Do you know what Big Data knows about you?

Data brokers use the staggering amount of information in a variety of ways, including helping clients target consumers with ads and offers based on their perceived interests

If you weren’t worried before about what information big data companies have tracked and stored about you, you might definitely worry after reading a new report released earlier this week by the Federal Trade Commission (FTC).

While it’s not exactly fresh news that companies track consumer behaviour across multiple platforms (think online and in retail stores) some of the details in the FTC report, which analysed the practices of nine data companies, should make any consumer sit up and take notice. Data brokers use the staggering amount of information (one data broker’s database included 1.4 billion consumer transactions and one had 3,000 data segments for nearly every US consumer) in a variety of ways, including helping clients target consumers with ads and offers based on their perceived interests.

Here are some highlights of the findings:

Data brokers collect consumer data from a wide variety of commercial, government and publicly available sources largely without consumers’ knowledge. They also obtain data from each other, making it all very hard for consumers to determine where the information came from. The information can range from a simple name and address to a consumer’s weight, or even if they like to gamble. (Hmm, could it be that data brokers know more about you than even your own spouse?)

They infer all sorts of things about consumers from the information they collect. Some of these inferences may be untrue, and could lead to consumers receiving only certain targeted advertisements such as for sub-prime loans, instead of ads for loan products that have lower interest rates. In another example, a consumer could be deemed by an insurer as engaging in risky behaviour and have to pay higher premiums or denied coverage because other data shows the consumer is a “Biker Enthusiast.”

They like to nickname consumers. You could be pegged simply a “Dog Owner” or something more exotic like “Urban Scramble” or “Mobile Mixer” (both of which refer to low-income Latinos and African-Americans). There is also “Rural Everlastings” (hello single men and women over the age of 66 with low net worth and education levels.)

It is definitely not easy to opt out of data collection. That’s because consumers have to go to a bunch of different data brokers sites, if they can even determine who is tracking them, to opt out and often the opt out language is confusing.

There is a gold mine of specific information about you out there stored on huge databases, making the databases an enticing target for hackers. And often the data is stored for years. Can you say major security risk?

“Many of these findings,” said the report, “point to a fundamental lack of transparency about data broker industry practices.” (That might be a huge understatement.)
To be fair, there is a plus side to some of this data collection. For example, a company will send you a coupon for your favourite perfume or you can use one of the people search sites fuelled by the data to connect with old friends.

But consumers need better protections and the FTC is joining a growing number of consumer advocates calling on (well, it did already raise the issue in a 2012 report) Congress to enact legislation that would enable consumers to learn of the activities of data brokers and provide them with reasonable access to the information. Until then, remember, Big Data is watching you.

Courtesy: TruthInAdvertising.org

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    Should a mental illness mean you lose your kid?

    Mindi has never harmed her daughter and is capably raising a son, but authorities took her daughter under a concept sometimes called “predictive neglect”

    This story was co-published with The Daily Beast.
    In August 2009, Mindi, a 25-year-old struggling new parent, experienced what doctors later concluded was a psychotic episode. She had been staying in a cousin's spare basement room in De Soto, Kansas, while trying get on her feet after an unexpected pregnancy and an abusive relationship. She'd been depressed since her daughter was born and was becoming increasingly distrustful of her relatives.

    Isolated, broke and scared, one Saturday morning, she cracked. She woke to change her 5-month-old daughter's diaper. When Mindi looked down, she believed the baby's genitals had been torn.

    Mindi's mind raced for an explanation. The one she came to? That her baby had been raped the night before; that someone—she did not know who—had put sedatives in the air vents.

    Mindi called her paediatrician's office. A receptionist told her to take her daughter to a children's hospital in nearby in Kansas City, Missouri. Doctors there found no evidence that the girl had been harmed or that any of what Mindi claimed had actually happened.

    After Mindi started arguing, medical staff sent her for a psychological evaluation and notified local child welfare authorities, according to court records. (As is typical in child welfare cases, the court documents do not include the full names of anybody in the family. Mindi has asked ProPublica to use only her first name, as did other parents in the story.)

