Archive for the ‘Uncategorized’ Category

School District Restrained From Firing Insurance Agent

Thursday, December 22nd, 2016

bob

Two South Texas insurance agents have spent 10 years fighting over a lucrative insurance contract allegedly worth millions of dollars in agent commissions……….

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Courageous Julie Broderick

Wednesday, December 21st, 2016

mulebriar

Julie Broderick had 15 years of experience as a securities regulator, and a propensity for speaking her mind before joining Prudential Financial Inc. as an investigative supervisor in 2012.

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Higginbotham Expands with Insurance Associates of the Southwest Merger

Wednesday, December 21st, 2016

mergerThis is the sixth merger Higginbotham has completed in 2016 as part of a growth initiative across Texas whereby the firm partners with brokers with strong local reputations……………….

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Prime Healthcare – Making Money Through Fraud?

Wednesday, December 21st, 2016

primehealthcare1“Feds say Prime Healthcare has figured out how to make money from hospitals — through fraud.”

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HCA Holdings: A Must Read Company Overview

Tuesday, December 20th, 2016

hca

Around 30% of the total admissions are reimbursed by managed care programs. These contracts are negotiated for terms between one and three years, and the rates are increased by around 4% to 6% every year.

Managed care strategy

With managed care forming a substantial portion of total revenues, entering contracts with favorable payment rates becomes an essential HCA business strategy. HCA Holdings negotiated for 80% of its total managed care plans in 2015, 40% in 2016, and 20% in 2017.

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Why We Can’t Control Medical Costs

Monday, December 19th, 2016

doctor11111111111111

“There was a universal code of belief everywhere I worked before I came to the USA that we do not torture patients in the off-chance they might live a few extra weeks or months………..but even today, 33 years after I arrived, I am still shocked at the wastefulness of physicians with the Health Care dollar.”

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Catholic Health Initiatives Pulls Out of Insurance Business

Monday, December 19th, 2016

shocked

“It’s tough in the health plan business. You lose money. You make mistakes. You plow forward. It takes cash.”

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Blue Light Special – A $49 Colonoscopy

Monday, December 19th, 2016

bluelight130x130

$49 Base Price for a colonoscopy is outstanding! Plus the patient gets to choose among several optional services to enhance their colonoscopy experience…………………….

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WebTPA

Monday, December 19th, 2016

webtpa

“We save our customers money. Most of our clients costs are below trend or flat ………….our average client covers more than 3,000 members…………”

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Broccoli Mandate To Be Overturned – Guaranteed Access Assured

Sunday, December 18th, 2016

broccoliAll Americans are currently required to purchase broccoli whether they like it or not. Those who can’t afford it get it free, and those who can only semi-afford it get subsidies (i.e, welfare). Rich bastards have to pay the full cost.

Broccoli prices have skyrocketed as a result of The Affordable Broccoli Act. Quality has eroded with many Americans stuck with purchasing rotten, hardly edible broccoli.

Employers must provide broccoli to all full time employees, or face punishing fines or imprisonment, or both.

With a new administration about to take office, The Affordable Broccoli Act is at risk of being overturned. Broccoli farmers are outraged. Employers are jubilant.

But, never fear, House and Senate Broccoli lovers vow to keep voluntary access to affordable broccoli available to every American.

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MD Anderson Suffers Financial Woes – Are Narrow Networks To Blame?

Friday, December 16th, 2016

potluck1

Will turning holiday parties into potluck events save MD Anderson from financial ruin?  I don’t think cost shifting to employees is a viable solution.

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The Federalization of Health Insurance: ACA Repeal & Replace Implications

Wednesday, December 14th, 2016

alanpreston Dr. Alan Preston

“When I evaluate the effectiveness of legislation, I first look to see if it will accomplish its objective. Whether I like the objective or not is a separate issue. The name of the legislation is telling and provides a clue to the objective. The Patient Protection and Affordable Care Act.”

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Managed Care Contracts & Trend Factors

Tuesday, December 13th, 2016

life

By Molly Mulebriar

Are escalator clauses, common to most Managed Care Contracts, the driving force behind trend factors?

