How To Make Millions Scamming Self-Funded Health Plans

By Bill Rusteberg

Life has never been so good for seasoned health insurance salesmen. They know how to stretch plan contributions to their advantage without increasing them. And medical inflation is their best friend, a convenient scapegoat that doesn’t exist yet blamed for cost increases upon every renewal whether deserved or not.

Risky Risk Pools Plague Texas School Districts

“How can a superintendent or school board, as fiduciaries of taxpayer funds, jeopardize a district’s assets by participating in a risk pool, when they have no idea as to the pool’s financial ability to pay losses?” – Robert Reim

Aldeen’s Sunday Morning Bathroom Read

State lawmakers could implement standardized model contracts for state employees, cities, counties and school districts…………..

King Murray – The Most Outrageous Insurance Salesman That Ever Lived!

Murray was a most amazing character and ended up selling me life insurance….. at 27 years old!

Skyward Specialty Insurance

By Arleigh Kennedy – Stop Loss Expert

It’s frustrating how many people still don’t know Skyward Specialty Insurance is a direct writer of Stop Loss. Through our wholly owned subsidiary, Great Midwest Insurance Company (GMIC), we hold the paper, bear the risk, and stand on our own balance sheet. We aren’t renting paper. We are the direct writer.

ATTN. RISK MANAGERS: Here’s A Doozy You Won’t Want To Miss

September 16, 2026 at 5:30 PM – Employee Benefits, Insurance and Risk Management Committee Meeting

Plan Sponsor Achieves The Impossible

QUESTON: How did this midsize group reduce their Rx spend by 45% while all plan members continue to receive the drugs they need? How was it possible to drop their PMPM Rx cost from $133 to $60?

Willacy County To Issue RFQ For Insurance Consultant

The prior consultant who served Willacy County for 20 years resigned effective August 1, 2026. The county is now seeking a replacement.

Another Wisniewski Truth Bomb

By Leon Wisniewski – Revolutionizing Healthcare Spending | Founder @Health Cost Labs | Actuarial & Forensic Audit Expert | 20+ Years of Experience Working in the Healthcare Industry | Top 100 Innovators & Entrepreneurs!

Today the primary reason why healthcare is messed up is because employers give their cash to another vendor to do the bookkeeping. And that vendor proves their value by demonstrating how they pay less for treatments by using a number that never expects to be used for payment.

Trump Plans $500 Obamacare Rebates

Solange Reyner – Wed, September 9, 2026

The Trump administration plans to distribute $500 direct deposits to roughly 1 million people who buy their own health coverage without federal premium subsidies in 30 states ahead of the Nov. 3 elections.

Dr. Juliet Breeze – “Our Story Is For Everyone”

Next Level was founded by Dr. Juliet Breeze, who is also a mother. She experienced first-hand how challenging and expensive it can be to seek care for her injured son at a freestanding emergency room.

Curative Insurance Company Meets With Texas House of Representatives

By John Bock

I wanted to share that our CEO, Fred Turner, recently testified before the Texas House of Representatives Select Committee on Healthcare Affordability and laid out why newer health plans like Curative keep running into the same wall: hospital consolidation.

Brownsville ISD Enters The Twilight Zone

Do-Nothing Meeting – A Must-See Lesson On How To Do Nothing While Trying To Do something………….

The Brownsville ISD Board of Trustees meeting is an amazing example of ineffective leadership and an incompetent administration too scared to act. The meeting revolves around a recent RFP for group health insurance for their $60,000,000 DEFICIT SPENDING HEALTH PLAN…………..that’s currently $20,000,000 in the hole.

Call Me DOCTOR!

Titles mean a lot to some people, especially among educators. Obtaining a PHD isn’t that hard if you know how. Now it’s much easier.

Medicus Pharma Inks Global Licensing Deal With Pfizer Worth Over $1 Billion

Story by Vandana Singh

Medicus Pharma Ltd. MDCX secured on Wednesday an exclusive, sublicensable global license from Pfizer Inc. PFE to develop, manufacture, and commercialize PF-08046031 (CD228V), an early clinical-stage antibody-drug conjugate targeting melanotransferrin.

Lawnchair Larry Had A Different Kind of Pilot Life Insurance

Lawnchair Larry had his own version of a life insurance policy thanks to his girlfriend. She bought Larry a parachute hoping he didn’t have to use it. He didn’t.

Here’s A Texas Health Insurance Company You’ve Never Heard Of…

“We empower families to take charge of their healthcare — equipping them to save money and find providers that align with their value”

The Number 1 Digital Agency For Small Business Insurance

SOURCE: Insureon

Insureon is the #1 digital agency for small business insurance. We’re licensed in every state and have access to 100+ top-rated insurance providers, including The Hartford, Chubb, Hiscox, Liberty Mutual, and Travelers.

Win Government Contracts Before The RFP Drops

Civic IQ monitors council meetings, CIPs, and contract expirations across 100,000+ state, local, and education agencies — and delivers ranked government procurement signals to your B2G sales team before the bid goes public.