    In 2009, Mindi had a psychotic episode—she believed her five-month-old daughter had been raped. But doctors found no evidence this was true, and called authorities to take custody of the girl. (Steve Herbert for ProPublica)

    That night, authorities took emergency custody of Mindi's daughter, who is referred to in court documents by her initials, QAH A court-appointed doctor later concluded that Mindi had experienced postpartum psychosis.

    But Mindi rebounded after the episode. She began to attend therapy and to see a psychiatrist, who prescribed an antidepressant. She found a job as a shift manager at Kmart and moved into her own apartment. Each morning, she'd call the foster home where her daughter had been placed and she'd read Q.A.H. a book.

    In time, her psychiatrist, therapist and even a panel of judges concluded that Mindi should get her daughter back.

    "I found the help I needed to be healthy," says Mindi, a wide-eyed woman with a round face and a chatty affect. "I was dealing with some mental battles at the time."

    Dr. Stanley Golan, the psychiatrist who treated Mindi, diagnosed her with a mix of post-traumatic stress disorder—likely, a therapist later said, related to abuse—depression and possibly a kind of "mild delusional disorder." Still, the diagnoses, Golan said in court testimony, "do not interfere with her parenting and she is able to adequately care for Q.A.H."

    "You can have these diagnoses and be symptom-free," he testified.

    Indeed, in September 2011, Mindi, who was in another relationship, gave birth again, to a boy named Jace, whom she's now raising capably on her own. Citing Mindi's pending case over Q.A.H., Kansas authorities took Jace at birth and placed him in foster care. But they soon returned him after finding no evidence that Mindi posed any risk to her son. As a family therapist testified, Mindi has provided a "nurturing, loving environment and had met all of [Jace's] needs."

    Yet four years later, after a protracted series of court fights, Mindi does not have her daughter back.

    "I couldn't see how they could keep one while I had the other," said Mindi, sitting on the carpet in a living room with her son, surrounded by toy trains and a pile of books. "I don't think I should have to fight for my own child to come home." (Missouri and county child welfare officials declined to discuss the case.)

    The question in Mindi's case is not about what authorities did when she plunged into a mental health crisis—nearly everyone involved in the case, including Mindi's own attorneys, agrees it was likely appropriate to remove her baby that day. Instead, the issue is whether a mental health diagnosis itself, in the absence of any harm, should be enough to keep Mindi from ever getting her daughter back.

    Under a concept sometimes called "predictive neglect," Missouri and about 30 other states allow courts to terminate a parent's connection to a child if authorities conclude a mother or father has a mental illness that renders them incapable of safely raising the child.
    Officials usually must present evidence that the illness poses a threat. Most cases involve significant mental illness, not run-of-the-mill depression or anxiety. Yet there need be no evidence of actual harm or neglect, just a conclusion that there is a risk of it.

    States typically do not track how many parental termination cases are related to mental illness, or how often parents have lost children based on a diagnosis. New York, one of the few states that does tally such cases, has about 200 parental terminations annually based on mental disability, a category that includes both mental illness and "mental retardation." If there were a similar rate nationally, that would amount to several thousand cases per year. The cases are typically sealed, and there's no way to know how many involve court overreach.

    But if it's impossible to know how many parents lose children unnecessarily because of the stigma of mental illness, it's clear that the process for deciding such cases is deeply flawed.

    Courts' decisions rest on the recommendations of evaluators who often do not observe parents at home or examine their actual record of parenting. Instead, they rely on psychological tests and case notes.

    Incomplete evaluations are an "endemic problem," said Joanne Nicholson, who directed a unit that conducted parenting assessments for Massachusetts child welfare agencies and is one the country's leading researchers on parents with mental illness.

    "Parents are often evaluated without a real analysis of their supports, of the life they actually live," said Nicholson, currently a psychiatry professor at Dartmouth College. As a result, "the diagnosis starts to speak louder than real life."

    Children can also pay a price when courts overstep. Research shows that forcing children in and out of different homes can leave lasting emotional scars.

    The logic of removing kids from parents with serious mental illness is straightforward. Studies have shown that serious mental illness correlates with higher rates of child neglect and abuse. Parents who can't take care of themselves aren't going to be in a position to take care of a child. And delusional thinking can lead to irrational, dangerous behaviour.

