TIMELINE 2018: A Public Education Purchasing Seminar

September 4th, 2017

Designed for Public Education Purchasing Professionals with special emphasis on the latest developments that are essential in educational purchasing……….

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Fat Americans

September 3rd, 2017

Civilian Turns Marine

” 70 percent of today’s youth are not fit to serve in the military due to obesity or being overweight, criminal records, drug misuse or educational deficits.”

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Access2MD

September 3rd, 2017

Access2MD™ was founded in early 2012 by practicing physicians who wanted to change the clinical landscape. Innovative, “out of the box thinking” and progressive ideas have brought Access2MD™ to where it is today and this same approach will drive the company direction into the future.

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Keypro

September 3rd, 2017

Since 1985, KEPRO has helped more than 20 million members lead healthier lives through clinical expertise, integrity and compassion. KEPRO was founded by physicians and clinical expertise is at the core of our organization.

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Not your Typical On-Site Clinic

September 3rd, 2017

Our health centers are not mere urgent care clinics but comprehensive health management platforms.
Modeled as Patient Centered Medical Homes, our health centers provide collaborative, patient-centric care and optimize resources, support, and value to the needs of each individual patient.

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Super TPA Shares Success Strategies

September 2nd, 2017

I had a conference call this week with the CEO of a company with 1,500 employees lives covered with one of the BUCA PPO plans. His employees deductibles were $1,500 and an OPM of $5,000. I told him the we, Continental Benefits, could give you the same “A” PPO network, but also add bundled guaranteed pricing for 100 + different medical speciality surgeries with vetted and high quality surgeons.

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Third Party Intermediary Screws Consumers

September 2nd, 2017

This is a bold-faced case of one business basically bribing another business to not use a certain other business!

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AMBS Third Annual Consortium Meeting Set For October

September 1st, 2017

Advance Risk Management Solutions, Inc. presents ARMS 2017 Consortium Conference – Tuesday, October 24, 2017 | Thursday, October 26, 2017…………..Moving HealthCare Risk Management in a New Direction

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David Contorno

August 31st, 2017

Attention all TPA’s and PBM’s that may want to work with me and my clients……you will give me any and all data I ask for, in an expeditious and COMPLETE manner, without talk of extra costs or complexity. Your entire purpose is to analyze data and make decisions on that data, on behalf of our clients, with their money.

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National Direct – Satisfying the Greed Factor

August 31st, 2017

WHY WORK FOR ANYTHING LESS THAN THE MOST YOU CAN GET?”
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Why The Healthcare Industry Will Eliminate PPO Networks

August 31st, 2017

Mike Dendy

Eliminating the PPO domination of healthcare financing will represent a paradigm shift but one that is long overdue.

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Anthem Steers Members Away From Hospital Based Imaging Services

August 30th, 2017

In a move that it says will save members money, Anthem is rolling out a program that steers individuals away from hospital-based imaging services and toward less costly, freestanding imaging centers.

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BCBS of Georgia’s Solution to Non-Emergency ER Visits?

August 30th, 2017

BCBS of Georgia held a webinar last week. From what we have been told, BCBS and Anthem are cancelling Emergency Room benefit payments that are not “emergencies.” We have done the same with some of our self-funded clients. Significant savings have been achieved. No longer will Mommy take little Johnny to the ER for a fever and pay a low co-pay. Now when Little Johnny’s mommy gets the bill, her co-pay for non-emergency ER visits will be 100%……………….

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To Promote Health Care Excellence, Let’s Recognize Approaches That Assure Value

August 29th, 2017

Aug 28, 2017

BY BRIAN KLEPPER

A challenge for health care purchasers is choosing vendors whose performance matches their cost and outcomes claims. A 2015 Mercer surveyfound that only 41 percent of worksite clinic sponsors think that they’re saving money. As Al Lewis and Tom Emerick have detailed, many wellness and disease management companies simply overstate their results. In many cases employers may not realize that they, not the vendor, take the risk for results.

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Report Touts PBM “Savings” off Egregious Sticker Prices?

August 29th, 2017

Part-time PBM Salesman

“Costs would run an estimated 58 percent higher without PBM management tools and the pharmacy pricing and manufacturer discounts negotiated by the PBM”.

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Aetna Violates HIV Patient’s PHI? 12,000 HIV Patients Affected?

August 29th, 2017

Legal groups on Monday filed a class-action lawsuit against the health insurer Aetna, alleging the company violated the privacy of its customers by sending many of them letters through which the phrase “filling prescriptions for HIV” was visible through envelope windows.

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WellNet’s Fall Broker Tour Offers Self-Funded Insights with Focus on Reference Based Pricing

August 27th, 2017

WellNet’s Fall Broker Revolution Tour is coming to a city near you. This tour is for brokers and consultants whose clients are tired of the carrier lip service.

