Cigna Sued for RICO Violations

August 8th, 2020

Court records allege Cigna uses four distinct schemes to embezzle and convert funds by defrauding patients, healthcare providers, and their own Self-Insured Health Plan clients …………………

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A Day in My Life as a Physician

August 6th, 2020

So guys, this is what my typical day looks like now………………………….

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What Does Simone and The Tyler Rose Have in Common?

August 6th, 2020

“What medical school did Zuckerberg go to?”……………………………….

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Patient Thicket

August 3rd, 2020

Why price of Humira keeps rising despite FDA approval of generic competition

“Patent thicketing, and Humira is the poster child for this, builds a patent fortress around their product to protect their ability to continue their monopoly pricing.’’

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Podcast: Alternative Medical for Texas School Districts with Russ Edwards

August 1st, 2020

Here are some highlights from the podcast:

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TDI Releases Report on Balance Billing Dispute Changes

July 31st, 2020

ARTICLE REFERRED BY: Charles Luke

7/29 TDI Releases Preliminary Report on Balance Billing Dispute Changes 

The Texas Department of Insurance has released a preliminary report on the effects of recent balance billing dispute resolution procedures passed during the 86th Session in Senate Bill 1264. In the report, TDI examined 9,000 requests over the first six months of SB 1264 implementation.

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Quote of The Day

July 31st, 2020

RFQ’s for Insurance Consultants

“The problem with these outdated methods of procuring consutlants services is how many windows you have in your office is irrelevant” – Carl Schuessler

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TBX

July 31st, 2020

We know a thing or two when it comes to employee benefits. Actually we’re what you might call an “industry leader” in all aspects of online employee benefits communication, education, enrollment and administration.

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The Remarkable Purple Cow

July 30th, 2020

The Purple Cow is down in Raymondville, Texas, lonely as hell………………

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Beating Health Insurance Company Cartels

July 30th, 2020

Whether you own a company it, run it, invest or influence it- WellNet refuses to play by the rules of the ‘health insurance company cartels’ that seem to only be interested in protecting their revenue streams.

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Chargemaster Maintenance Ensures Financial Viability for Hospitals

July 30th, 2020

Hospitals are becoming increasingly proactive in updating their Charge Master’s and doing so on more than a quarterly or annual basis yet Hospitals Dismiss Significance Of Chargemaster Prices?

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Pandemic Chaos To Subside November 4 – Women Rejoice

July 29th, 2020

Gerard, our in-house prognosticator who is never wrong announced this morning that the dreaded Chinese Flu (The Pandemic) chaos will end abruptly on November 4, 2020. That’s good news for exhausted Americans.

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Puff The Magic Dragon – The TRS ActiveCare Rebellion Gains Traction

July 27th, 2020

At the stroke of midnight, August 31, 2020 as much as 5% of TRS ActiveCare membership may vanish……………

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The TRS ActiveCare Feeding Frenzy

July 26th, 2020
There is a frenzy of activity among insurance brokers, consultants, third party administrators and others towards seizing what is perceived to be a new found opportunity in selling lucrative group medical plan alternatives to the TRS ActiveCare program.

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Another Texas School District Challenges TRS ActiveCare Mandate

July 26th, 2020

Texas school district to over TRS ActiveCare alternative health plan effective September 1, 2020

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First Financial Offers Assistance in Exploring TRS ActiveCare Alternatives

July 26th, 2020

First Financial has engaged key partners in our market to provide access to the best and most immediate solutions available to Texas schools……………….

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The Affordable, Biblical Alternative to TRS ActiveCare

July 26th, 2020

TAKE COMMAND HEALTH touts cost saving alternative to TRS ActiveCare………………

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Mike Rowe Opines On Pandemic

July 25th, 2020

Mike, in a recent post, you said you’ve been to Tennessee and Georgia, giving speeches and filming for your new show. Before that, you were on the road shooting for Dirty Jobs. Is it really so important to film a television show in the midst of pandemic? Is it responsible of you to encourage this kind of behavior when infection rates are spiking? Don’t you watch the news? More and more cases every day – aren’t you concerned? – Darlene Gabon

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It Ain’t Over Until It’s Over………………

July 25th, 2020

Reference Based Pricing vendors rejoiced when a jury sided with a patient over an egregious hospital bill (Jury-sides-with-patient-in-hospital-bill-lawsuit/) But plaintiff’s attorneys were singing It Ain’t Over Til It’s Over………..