    "You have to put protection first," said Mary Kay O'Malley, who worked for years as a foster care caseworker, is now a professor at the University of Missouri Law School and has dealt with many cases like Mindi's.

    When officials fail to intervene to protect children from mentally ill parents, the results can be tragic, irrevocable and front-page news. In one notorious 2008 case, a Long Island, New York, mother drowned her three children after county officials failed to respond to repeated warnings from relatives that she was dangerously unstable.

    But O'Malley says she's seen agencies and courts unnecessarily cut off parents from their children. She says that's what happened to Mindi.

    Six months after Mindi brought her daughter to the hospital, in February 2010, a parenting counselor reported that Mindi "is ready to be there for [QAH] emotionally, mentally, and [she] can support Q.A.H."

    "The parent changed in this case," said O'Malley, who consulted for Mindi's attorneys for free after learning about the case. "But the court didn't."

    The laws permitting termination of parental rights were mostly written in an era when serious mental illness was assumed to disqualify patients from participation in normal life, including parenting. Parents like Mindi may have been institutionalized. In many states, the mentally ill or intellectually disabled could be sterilized. The phrasing in the law has often changed—states have removed words like "feebleminded" and "depravity"—but the same concepts echo.

    Indeed, a 2012 presidential commission report found that "parents with psychiatric disabilities experience the most significant discrimination when they attempt to exercise their fundamental right to create and maintain families."

    "When [mentally disabled] people were institutionalized, they could not keep their kids. Now they're living on their own, and they're not allowed to keep their kids," said Patrick Yewell, who recently retired from a career as a foster care caseworker, supervisor and administrator in Kentucky's child welfare system.

    Rudy, a 42-year-old West Indian-born man in the Bronx, New York, was also denied custody of his daughter. His chance to raise her now rests largely on a psychiatrist's evaluation consisting of two visits and a review of Rudy's records.

    Rudy has long struggled with chronic bipolar disorder, for which he has been repeatedly hospitalized. Rudy is also intellectually delayed—an IQ test placed him at the borderline of intellectual disability.

    He has no history of violence, abuse or neglect. His only child, J, who is now 3, was removed from the hospital immediately after she was born and placed in foster care. Rudy has been asking to be allowed to raise his daughter with help from his mother and sister.

    Authorities first took J because of significant concerns about her mother. J's mother, from whom Rudy had separated before J was born, had already lost three other children to foster care. One of the children removed from J's mother and placed in foster care later died at the hands of a relative of J's mother. And like Rudy, J's mother suffers from mental illness and intellectual delays.

    On June 28, 2010, Rudy watched as two Nassau County caseworkers and a cop walked out of the hospital with 4-day-old J. (ProPublica confirmed details of the case through court documents and multiple interviews.)

    Rudy, who has closely cut hair and often dresses in baggy sports jerseys, recalls the day his daughter was taken as the saddest of his life. "I asked them why they took my daughter, and they didn't respond," Rudy remembered in a soft stuttering voice with an accent left over from his childhood in St. Croix. "I asked them if I could hold her before they took her, and they wouldn't let me hold her."

    Rudy began what would become a weekly ritual: Riding two trains and a bus every Tuesday from the Bronx to Long Island to spend 75 minutes with J in a room in the county child welfare office. Some caseworkers were suspicious of Rudy. "The major concern for the family is both parents' mental health issues," child welfare officials wrote in a court document.

    Others described him as a loving, if inexperienced, father. One caseworker note from a visit in September 2011 described Rudy as "gentle and caring," rocking J to sleep on the couch at the county office.⁠ Two weeks later, a different worker wrote that he was "getting more adept at caring for the child."⁠ J's mother, meanwhile, stopped showing up for visits and failed to appear in court.

    But just over a year after J was first placed in foster care, two Nassau County officials pulled Rudy into a meeting room after a visit with J and told him that the county planned for J to be adopted by her foster family, case documents show.