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General Patton Addresses His Troops

August 25th, 2017

Damn it! We can’t continue to go around selling PPO plans instead of reference based pricing plans…..

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Converting PPO “Discounts” To Medicare Allowable

August 22nd, 2017

They were floored and shocked to find out that the 60% discount of billed charges in their area actually converted to 270% of Medicare charges!……………

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Money Affects Behavior

August 22nd, 2017

Amazing what people will do when they get told what their real costs are…………….

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PBM’s Bypass Middlemen – Cutting Out Insurance Companies From Gravy Train

August 18th, 2017

By cutting certain players, often insurers, out of the drug supply chain, disruptors are challenging the drug-pricing paradigm, as well as the value of prescription coverage…………

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Express Scripts Lawsuit Should Raise Everyone’s Eyebrows 

August 18th, 2017

The information that’s revealed is shocking………………….

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Texas Balance Billing Law To Take Effect September 1

August 17th, 2017

The bill expands a patient’s ability to mediate their claims with the insurance companies and sets new guidelines for mediation………………….

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Bernhard Opines on Fake News – PPO Discount Game

August 17th, 2017

Jeff Bernhard – President of Continental Benefits

Does everyone realize that a discount guarantee is really useless/ineffective for a self-funded offer/RFP? When does a discount ever lead to lower spend? How silly!

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Medicaid Overpaid Texas $18.9 Million For School Based Health Services

August 17th, 2017

Texas received $18.9 million from Medicaid for school-based health services that were billed improperly, and the federal government is seeking to get the money back.

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Blue Cross Michigan Hit With Flurry of ERISA Lawsuits

August 17th, 2017

A Shell Game Common To Health Care Financial Transactions

As a plan sponsor are you paying undisclosed fees that don’t show up on the fixed cost side of the ledger but rather on the claim cost side? There are numerous lawsuits that have exposed this industry practice and is not limited to BCBS………………….

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Texas Permanently Bans Taxpayer Funding of Abortion

August 16th, 2017

Bill prohibits insurance providers from forcing Texas policy holders to subsidize elective abortions

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Freedom Plan

August 15th, 2017

A Man Before His Times – Martin Luther announcing “Free at Last” Reference Based Pricing Plan

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Nixon Went to China. Can Trump Go to Single Payer?

August 8th, 2017

Only Trump can make single-payer health care happen in this country…………..

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Why A Pennsylvania Insurer’s Collapse Could Whack Californians In the Wallet

August 7th, 2017

Penn Treaty’s liquidation poses a “potential shock to the health marketplace” as the losses pile up, according to the A.M. Best credit rating firm. Industry analysts estimate the parent company has long-term claims liabilities approaching $4 billion, but only about $700 million in assets.

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Your Network Discount Analyses Are Useless

August 5th, 2017

Throw it in the trash. Seriously…………………. 

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Smoke & Mirrors – Comparing PPO “Discounts”

August 5th, 2017

Many independent fee based insurance consultants are sucked into the PPO “discount” vortex……………..

The carriers are very good at playing this game and my belief is that most consultants don’t get it or pretend not to get it, thus doing a great dis-service to their client.”   – PHO Sales Representative

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Cigna, Other Health Insurers’ Profits Surge, Ignoring ACA Chaos

August 4th, 2017

U.S. health plans stocks up 26%, outperforming S&P 500…………….

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Institute For Supply Management Announces September Seminar

August 2nd, 2017

 

This program is applicable to all areas of the public education sector, including school districts, junior colleges, and colleges.

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What Employers Need To Know To Manage Health Costs

August 1st, 2017

Employers can immediately reduce the cost of health insurance by 20% by simply shifting their focus to proven strategies…..

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Why Most Health Plans Strive To Make Healthcare Cost More

August 1st, 2017

 Brian Klepper

“The truth is that group health plans typically earn a percentage of total expenditures, and it is in their interest for healthcare to cost as much as possible.”

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Crowne Consulting Group

July 31st, 2017

As the future of healthcare lingers in a national debate, Crowne Consulting Group, Inc.delivers achievable ways for employers to decrease medical expenses while enhancing care for employees.

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Amazon Launches Secret Healthcare Team?

July 29th, 2017

Is this the beginning of Amazon’s move into the healthcare industry?

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How to Determine if Your Company [or Client] is Overpaying for Rx

July 28th, 2017

The costs shared here are what the pharmacy actually pays; not AWP, MAC or WAC…………

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McCain Kills Repeal

July 28th, 2017

The Republican party is split. The Democrats are unified. This is a perfect case where “You don’t interfere when your opponent is committing suicide.”