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Seasonal Flu vs The Dreaded Chinese Flu

July 24th, 2020

SOURCE: Greg Rudisill on Linkedin

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Fred Rusteberg

July 23rd, 2020

Fred Rusteberg wasn’t interested in the limelight, but he was always there to help the people of Brownsville, his beloved hometown, and he left an indelible mark in the process.

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Explaining American Health Care System To A Brit

July 22nd, 2020

A couple of weeks ago I was interviewed by someone in the U.K. for a podcast called The Jist. I spent about an hour trying to explain our crazy healthcare system to someone who’s had no firsthand experience with any of it. As you can imagine, most of what I told him sounded quite insane to him.

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Pam Demic

July 22nd, 2020

What exactly is being peddled here?

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Texas Facing $4.6 Billion Deficit

July 21st, 2020

Will Texas finally do something to fix health care for state employees and Texas educators? Fighting a $4.6 billion budget deficit can start with injecting common sense, reason and logic into how Texas funds health care………………….Or Is Texas still searching for their missing cajones? Hint: The little lady in Montana has them…………….

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Butler Benefits

July 20th, 2020

Josh Butler is a West Texan who knows how to fix health care…………

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Express Scripts Consultant News

July 20th, 2020

Shortly after posting the blog entry immediately preceding this post entry we received the following email message from Express Scripts:

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Ohio Sues Express Scripts

July 20th, 2020

“It’s no secret that PBMs have been keeping secret their prescription pricing in order to evade public scrutiny and rake in revenue,” Mr. Yost said. “I intend to shed light on their business model………”

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Obesity and Diabetes Fuel The Chinese Flu Dragoon

July 20th, 2020

“We knew that this was a time bomb because the percentage of obesity, hypertension, diabetes is so high,” said Dr. Adolfo Kaplan, a critical care physician who works with Dr. Brown at DHR Health in Edinburg, Texas. “

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Fly-By Medicine Sucks

July 19th, 2020

Patient Centered Health Care vs Conveyor Belt Health Care

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UHC Q2 Report Reveals Chinese Flu Impact

July 19th, 2020

UnitedHealth Group was the first major payer to release it second quarter earnings report, offering insight into how the coronavirus pandemic impacted the payer industry following the first quarter surge.

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Marty Opines – 5 Ways To Fix America’s Health Care Blivit

July 17th, 2020

Brokers who sell pharmacy plans and health insurance to American businesses are paid a 4 percent commission on all health-insurance premiums in perpetuity. They are often also paid kickbacks from the pharmacy plan (eloquently called rebates) and insurers………. Similarly, middlemen called “group purchasing organizations,” who sell drugs and devices to hospitals, receive kickbacks that would be illegal if it weren’t for a 1987 “safe harbor” law that created an exemption for health care. It’s time to ban all kickbacks in health care……………..

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Lawsuit Accuses UHC of Looting Employer Plans

July 15th, 2020

“UnitedHealth Group treats all of the plans it administers as one huge piggybank, moving money around as it sees fit……………….”

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Ozzie The Whistleblower

July 15th, 2020

It was his dream job. He never thought he’d be bribing doctors and wearing a wire for the feds.

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Invoice-Based Drug Reimbursement Does Not Cut Spending?

July 14th, 2020

Rather than basing Rx pricing by applying a discount off arbitrary sticker prices the strategy is to base pricing off what retail pharmacies pay for drugs. For example, if a pharmacy pays $10 for Drug A, the plan sponsor pays $10 plus a margin. This is Reference Based Pricing for Rx claims. But according to the following article this strategy does not save money. The American Rx pricing mystery continues…………….

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Supreme Court Issues Half Pregnant Ruling

July 12th, 2020

Celebrating Too Soon? Wait Until November 3…………

“The court sent the case back to a lower federal court for further action, inviting additional challenges………………”

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Texas Rebellion

July 10th, 2020

Lone Ranger Refuses To Wear Mask in Solidarity 

“I think it’s an insult to Texans to be required to do something they should have discretion for,” said Hugh Reed

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Texas Bans Tummy Tucks

July 10th, 2020

Texas expands elective surgery ban to more than 100 counties

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Non-Compete Clauses Hurt Both Doctors & Patients

July 10th, 2020

Big Medicine would love to trap your doctor in their job, even if it’s abusive.

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Sex Sells – Winning Sales Quota by Banging Doctors?

July 9th, 2020

In 2012, Insys hired a new sales executive: Sunrise Lee, a Florida escort service manager and former strip club dancer with no academic degree, according to Guzman’s complaint. Burlakoff allegedly defended the decision, claiming, “Doctors really enjoyed spending time with her and found Sunrise to be a great listener.” He added, “She’s more of a closer.”