    "They said I have a mental illness, they were trying to see if I would sign away my rights," Rudy said as he sat one recent evening in his Bronx apartment, a pot of rice steaming on the stove. "They expected it to go smoothly, they expected me to surrender my rights."

    In New York, counties are required to appoint an attorney for parents at risk of losing their kids, but Rudy hadn't yet been given one. Unsure of what was happening, Rudy went home and called his sister Rubeka, in Tampa, Florida.

    "He sounded really upset. Not really angry, but more hurt," said Rubeka, who works as a psychiatric nurse.

    Rudy and Rubeka consulted a lawyer and came up with a plan in which Rudy would move in with his sister and mother in Florida so they could raise J together. J's mother, who was also facing the termination of her parental rights, and whose mental health, according to case notes, was deteriorating, agreed to the plan. (J's mother declined to discuss the case with ProPublica, except to say she supported Rudy's effort to get custody.)

    But Nassau County officials told Rudy that he should have laid out the plan months earlier and that because so much time had passed, federal child welfare law required them to request termination of his parental rights. The county's records suggest that caseworkers had warned Rudy about this; Rudy said he did not understand he could lose his rights so rapidly and that he waited because he believed J's mother was going to regain custody. Caseworkers also noted that visits between Rudy and J had gotten harder as she grew older—she would often cry inconsolably; she knew her father only as the man she saw on Tuesdays and considered her foster parents her real mother and father.

    But these were not the reasons Nassau County authorities listed when they petitioned a county court to sever Rudy and J's legal ties. Instead, the county filed to terminate his rights based on his mental illness. Under New York law, parents can lose their children if courts decide their mental disabilities render them incapable of parenting for the "foreseeable future."

    The Nassau County Department of Social Services would not respond to questions from ProPublica about the case or any related policy issues. The county referred ProPublica to the New York State Office of Children and Family Services. That office declined to comment as well and referred us back to Nassau County. The foster parents' attorney and the attorney appointed to represent J also declined to discuss the specifics of the case.

    In the summer of 2012, a judge sent Rudy to Dr. Joseph Scroppo, a psychologist and attorney who has held appointments at several New York universities. Scroppo has a contract with Nassau County to perform forensic psychological evaluations and make recommendations about whether parents should keep their children.

    Scroppo's evaluation was exhaustive compared with many in other parental rights cases. He met with Rudy alone for nearly 10 hours. Then Scroppo watched Rudy interact with J for 30 minutes. He gave Rudy an IQ test, asked him to define words, stack blocks and read a few sentences.⁠ He reviewed Rudy's mental health records, including his hospitalizations for manic episodes, and case notes from the child welfare department.

    Scroppo concluded that Rudy could not be trusted to raise his daughter.

    Rudy's "score indicates that he is probably capable of semi-independent living but would experience significant problems if he were to attempt fully independent living," Scroppo wrote. Citing Rudy's hospitalizations, Scroppo concluded that Rudy "is now, and for the foreseeable future, unable to adequately care for the subject child."

    During a hearing in May 2013 in Rudy's continuing parental rights case, Rudy's lawyer, who was appointed to the case when the county filed for termination, grilled Scroppo on his evaluation.

    "Your testimony...suggested that [Rudy] would have difficulty functioning fully independently; is that correct?" Rudy's lawyer, Lauren Broderick, asked.

    "Yes," Scroppo replied.

    "[But] wasn't it your understanding that [Rudy] was cooking his own meals at the time of your evaluation?" Broderick said, looking down at her notes.

    "I'm not sure whether he was cooking his meals or not," Scroppo said.

    "Did you inquire?" Broderick asked, looking up.

    "No, I did not," he said.

    "Wasn't it true at the time of your evaluation that [Rudy] was paying his bills?" she went on. "He was responsible for his own hygiene?"

    "As far as I knew, yes," Scroppo said.

    Broderick continued to push Scroppo to offer evidence from Rudy's life. Instead, Scroppo said, "I based the [categorization of] semi-independent status on the test that I administered to him."

    New York's law allows mothers and fathers to present alternative evaluations in court, though funding is not always made available to pay for them. Rudy's sister and brother scraped together several thousand dollars to hire an evaluator for a second opinion.

