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 …………………
Cigna Sued for RICO Violations
August 8th, 2020A Day in My Life as a Physician
August 6th, 2020
What Does Simone and The Tyler Rose Have in Common?
August 6th, 2020“What medical school did Zuckerberg go to?”……………………………….
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.’’
Podcast: Alternative Medical for Texas School Districts with Russ Edwards
August 1st, 2020Here are some highlights from the podcast:
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.
Quote of The Day
July 31st, 2020RFQ’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“The problem with these outdated methods of procuring consutlants services is how many windows you have in your office is irrelevant” – Carl Schuessler
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.
The Remarkable Purple Cow
July 30th, 2020
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.
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?
Pandemic Chaos To Subside November 4 – Women Rejoice
July 29th, 2020
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……………
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.
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
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……………….
The Affordable, Biblical Alternative to TRS ActiveCare
July 26th, 2020TAKE COMMAND HEALTH touts cost saving alternative to TRS ActiveCare………………
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
It Ain’t Over Until It’s Over………………
July 25th, 2020Reference 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………..
Seasonal Flu vs The Dreaded Chinese Flu
July 24th, 2020
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.
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.
Pam Demic
July 22nd, 2020
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…………….
Butler Benefits
July 20th, 2020
Express Scripts Consultant News
July 20th, 2020Shortly after posting the blog entry immediately preceding this post entry we received the following email message from Express Scripts:
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………”
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. “
Fly-By Medicine Sucks
July 19th, 2020
UHC Q2 Report Reveals Chinese Flu Impact
July 19th, 2020
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……………..
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……………….”
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.
Invoice-Based Drug Reimbursement Does Not Cut Spending?
July 14th, 2020
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………………”
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
Texas Bans Tummy Tucks
July 10th, 2020
Non-Compete Clauses Hurt Both Doctors & Patients
July 10th, 2020Big Medicine would love to trap your doctor in their job, even if it’s abusive.
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.”
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.”
West Texas Doctor Says We Are Treating Covid 19 Wrong
July 8th, 2020SOURCE: 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.”
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……..
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.
The Villains of Health Care
July 4th, 2020
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……………………………..
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.
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.”
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.
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
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?”
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………………
Hospitals Sued to Keep Prices Secret. They Lost.
June 25th, 2020Let the Sun Shine In…………………………………………………………
This will be the end of PPO networks and will turbocharge the explosive growth of Reference Based Pricing strategies…………………..
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………………………….
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………………..
David Belk Opines
June 23rd, 2020
Dr. Belk gives a talk to One Payer States, a group advocating for a single payer system…………
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?
$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………………..
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.”
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.
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?
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.
Recovered Chinese Flu Patient Racked By Guilt
June 13th, 2020
Man Racked By Guilt Complex – Scientists determine post recovery symptoms may require lifetime counseling………………..
Money Bucket Strategy Solves Employer Sponsored Health Care
June 11th, 2020
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.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
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.
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……………..
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
The Rise of TeleHealth
June 5th, 2020
Telehealth claim lines increased more than 4,000% in the past year………………
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………..
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.
BCBS Special Broker Bonus Program
June 4th, 2020
Earn a total bonus of up to $24,000 with the BCBSTX Grand Slam Bonus Program!
Doctors Smoke More Camels Than Any Other Cigarette
June 2nd, 2020UHC & Houston Methodist Cat Fight Ends
June 1st, 2020We 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……………..
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%.