Surgeons Excited About Slug Slime

July 28th, 2017

The European slug is average in every way: slimy, brownish, shorter than a credit card. But Arion subfuscus has a minor superpower………………

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Adam Ruins Everything

July 28th, 2017

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Leap Of Faith: Will Health Care Ministries Cover Your Costs?

July 28th, 2017

Health care ministries are essentially cost-sharing programs. Members’ monthly fees are applied directly to other members’ medical bills, no matter where they live in the U.S. 

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News Reporters Obtain Sensitive, Closely Held Health Care Industry Secrets

July 27th, 2017

UHC Sales Rep. Reacting To News

FOX 8 has obtained a document – among the most sensitive in the healthcare industry……….A local provider sent us a spreadsheet that shows his businesses’ negotiated rates with three insurance companies, Blue Cross Blue Shield, United Healthcare and Humana………………

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Medical Travel Today Spotlights Asserta Health

July 26th, 2017

Facilitating cash pay arrangements for self-funded employers and health plans, achieving significant savings in partnership with medical care givers………………..

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TRS Marketing Opportunity Addresses Melting Raspa

July 26th, 2017

TRS Health Programs Imploding Faster Than A Melting Raspa

The Texas Teachers Retirement System health plan changes have been announced for January 1, 2018 and they are not impressive…………………TRS Participants are beginning to picket on the State Capital steps in Austin.

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Surprise! Out-of-Network Billing for Emergency Care in the United States

July 24th, 2017

Out-of-network billing allows physicians to significantly increase their payment rates relative to what they would be paid for treating in-network patients…………...

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AmericanRisk

July 24th, 2017

Medical stop loss doesn’t have to be a boiler plate, off the shelf, cookie cutter product. It needs to be innovative and compelling.

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Flabbergasted

July 24th, 2017

m.youtube.com/watch?v=e2yzlW_XVZk

More Doctors Smoke Camels Than Any Other Cigarette

July 24th, 2017
Don’t be foolish, take your doctor’s advice: Smoke a fresh cigarette………………..

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Swamp Watch: Health Insurance Companies

July 24th, 2017

Contributed by Mike Reagan

video.foxnews.com/v/5518549927001/?#sp=show-clips

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HHC Group’s Bulldogs Will Bark When Providers Balk

July 24th, 2017

More and more employers with self-funded health plans are turning to reference-based pricing to reduce their overall spend. They like the deep savings, and they appreciate the price predictability regardless of which provider the plan member uses.

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Starmark Embarks On Reference Based Pricing Strategies For Small Groups

July 23rd, 2017

Designed specifically to address rising healthcare costs for employers with 5 to 99 employees, Healthy Choices plan designs generally calculate reimbursement amounts for healthcare services using reference-based pricing. This approach results in a reasonable fee, which is a multiple of Medicare’s reimbursement rate…………….

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Mike Dendy Opines – How To Make Commercial Health Insurance Reasonable

July 23rd, 2017

Mike Dendy

The health insurance industry is a cartel and cartels have to be broken because by definition they can’t be fixed………………………

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Introducing….The Point by Apex Benefits

July 22nd, 2017

Apex Benefits, an Indianapolis-based benefits consulting firm, develops innovative strategies and programs to provide employers unique, cost-savings health benefits programs…………

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Richard Sutton

July 21st, 2017

I’m very fortunate to be able to collaborate with a group of true reformers from around the country.  We’re committed to transforming our current system of inefficiencies into an efficient system where primary care is empowered, quality and outcomes are measured, and the price tag for services is greatly reduced – Richard Sutton

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America’s Healthcare Secret Pricing Scandal Exposed

July 20th, 2017

Insurance companies create vast networks, referred to as PPOs (Preferred Provider Organizations). The only thing that is preferred is the deal the insurance company cuts itself. About a full one third of the total medical spend by an employer can be eliminated by removing in-network pricing variation for commodity care alone. 

Employers need to realize that when they pay for PPO access, they are paying to access a network designed to maximize the insurance company’s revenue – not to save the employer money on medical care. 

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Trump Signs Executive Order – Medicare For All

July 18th, 2017

Democrats are in orgasmic euphoria……………..

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TPA Loses Lawsuit Against Private Citizen

July 17th, 2017

Murry B. Cohen, Appellate Lawyer 

Gloria Hicks, v. Group & Pension Administrators, Inc., 13–14–00607–CV, (Tex. App. 2015). Reversing District Court and holding that a citizen’s email to school board trustees urging the board not to contract with plaintiff concerned a matter of public importance, was not commercial speech, and defendant was protected from suit by the Texas Anti-SLAPP statute.

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Witch Doctors & Palm Readers

July 16th, 2017

Managed Care Executive

We just can’t think anything other than they are as stupid as stupid gets…….……

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Political Subdivisions – Chasing Windmills Can Be Expensive

July 16th, 2017

The problem facing political subdivisions in seeking competitive bids are many. Politics almost always plays a pivotal role in the process and oftentimes encompasses a mixture of ignorance, money, clan loyalties, and employment.