    Dr. Barry Rosenfeld, a psychologist who directs clinical training at Fordham University, did not just administer tests. He spoke to the people in Rudy's life to get a better sense of him—and pieced together a very different picture.

    Continue reading....

    Courtesy: ProPublica.org
     

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    Medicare overpays billions for office visits, patient evaluations
    The findings by the inspector general of the US Department of Health and Human Services complement a recent ProPublica review that found many doctors bill for services very differently than their peers 
     
    Medicare spent $6.7 billion too much for office visits and other patient evaluations in 2010, according to a new report from the inspector general of the U.S. Department of Health and Human Services.
     
    But in its reply to the findings, the Centers for Medicare and Medicaid Services, which runs Medicare, said it doesn't plan to review the billings of doctors who almost always charge for the most-expensive visits because it isn't cost effective to do so.
    The inspector general's report, released today, estimates that overpayments account for 21 percent of the $32.3 billion spent on evaluation and management (E&M) services in 2010. The E&M category includes office visits, emergency room assessments and inpatient hospital evaluations.
     
    This is the second time that the inspector general has singled out this area for more scrutiny. In 2012, the watchdog said physicians had increasingly billed Medicare for more intense—and more expensive—office visits over time. But that didn't prove the claims were improper.
     
    "The natural question that comes out of this is: Are these physicians billing appropriately?" said Dwayne Grant, regional inspector general for evaluation and inspections in the Atlanta region, who oversaw the new report. "We don't want to pay them too much but we don't want to pay them too little either."
     
    For this review, the inspector general gathered the medical records associated with 657 Medicare claims and asked professional coders to see whether the records justified the rates charged.
     
    Overall, more than half of the claims were billed at the wrong rate or lacked documentation to justify the service. Sometimes physicians billed for a lower-cost service than the one they delivered, but more often they billed for a higher-cost one. The inspector general extrapolated from its sample to estimate the amount Medicare overpaid on all 2010 E&M claims.
     
    "We have to do a better job of curbing improper payments and protecting taxpayer dollars," Sen. Bill Nelson (D-Florida), chairman of the U.S. Senate Special Committee on Aging, said in a statement.
     
    The inspector general's findings complement a recent review by ProPublica of data recently released by Medicare on payments to individual health professionals for services in its Part B program. We found that in 2012, more than 1,800 doctors and other health professionals almost exclusively billed Medicare for the most complicated and expensive office visits for their established patients.
     
    Office visits are the most common services provided in the program.
     
    While most providers had a tiny percentage of visits for which they charged the highest rate, known as level 5, more than 1,200 billed exclusively at that level. Another 600 did it more than 90 percent of the time. About 20,000 health professionals billed only at the top two levels, 4 and 5.
     
    Experts we consulted said that these billing patterns were highly implausible and could indicate fraud. Some doctors, however, said that their patients were sicker than those of their peers and required more time and attention.
     
    ProPublica also launched a new tool called Treatment Tracker that lets users look up their doctors and see how they compare to peers on office visits and other measures.
    In its report, the inspector general's office recommended that CMS educate doctors about proper billing practices. It also suggested that Medicare pursue doctors who consistently billed for higher-level services than they actually delivered, a practice known as upcoding.
     
    While CMS agreed with the need for education, it disagreed with the recommendation to review the physicians' billings. It said one of its contractors recently reviewed 5,200 medical claims of high-coding physicians and the process cost more money than it caught in overpayments.
     
    CMS said a second phase of the review—of 13,500 claims—was nearing completion. "Based on the results of this effort, CMS will reassess the effectiveness of reviewing claims for high-coding physicians" versus other efforts, such as sending these doctors reports that compare their billings to their peers.
     
    Grant, of the inspector general's Atlanta office, said that while the individual E&M services do not cost much, they add up -- and that if CMS declares that it won't review outliers, it could send the wrong message.
     
    "The challenge that CMS is trying to figure out is what is the best way to get at this," Grant said. "We see the advantage of continuing to look at these high billers. Not only are they billing high now; it could have an impact on future billings...This is not just free rein to bill whatever you want."
     
    Courtesy: ProPublica.org
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