The regional sales manager reported that the new employee was “dumb as rocks, but that she was sleeping with another doctor and getting a lot of prescriptions out of him.”

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Texas Sheriffs Refuse To Arrest Tonto

July 9th, 2020

Look Kemosabe, Greg’s Pulling His Hair Out!

“The order is not a law, there is no requirement that any police officer enforce it, and it’s unenforceable. We can’t spend our time running from place to place for calls about mask we can really do nothing about.”

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West Texas Doctor Says We Are Treating Covid 19 Wrong

July 8th, 2020

SOURCE: Mike Reagan on Linkedin

“This West Texas doctor says he has a low cost cure for Covid-19 (Budesonide), we don’t need a vaccine and the “stay at home, shut down businesses mentality” is politically motivated. He further states that the way we are treating Covid is wrong.”

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Government Bureaucrats Change Rules – Are You or Are You Not?

July 7th, 2020

Plan sponsors should determine whether they are a “covered entity” as newly defined under the final rule for nondiscrimination purposes. If not Katy-Bar-The-Door for out-of-the-box risk management strategies……..

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Radiology Reading Is Not A Perfect Science

July 5th, 2020

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RiskManagers Interlocal Purchasing Cooperative

July 5th, 2020

RiskManagers Interlocal Purchasing Cooperative is designed for Texas political subdivisions seeking alternatives to traditional managed care health insurance plans.

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The Villains of Health Care

July 4th, 2020

“This first article in a three part series will focus on Pharmacy Benefit Managers – one of the three most influential opponents of price transparency.”

Twenty years ago Express Scripts was a $1 Billion revenue company, but now they have over $100 Billion in revenue per year.  No inventory to trouble with, no warehouses needed, no fleet of trucks to maintain………………the only thing needed are contracts of adhesion cleverly designed to screw third party beneficiaries……………………………..

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Lasers Killed My Health Plan

July 3rd, 2020

All the proper reserving in the world may not cure a severe case of lasers. The Great Laser Pandemic is running rampant, striking angst and fear among plan sponsors everywhere.

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We Won, We Won!

July 1st, 2020

Great news: We and our partners at CBS News won the 2019 Society of Professional Journalists – Sigma Delta Chi Public Service gold medal for network news for our health costs partnership, “Medical Price Roulette.”

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Underwriting Medical Plans The Old Fashion Way

June 28th, 2020

These are the tools of the trade a 72 year old industry dinosaur uses to underwrite group medical plans, projecting future costs, rate setting, reserve requirements, quantifying IBNR, etc.

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Xerox, Eastman Kodak And Cost Plus Insurance

June 27th, 2020

Xerox, Eastman Kodak And Cost Plus Insurance

“The challenge facing successful business ventures is to understand the necessity to continuously respond to market forces in a proactive manner since competition will certainly become a factor to consider at some point. To ignore this basic business premise by remaining complacent is business suicide.” – Bill Rusteberg

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A “Must Have” for Health Care Disruptors

June 25th, 2020

Works on Brass But Not on Walnuts

When asked recently during a question and answer period at a symposium I attended, a member of the audience asked “What do you tell employers who voice concern about some of your strategies to reign in health care costs?

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The Largest Cartel We All Unknowingly Participate In

June 25th, 2020

Pssst, God Father, Justin’s At It Again!

Cartels: “an association of manufacturers or suppliers with the purpose of maintaining prices at a high level and restricting competition………………

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Hospitals Sued to Keep Prices Secret. They Lost.

June 25th, 2020

Let the Sun Shine In…………………………………………………………

This will be the end of PPO networks and will turbocharge the explosive growth of Reference Based Pricing strategies…………………..

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Specialty Drug Risk Transfer Strategy – The Hot Potato Method

June 24th, 2020

SPECIALTY DRUG MANUFACTURER

The best method to transfer risk is to stop paying for it………………………….

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Statue of The Week – Robert E. Lee

June 23rd, 2020

RiskManagers.us celebrates our country’s rich historical past with this new, weekly series of STATUE OF THE WEEK………………..

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David Belk Opines

June 23rd, 2020

Dr. Belk gives a talk to One Payer States, a group advocating for a single payer system…………

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You Have Got To Be Kidding!

June 20th, 2020
“Hospitals claim that hiding prices allows them to offer large discounts to insurance companies.” Then why do Hospitals Dismiss Significance Of Chargemaster Prices?

