at overhead expenses and medical costs."

And, beyond that, Baseline says "In addition to EMIS, Rowe also touts Aetna's 14-terabyte data warehouse of medical-cost and medical-quality data as a key element of initiatives to deliver more cost-effective yet higher-quality health care. The business unit responsible for that analytical database, formerly known as U.S. Quality Algorithms, has been more tightly integrated with the core organization and is now known as Aetna Integrated Informatics."

In short, Aetna has automated health care.  Computerized it, as it were, to protect their bottom line.   

For American consumers, and Aetna customers, that sucks, not because it wasn't a good idea to set up an evaluation system - because I'm FOR that idea, but because Aetna never took the time to evaluate the data (the measuring sticks) they were using to evaluate medical, or dental, care.  And, that got them another lawsuit - Cavitat v. Aetna. 

 

The End of Aetna?

Cavitat, a company that invented a device that finds cavitations in the bone under teeth caused by NICO (Neuralgia-Inducing Cavitational Osteonecrosis) described as "literally, dead bone from poor blood flow," spent years developing, and properly testing, and scientifically proving the use of, a unit that would detect NICO long before it became an unsolvable problem.  Then they got FDA approval to market it, and got a CPT code so Dentists using the Cavitat unit could bill for it.

Bob Jones, the CEO of Cavitat, couldn't have done more to "do the right thing" to bring his product to market.

But Aetna, using its medical care measuring system, tells an entirely different story about Cavitat.  One that, after all of his years of hard work, shocked Cavitat CEO Bob Jones.  According to Cavitat v. Aetna Federal RICO (racketeering) case, the Plaintiffs, CAVITAT Medical Technologies, Inc, and Robert J. Jones are suing the Defendant, Aetna, on FIVE counts "(1) Publication of an Injurious Falsehood, (2)  Tortious interference with a Prospective Business Advantage, (3) Negligent interference with a Prospective Business Advantage, (4) Interference with contract or prospective Contractual Relation, (5)  Federal and State RICO (18USCA 1961 et seq. and C.R.S. 18-17-104)."

The suit names as RICO (racketeering) conspirators, Quackwatch.com, its author failed MD Stephen Barrett, the National Council Against Health Fraud (NCAHF), and its hair-removal specialist president Robert S. Robert S. Baratz, and two authors of an article on quackwatch.com - Dodes, and Schissell.

Simply spoken, Aetna made the mistake of using information found on "quackwatch.com," to discredit Cavitat's device.  The article, supposedly written by Dodes and Schissell, claims there is "no science" to the Cavitat device, and was used by Aetna to condemn Cavitat.  In fact, CEO Jones had delivered over 3,700 studies to the FDA, they examined 392, and used 92 of those to determine that the device had a 98% accuracy rate.

In the Cavitat case, an important issue has arisen - the value of Aetna's "14-terabyte data warehouse of medical-cost and medical-quality data."  The measuring stick. 

In the Cavitat incident, and in many other place in their evaluation system,  Aetna put its "measuring stick" eggs in the "quackbuster" basket.  And that says it ALL about Aetna.

 

Why Could This Be the End?

Again, according to Baseline "Aetna was one of several large health insurers targeted  in a class-action lawsuit by physicians alleging deliberate underpayment of claims. In May 2003 Aetna agreed to a $170 million settlement with the physician groups and promised to reform its business practices. (The total cost, including the money Aetna will spend internally to change its systems and way of doing business, is estimated at $500 million.)"

It's obvious that Aetna has problems with its "Aetna Integrated Informatics" medical care evaluation system.  What Aetna failed to do is realize what every data system manager knows - "Garbage In = Garbage Out."

The Cavitat action leaves Aetna vulnerable to every attorney in the world whose client's product, or service, has been rebuffed by Aetna.  From now on they'll be questioned about the value of their judgment system - and rightly so.

 

What Should Aetna, and the Other Insurers,  Be Doing?

(1)  Aetna "talks" about the idea of "prevention" in health care.  It's a good idea - but lets get real.  If they want "prevention," and they should, then let's embrace the idea.  Start, by having tiered medical coverage - one plan for those that smoke, have mercury amalgams in their mouths, have silicone implants, root canals, have problems with drugs or alcoholism, ride daredevil motorcycles, or have abused their bodies in some other way - and another, less expensive, plan for normal people.

(2)  Set up a "prevention" system.  Have everyone over forty get a blood, urine, and hair analysis lab test to find toxins and heavy metals - and remove those toxins and heavy metals.

(3)  Educate their clients about "health."

(4)  Look into what Americans are buying in "alternatives" to medical care.  Find out why they are being offered and why American are buying them.  Learn from this.  Step into the new century.  Offer those things.

(5)  Put a valid medical evaluation plan in place.  Never, under any circumstances, rely on the blatherings of a "quackbuster."  Use only REAL authorities.  Be credible.

 

Stay tuned...

Tim Bolen - Consumer Advocate

This "Millions of Health Freedom Fighters - Newsletter" is about the battle between "Health and Medicine" on Planet Earth. Tim Bolen is an op/ed writer with extensive knowledge of the activities of a subversive organization calling itself the "quackbusters," and that organization's attempts to suppress, and discredit, any, and all health modalities that compete with the allopathic (MD) paradigm for consumer health dollars. The focus of the newsletter is on the ongoing activities, battles, politics, and the victories won by members of the "Health Freedom Movement" against the "quackbusters" It details "who the quackbusters are, what they are, where they are operating, when they appear, and how they operate - and how easy it is to beat them..."

For background information on the "Battle between Health and Medicine" go to: http://www.savedrclark.net/by_whom2.htm. A copy of THIS newsletter, and older ones, are viewable at the website http://www.quackpotwatch.org/default.htm.

For EVEN MORE interesting and related articles go to http://www.bolenreport.com.