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Plan Sponsor Dilemma

Tuesday, December 13th, 2016

confused

How do we know we are doing much better this year than last year?

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Texas Teachers Migrate To High Deductible Plan

Sunday, December 11th, 2016

angryteacher

Many Texas educators are insured through the Texas TRS ActiveCare health plan. Projecting a $54 million deficit for the upcoming FY 2017, TRS trustees realized plan benefits and premiums changes were necessary. More and more plan participants are selecting  the high-deductible plan option with lowest costs and lowest benefits………………

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A Better Way to Pay for Healthcare

Saturday, December 10th, 2016

asserta123

Cash pay health plans make sense…………………………..

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Executives, Physicians & Hospital Indicted In Kickback Scheme

Saturday, December 10th, 2016

omgPhysicians, founders, executives and investors of physician-owned Forest Park Medical Center in Dallas have been charged in a federal indictment for their alleged involvement in a bribe and kickback scheme, according to the Department of Justice.

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Tx. Senator Proposes Bill To Protect Hospitals Against Themselves

Saturday, December 10th, 2016

jacket

Out of control hospital administrator restrained by staff

“Texas can’t tolerate poor quality care, poor leadership, and individuals who defraud people who are vulnerable and sick.” 

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Texas Free Market Surgery Launches Innovative Bundled Payment System

Wednesday, December 7th, 2016

bundlesInnovative bundled payment system is first of its kind in the state of Texas, currently offers more than 200 surgeries…………….

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Small to Midsized Employers are Now Contracting Directly with Healthcare Providers

Tuesday, December 6th, 2016

sense

Cutting out the “middle man” results in substantial savings and puts employers in control……

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Aetna Fights To Save Humana Merger

Tuesday, December 6th, 2016

perrymason

In his opening statement Monday, DOJ lawyer Craig Conrath, a top lawyer in the department’s Antitrust Division, said Aetna’s retreat from ACA exchanges was an attempt to evade antitrust scrutiny “by the equivalent of closing up shop.”

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Health City Places Ad In Wall Street Journal – Publishes Health Care Fees

Tuesday, December 6th, 2016
advertisingHere’s an ad for Health City Cayman Islands that appears in today’s WSJ. It’s volumes are now up significantly over their levels a year go. With tremendous quality and more American businesses are seeing the sense in sending patients there – Brian Klepper

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Webinar: Strategies To Achieve Better Outcomes Using Bundled Pricing

Tuesday, December 6th, 2016

Complimentary Live Webinar:
Strategies to Achieve Better Outcomes Using Bundled Pricing
Organized by:
World Congress

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2016 Medical Stop-Loss Premium Survey

Sunday, December 4th, 2016
stop-loss
This year’s survey, its tenth year, reflects the ongoing rise in stop-loss premiums and a continued commitment to employer-sponsored, self-funded health plans.

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Klepper Partners With Prominent Indianapolis Broker Richard Sutton

Saturday, December 3rd, 2016

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High School Students Recreate $110,000 Drug for $20

Saturday, December 3rd, 2016

amazingFor $20, a group of high school students has created 3.7 grams of an active ingredient used in the medicine Daraprim, which would sell in the United States for between $35,000 and $110,000.

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Why Competition Drives Drug Prices Up, Not Down

Wednesday, November 30th, 2016

viagraIn June, New York City-based Pfizer raised the price of Viagra by 13 percent. Just days later, Indianapolis-based Eli Lilly followed suit, increasing the price of Cialis by the same amount, reports The Wall Street Journal.

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BCBS To Pay $50,000 Broker Sales Incentive Each Fully Insured Group Sold

Wednesday, November 30th, 2016

holycrap

Holy Crap! BCBS announces $50,000 sales incentive bonus on each new fully insured group sold! Why sell anything else?

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Case of the Singing Canary?