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Replacing Wrap Networks For Something Better

July 15th, 2017

Unwrap Me Please!

With Phia Unwrapped, The Phia Group replaces wrap network access and modifies non-network payment methodologies, securing payable amounts that are unbeatably low, based upon fair market parameters.

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Lily Livered Republicans Cower in Trenches While Democrats Rule Congress

July 13th, 2017

Republicans are going to fund Obamacare subsidies that the Democrats forgot to fund?

It will be voter payback time in 2018 – Lily Livered, Yellow Bellied Cowering Republican elites will be targeted for punishment……….Too many lies for too many years will impact the 2018 mid term elections. 

The Democrats are smart. They have learned “Never interfere when your opponent is committing suicide”

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The Ultimate Secret In Controlling Health Care Costs

July 12th, 2017

Joe’s choice of beer is a good example of his philosophy. He knows that in order for beer vendors to stay in business they must agree to sell based upon the price Joe and others are prepared to pay……………

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Mike Dendy – Innovator & Market Leader

July 12th, 2017

Mike Dendy, MBA/MHA, vice chairman & CEO, Advanced Medical Pricing Solutions (AMPS) is certainly a market leader and really “gets it”…………..…..Laura Carabello

In 2013 I wrote “Xerox, Eastman Kodak And Cost Plus Insurance” which predicted the inevitable rise of the Mike Dendy’s of the world.(See article at end of this blog entry).

In the article I wrote: “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……………..pioneering, successful business endeavors that fail to react quickly and appropriately to market threats end up losing market dominance……………….”

And then, as predicted, (a) Mike Dendy gobsmacked the market with a set of fresh eyes. His company, AMPS, has since become the national leader in Reference Based Pricing strategies, experiencing phenomenal market growth.

“Companies must work constantly to eliminate any cost factor that does not add value to a business process” – Mike Dendy

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Texas Supreme Court Disputes Reach of Obergefell in Employee Benefits Case

July 10th, 2017

Texas Supreme Court has ruled state governments do not necessarily have to extend marital benefits to same-sex married couples………………

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UNITED STATES OF AMERICA and THE STATE OF NORTH CAROLINA, Plaintiffs, v. THE CHARLOTTE-MECKLENBURG HOSPITAL AUTHORITY d/b/a CAROLINAS HEALTHCARE SYSTEM, Defendant.

July 10th, 2017

This case involves the relationship between hospital system and insurance company, and how that relationship affects everyday patients and consumers……..

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RiskManagers.us Business Statement

July 8th, 2017

The shared vision of RiskManagers.us and clients who retain our services is to establish and maintain a comprehensive employee health and welfare plan, identify cost areas that may be improved without cost shifting to any significant degree, and ensure a superior and sustained partnership with a claim administrator responsive to members needs on a level consistent with prudent business practices.

Plan costs, in all areas including fixed expenses and claims are open for review on a continuing basis. Cost effective plan administration and equitable benefit payment to providers are paramount to fulfilling our mutual fiduciary duties. As we proactively monitor and manage an entire benefit program we are open to any suggestions members may make or the dynamic health benefit market may warrant in order to accomplish these goals.

Duty of loyalty to our clients, transparency and accountability are essential to the foundation of our services. To that end, we expect our clients to realize a substantial savings based upon the services that we will deliver.

2017 RiskManagers.us All Rights Reserved           

Email: RiskManager@RiskManagers.us

Selecting a Third Party Administrator

July 8th, 2017

By William Rusteberg

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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Equifax Reaches Agreement To Acquire ID Watchdog

July 7th, 2017

ID Watchdog Signs Agreement to be Acquired by Equifax Inc…………..

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Retired Teachers Face Huge Health Care Cost Increases

July 6th, 2017

The average premium for a high-deductible health plan for a retired teacher under 65  with no beneficiaries could rise from $1,300 to $9,550 in 2018, under the legislature’s fix…..

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11-Questions to ask your Group Insurance Company or Third Party Administrator

July 6th, 2017

 

Having the right claim payer for your company’s healthcare program(s) will make a positive impact to your bottom line and employee productivity……………..

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The Hospital Industry Is A Big Game Of Monopoly Right Now

July 4th, 2017

The hospital industry is participating in a massive flea market, with large chains buying and selling hospitals like Pokémon cards or Monopoly properties.

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Making A Hospital More Efficient?

July 4th, 2017

Prime Healthcare Foundation has a record of purchasing distressed hospitals and making them profitable…………………….

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Texas Association of School Boards Admits Security Breach – Members At Risk

July 4th, 2017

Once it’s out there it can be sold on the black market………………

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