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$50 Million Prescription Drug Scam

June 18th, 2020

Authorities said Hickman and the others recruited public-sector employees who were paid to get prescriptions they didn’t need and hadn’t been prescribed. Among the more than two dozen people who have pleaded guilty was John Gaffney, a Margate-based doctor who admitted signing prescriptions for patients he never saw………………..

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Fuzzy Math & Missing Dollars

June 17th, 2020

Tom, Dick and Harry on the way to a conference decided to stop along the way and get a hotel room. It was late at night, but they saw in the distance ahead a hotel with a neon sign that said “Vacancy.”

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Top Disruptor 50 Companies

June 16th, 2020

In the eighth annual Disruptor 50 list, CNBC identifies private companies whose breakthroughs are influencing business and market competition at an accelerated pace. They are poised to emerge from the coronavirus pandemic with tech platforms that have the power to dominate.

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El Paso ISD Health Insurance Update

June 15th, 2020

The El Paso Independent School District was the second public school district to challenge TRS ActiveCare in 2019 by offering employees a commercial health plan option in direct violation of TRS ActiveCare mandate prohibiting Texas school districts from doing so. So how has the commercial plan option fared financially so far?

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Texas County Seeks TPA Proposals

June 15th, 2020

San Patricio County is seeking proposals for TPA services to be effective January 2021. San Patricio County was the first political subdivision in Texas to adopt Reference Based Pricing more than ten years ago.

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Recovered Chinese Flu Patient Racked By Guilt

June 13th, 2020

Man Racked By Guilt Complex – Scientists determine post recovery symptoms may require lifetime counseling………………..

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Money Bucket Strategy Solves Employer Sponsored Health Care

June 11th, 2020

99% of traditional health plans offer no incentives to shop for best prices and outcomes. Doesn’t matter where an insured goes, the same patient responsibilities apply. The same deductible, same co-pays, same maximum out-of-pocket costs.

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Putting Healthcare First – A Video Journey By David Contorno

June 10th, 2020
Giving employees daddy’s unlimited credit card and telling them they can go anywhere they want for treatment and their out-of-pocket expense will be the same no matter where they go or who they see, is the dumbest thing employers can do to their employees.

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9 Ways Chinese Flu May Forever Upend U.S. Health Care Industry

June 10th, 2020

Pay particular attention to #2,. ICHRAs make sense for employers who are tired of fighting health care costs every year, dealing pesky insurance salesman all while at risk of government punishment should they misstep along the way…………..ICHRA’s Shake Up Market

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Willis Towers Watson Faces Shareholder Lawsuits in U.S. Over Sale to Aon

June 9th, 2020

The suits allege that Willis and its directors breached their fiduciary duties under U.S. securities laws by filing incomplete and misleading information with the Securities and Exchange Commission on the transaction.

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Reference Based Rx Pricing

June 8th, 2020

PBM’s have traditionally used Average Wholesale Price (AWP) and Maximum Allowable Cost (MAC) as pricing benchmarks. Now there is another method……………..

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Texas Businessman Says “Send Me All Your Covid 19 Patients!”

June 8th, 2020

“Telemedicine has advanced ten years in only two months.” – Gilberto ‘Beto’ Garcia, Jr

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The Rise of TeleHealth

June 5th, 2020

Telehealth claim lines increased more than 4,000% in the past year………………

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Sedera Demonstrates What Health Insurance Should Really Cost

June 5th, 2020

Remove third party barriers to care and guess what? Presto, you’ve just solved health care………..

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United HealthCare Producer Compensation

June 4th, 2020

We believe it is important that our customers understand how these independent producers are compensated, so we offer this overview of our producer compensation programs.

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BCBS Special Broker Bonus Program

June 4th, 2020

Earn a total bonus of up to $24,000 with the BCBSTX Grand Slam Bonus Program!

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Doctors Smoke More Camels Than Any Other Cigarette

June 2nd, 2020

UHC & Houston Methodist Cat Fight Ends

June 1st, 2020

We all knew how UHC vs Houston Methodist  cat fight would eventually turn out. This type of thing happens all the time, going all the way back to the previous century. No one knows what these cats have agreed to as far as what we all will end up paying for health care. Neither side wants you to know and therein lies the basis of their shared interests……………..

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Reference Based Pricing + DPC = Up To 40% Savings

June 1st, 2020

Payer Compass’s reference based pricing plus direct primary care can reduce plan costs by up to 40%.

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