Wednesday, November 30th, 2016

canaryWill Haff, a San Antonio insurance consultant, has had his sentencing postponed a second time (Consultant Sentencing Delayed Again – Now 30 November 2016).Sentencing is now set for February 1, 2017.

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Rising Drug Costs Lead to PBM Scrutiny

Tuesday, November 29th, 2016

kickback222

If prices rise more than an agreed upon rate, excess increases may be offset by additional rebates. For some employers this means the PBM is pocketing some or all of the rebate money, driving record profits. In these cases there is absolutely no incentive on the part of the PBM to lower Rx costs. Rather, they earn more kickbacks as drug costs escalate. This revenue sharing between the PBMs and manufacturers at the expense of consumers continues to fuel spiraling Rx costs.

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Defenseless Utah Hospital System Faces RBP Blitzkreig

Tuesday, November 29th, 2016

blitzkreig

“The purpose of this notice is to formally advise you that University of Utah Health Care does not participate with ELAP or other “cost plus” plans being promoted in Utah or surrounding states.”

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Weslaco Independent School District Continues Aggressive Risk Management Strategies

Tuesday, November 29th, 2016

txfreemkt

Much to their advantage, Weslaco Independent School District in deep South Texas has effectively injected competition in local health care delivery. WISD has learned that health care givers will compete for business if given the opportunity

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Are Health Systems Improving Price Transparency?

Monday, November 28th, 2016

pricinggood“Some business is being diverted away from hospitals and toward retail clinics, standalone surgical centers and urgent care facilities that advertise their prices and services……….…’

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After Healthcare’s “Katrina”, Who Wins/Loses?

Monday, November 28th, 2016

competitionHealthcare stole the American Dream. But I’m excited to tell you a story about how forward-looking citizens, nurses and doctors are taking it back by fixing healthcare. And it’s working. 

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MEC Plans – A Tax Dodge Whose Time Has Come & Gone?

Saturday, November 26th, 2016

mulebriar

By Molly Mulebriar

Minimal Essential Coverage (MEC) plans are simply a tax dodge utilized by employers seeking to minimize the Affordable Care Act’s punishing mandates. By offering a MEC plan with essentially no benefits other than coverage for preventative care an employer can avoid the $2000 per year fine for every full time employee (minus the first 30).

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Cleveland Clinic CEO Dr. Toby Cosgrove’s warning to all US hospitals

Wednesday, November 23rd, 2016

hospitalbeds

“Hospital occupancy across the United States is about 65 percent,” said Dr. Cosgrove.

Possible reader concluesion/s:

  1. Too many hospitals
  2. Not enough sick people

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Selecting a Third Party Administrator

Wednesday, November 23rd, 2016

tpa

Selection of a third party administrator (TPA) is crucial to the success of a self-funded plan. Criteria usually revolve around several factors including compatibility. Corporate philosophies of the employer and TPA should harmonize.

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Interesting News From Medical Mutual of Ohio

Tuesday, November 22nd, 2016

Rx Ch-ch-changes

Interesting news from Medical Mutual of Ohio (via email):

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Belk: Generic Drug Pricing Going Down

Tuesday, November 22nd, 2016

belk

Hello again and Happy thanksgiving…………
Good news is a pretty rare thing when discussing health care costs in the US. In fact, good news has been a rare thing overall this year. This is why I was rather shocked to discover very good news in the last place I would ever expect to find it: prescription medication prices.

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Has Health Care Hacking Become An Epidemic?

Monday, November 21st, 2016

batman1

One in three Americans, more than 113 million medical records were compromised in 2015. 2016 statistics show the trend will be worse, with one in four Americans affected.

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Moving Away From PPO’s Can Be Legally Challenging – Contracts Really Do Mean Something

Friday, November 18th, 2016

confusedWhat Should I Do?

By Molly Mulebriar

Tired to seeing your claim costs escalating, year after year despite representations from managed care intermediaries that cost saving “discounts” are ever increasing and have never been higher? And, you should thank PPO’s for saving you 50% or more off health care costs.

But, RiskManagers.us has now proven to your satisfaction the real truth behind ever increasing health care costs. You are finally ready to jump off the cliff into what you perceive as shark infested waters with the assurance you will (1) survive, (2) the sharks are more afraid of you than you are of them and (3) the cleansing currents will take you to an island paradise where health care costs are fair, reasonable, predictable and essentially static. Umbrella drinks abound.

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Edison Machine Focus of $140 Million Lawsuit

Friday, November 18th, 2016

bloodfinger

Claims she would revolutionize the blood-testing industry with her patented Edison machine, a device that she said could conduct diagnostic tests with a single pinprick……………….

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Health Care Watch Dog Continues Search For Truth

Thursday, November 17th, 2016

belk David Belk

Hello Again Everyone! You might remember that, last Summer, I wrote a blog that questioned United Health’s claim that they lost hundreds of millions of dollars on the ACA exchanges last year. In short, I used their own financial statements to show that their profits, revenues and madical loss ratios didn’t square with their claims very well.

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Cancer Treatment In Cuba

Thursday, November 17th, 2016

cuba

“She exhausted all possible treatments in the U.S. and decided to go to Cuba to try a cancer vaccine available there called Cimavax. After starting the medication, her breathing improved and energy was restored.”

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Mexican Dogs Get Better Deals

Tuesday, November 15th, 2016

mexicandogA friend  runs a hunting lease in deep South Texas. I asked if rattlesnakes pose a danger to hunters. “Yes, could be, but not that prevalent. What you may find interesting is antivenom for my hunting dog who had an unfortunate up close experience with one was $700 but the same antivenom needed by one of my hunters was $20,000. Same drug. You ought to put that on your blog.”

That’s interesting, I thought, but Mexican dogs get it much cheaper, around $200. Savvy ones, who have been around the block a few times and know how to negotiate, get it slightly north of $14…………..It’s those Mexican dogs that can teach Trump a thing or too about the “Art of the Deal.” 

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Veterans Day Weekend in Houston Heights

Sunday, November 13th, 2016

houston

While in the Houston Heights over Veterans Day weekend, I took my daily walk through the Heights. As I turned to go down Courtlandt Street, I noticed a “garage sale” ahead with a small crowd around a table. As I got closer, I saw this was something extraordinary. It was not a garage sale, but something very different. And, it turned out, something very special.

Curious, I joined the small crowd of on-lookers as a young man explained the history of various WWII artifacts on display. “This is A WWI helmet, still has the insides all intact, worn by British soldiers in the trenches of France. This is a WWII helmet, used by Americans although this on has a German flag symbol on the side of it. ….”

Standing next to me was a 94 year old veteran and his daughter. He was clutching a photograph. I asked him if he was a veteran. “Indeed, here is a picture of me with my crew. I was the pilot, the one standing on the far left here.” How old were you back then I asked. “I was 21.”

I could tell this was a special gathering of spectators. The atmosphere was thick as the young man gave his most interesting “tour” of his mini-museum. He overheard my conversation with the old man, and asked if he could see the picture too. After a brief discussion, he asked “Sir, my I have your signature please. “Yes” he chuckled, “As long as it’s not on a check!”

The old man continued, “I have quite a few things I have kept since the war that I want you to have. I think this will be a good home for them…………………….

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Hospital Strong-Arms Self-Funded Employers

Sunday, November 13th, 2016
godfather
Dozens of companies have received a letter, via their insurance administrators, asking them to waive their rights to sue……. . If they don’t, a fact sheet included in the letter says, the companies’ employees  will no longer have access to discounted in-network prices………..……..

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On Draining Swamps

Saturday, November 12th, 2016

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Veterans Day 2016

Friday, November 11th, 2016

 rusreberg

Lt. Col. E. Rusteberg – West Point 1934 – Two Silver Stars, One Bronze Star, Presidential Unit Citation (Battle of Hatten), Purple Heart. American hero.

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HealthSmart Announces New CEO

Friday, November 11th, 2016

healthsmartDALLAS, TEXAS, November 11, 2016 – HealthSmart, a leading independent provider of managed care solutions for self–funded employers across the country, today announced that Phil Christianson has been named the Company’s new President and Chief Executive Officer, succeeding Tom Kelly, who has resigned from the Company to pursue other interests.

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Who’s Your Daddy?

Wednesday, November 9th, 2016

daddy“Mr. Rosenthal’s company, Health Street, has over the last six years grown into one of the city’s leading providers of drug tests and, more recently, DNA tests. He has contracts with some 10,000 companies……….……………..”

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State of Texas Employees Lose 3.8 Lbs Each In Bold Weight Reduction Program

Wednesday, November 9th, 2016

fatwomen1

We Collectively lost 15.2 Lbs!

“Since April, 15,000 current and former state employees—90 percent of whom are at risk for diabetes, cardiovascular disease or other related conditions—have lost more than 57,000 pounds through Real Appeal.” 

57,000 lbs / 15,000 employees = 3.8 lbs each

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Hidalgo County Voters To Decide Financial Health Care Scam Today

Tuesday, November 8th, 2016

scam“Hospitals agreed to assess a fee on themselves for every outpatient served and put that money into a fund that is then sent to the federal government to be multiplied.” TRANSLATION: Hospitals inflate medical charges to consumers, put these additional inflated dollars into a fund that Uncle Sam will match with money taken from working men and women through forced taxation.  Consumers are charged twice, once in the form of onerous taxation and second when they seek medical care.

“Many opponents believe the district would mostly benefit the shareholders at Doctors Hospital at Renaissance. The physician-owned hospital is one of the biggest supporters of Proposition 1.” TRANSLATION: Hospital can’t lose. They fund through overcharging patients which Uncle Sam matches, then these funds which are now double return back to the hospitals in the form of patient revenue.

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CVS Warns of Coming Retail-Prescription Tumult

Tuesday, November 8th, 2016

cvs“Very-recent pharmacy-network changes in the marketplace are expected to cause some retail prescriptions to begin migrating out of our pharmacies this quarter.”

Editor’s Note: We have found PBM pricing at CVS to be some of the highest, along with Wallgreen’s pricing. Some of our clients have excluded both pharmacy chains from their network and have achieved plan cost reductions.

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Boots Predicts Hillary Win

Monday, November 7th, 2016

goat

A “psychic” billy goat from Scotland named Boots chose a piece of paper that had Clinton’s name on it, thus predicting her victory.

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Chinese Monkey Predicts Trump Win

Monday, November 7th, 2016

chinesemonkey

A “mystical” Chinese monkey named Geda, who often predicts the winners of European soccer games, chose Trump as the winner of the U.S. election by choosing a banana near a cardboard cutout of the GOP candidate.

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The Truth About Managed Care Contracts

Saturday, November 5th, 2016

hmo1

“Paying protection money for the promise of no balance billing against egregious, arbitrary sticker pricing that has no relationship to costs whatsoever, and agreeing to provider reimbursement levels based upon secretive contracts you cannot see or audit, violates fiduciary duties and is contrary to basic, common American business practices”  – Molly Mulebriar

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Wikileaks: Mulebriar Exposes PPO Kickback Scheme

Friday, November 4th, 2016

shocked

Health care consumer reacts to shocking revelation

Wikileaks has released a purloined email today in response to Mulebriar’s interview with Julian Assange earlier this week (Wikileaks Releases Mulebriar Transcripts – Part One). In an email dated 2011 to RiskManagers.us, Mulebriar expresses shock and amazement that PPO contracts may not always pass on the full “discount” to consumers. She asks, “Are 100% of PPO discounts passed on to the consumer? In this case, the answer is no.”

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Insurance Broker Pleads Guilty To Bribery

Thursday, November 3rd, 2016

Samuel Mullen, (left) who is alleged to have bribed an insurance consultant for area school districts, walking out of federal court today in San Antonio with his lawyer, David R. Gorena (right). Mullen entered a not guilty plea to a charge of conspiracy to commit wire fraud. Photo: /Guillermo Contreas /Staff / San Antonio Express-News

Samuel Mullen, (left), walking out of federal court today in San Antonio with his lawyer, David R. Gorena (right) admitted Tuesday that he bribed a consultant for area school districts for inside information to help win insurance contracts.

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Wikileaks Releases Mulebriar Transcripts – Part One

Thursday, November 3rd, 2016

mulebriar123

Wikileaks today has released Part One of Mulebriar’s exclusive interview with Julian Assange. The interview was held at the Ecuador embassy in London on Monday.

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The Ethical Stain on U.S. Medical Care

Wednesday, November 2nd, 2016

klepper

Treatments Dr. Bestermann advocates for are based on solidly established science. They have been disregarded, not because most physicians don’t believe in science, but because healthcare’s scientific foundation has been trumped by financial incentives.” 

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Wikileaks To Release Interview Transcript With Molly Mulebriar

Wednesday, November 2nd, 2016

mulebriar123Wikileaks will release the first installment of Assange’s interview with Molly Mulebriar sometime later this afternoon or tomorrow morning. Julian Assange, founder of Wikileaks, says the release will rock the managed care industry.

The Extinction of Health Insurance Agents

Monday, October 31st, 2016

salesman2

“What is an health insurance salesman daddy?”

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Reference Based Pricing – The Hospital’s Perspective

Sunday, October 30th, 2016

othereside

A 2017 webinar will cover hospital’s view of Reference Based Pricing. An attorney who has advised multiple hospitals on how to respond and interact with self-insured payers taking RBP approaches shares her unique insights on how hospital administrators view common points of contention, as well as opportunities for more collaborative payment arrangements.

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HCA Profit Rises 38% in Q3

Saturday, October 29th, 2016

everybodywins

Revenue has  increased 4.2 percent year over year, to $10.3 billion in the third quarter of 2016. Could the ever present annual escalator clause found in managed care contracts be driving revenue increases?
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Bob, Let Us Know When You Run Out of Money

Friday, October 28th, 2016

thatcherq

Your decision to continue your current PPO program is understandable. You are not out of money yet.

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British Physicians List 40 Procedures Of Little Or No Benefit

Thursday, October 27th, 2016

hangoverq

Providing an intoxicated patient with intravenous fluids will not help them feel better or speed discharge from the hospital.

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Poor Lisita!

Thursday, October 27th, 2016
lisitaa
One of this blog’s three readers sent the following sad story in response to one of our recent posts (Yikes)

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Yikes

Wednesday, October 26th, 2016

mad

Martita, a sixty year old Texan, just received her individual health insurance renewal notice from Blue Cross, the only health insurance company that sells individual health insurance in her area in Texas.

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Aetna Exec: People Will Pick Beer Over ObamaCare

Tuesday, October 25th, 2016

germanbeer34

People can do the math. Gas for the car, beer on Fridays and Saturdays, or health insurance.

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What If An Employer Cannot Pay Government Fees (Taxes)?

Tuesday, October 25th, 2016

confused

Many employers incorrectly believe there is a chance they can play the “audit lottery” and avoid all ACA related penalties………….

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Healthcare Fraud Investigations Target C-suit

Tuesday, October 25th, 2016

bernieWhy Didn’t I Think of This!

The Department of Justice has taken a strong stance on pursuing healthcare executives involved in fraud cases to hold them personally responsible.

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The Out-of-Network Battle Heats Up

Sunday, October 23rd, 2016

blitzkreig

Payors have begun to take internal steps to avoid the “phantom charges” they claim are being billed by out-of-network providers……………...

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Tribal Health Plans Utilize Medicare Rates For Savings

Sunday, October 23rd, 2016

tonto

“Tonto, is that your health plan!” ….”Yes, Great White Father finally came through – It’s called Reference Based Pricing!”

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Edgewood ISD To Drop Reference Based Pricing Plan

Sunday, October 23rd, 2016

mulebriar

The Edgewood Independent School District in San Antonio, Texas, has decided Cost Plus / Reference Based Pricing is not for them.

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