The ICHRA Shop Does It Again

By Brad O’Neil

BREAKING: ICHRA is becoming the CHOICE Arrangement—and we were already building for what came next.

Insurer of Last Resort

“No problem Joe, I’ll make a call for you”

The obituary is fake. George Parr, The Insurer of Last Resort, is alive and well……….

Brownsville ISD Insurance Committee To Address Decision Making Process

The Brownsville Independent School District’s self-funded health plan has a rich history going back years. Now, as we enter yet another episode of “As The World Turns” a BISD board member with a little help from his friends is on the warpath. You don’t want to miss this episode……………….

RiskManagers Website Defies Normalcy Because It Does

How many times have you visited a website and walked away wondering what exactly do they do? That’s by design. The strategy is to create as much curiosity as possible to motivate engagement.

Rx Financing: If It Doesn’t Make Sense It Does

By Bill Rusteberg

Why do we need insurance when 85% of the 26,715 FDA approved drugs covering every therapeutic class are low-cost generics with most costing $4 – $10 for a 30-day supply and the national average including higher cost generics costing an average of $35-$45?

Aon Acquires USI Insurance From KKR in $17 Billion Deal Targeting Middle Market

By Chad Hemenway | August 31, 2026

Aon plc early Monday confirmed a definite agreement to buy USI Insurance Services from private equity firm KKR for $17 billion.

City of Dallas Health Plan Suffers $51,000,000 Budget Shortfall

After layoffs, furloughs, Dallas looks to cut employee healthcare

The changes could affect which doctors employees can see and eligibility for GLP-1 coverage.

Why Healthcare Price Transparency Will Fail

Five fatal flaws — and how putting patients back in control of their own money fixes everything.

Does Commercial Insurance Always Pay More Than Medicare?

By Jason Nakka

Commercial insurance is supposed to pay more than Medicare. That is the whole reason a practice takes commercial patients in the first place.

Employer Sponsored Family Coverage Can’t Compete With Market Place Coverage

Mary, who teaches smartness because she is, learns artificial economics is driving market demand…………….and she gets a self-imposed pay raise.

Independent PCP Considers Insurance Sales

By Bill Rusteberg

In response to a previous blog posting (SEE POSTING HERE) we received an email from a primary care physician we know asking if insurance sales was an opportunity for him and “if so, how?”

Martin Frankel: The Recluse Who Looted Insurance Companies

SOURCE: The Fraud Archive

He was a recluse who hid from the world, then learned how to buy other people’s caution, their trust, and their reserves. Martin Frankel turned insurance companies into a private vault—and tried to wrap the scheme in Vatican respectability.

Mulebriar Strikes Again

“Texas takes unlicensed TPA activity very seriously, especially when municipalities or public funds are involved……..”

American Healthcare Finance – Is History Repeating Itself?

“Distribute a benefit and you distribute dependency. Distribute dependency and you distribute political power to whoever controls the distribution.”

47% of the American population is receiving government funded healthcare……

Teneshia – Houston’s #1 Fiscal Conservative

Credit: KHOU 11

A Harris County official was just approved for a $305,000 salary. She says she won’t take it.

RiskManagers Website Defies Normalcy Because It Does

How many times have you visited a website and walked away wondering what exactly do they do? That’s by design. The strategy is to create as much curiosity as possible to motivate engagement.

Chasing Dollars 7 Minutes At A Time

By Kendrick Johnson DO

I spent years inside the insurance-based primary care system. Here’s the part nobody says out loud: The 7-minute visit isn’t a failure of the system. It’s the output of the system.

Disney Is Dropping Healthcare Coverage For Working Spouses

The Affordable Care Act requires large employers to offer coverage to employees and their dependent children but imposes no obligation to cover spouses…….200,000 Disney employees lose spousal coverage…………….

Medicare For All Is Only One Election Away

“It’s time we eliminate the world’s longest waiting period!“ says Johnny Walker. “Not only is it the longest waiting period known to mankind, it requires decades of prepayment to the tune of hundreds and thousands of dollars before coverage ever begins!”

Small-Town Pharmacist Reveals the Financial Reality of Owning a Drug Store, Says She’s ‘Barely Making Enough’ (Exclusive)

Fair Jones tells PEOPLE she is “working myself to the bone” to save the Mississippi pharmacy she dreamed of owning

“Some can cost the pharmacy $1,000 or more for one patient’s one-month supply, while Jones says she may make only $10 in profit on the prescription. Filling 10 of those prescriptions in a week could cost her $10,000 upfront while bringing in just $100 in profit.”

Negotiating 2027 Renewals with Blue Cross and other BUCAs

By Daniel Meylan – Independent Healthcare Risk Financing Consultant

Over the past week I’ve had multiple advisor conversations across the country from Kansas to Texas to Missouri to Pennsylvania and heard about many Blue Cross fully insured renewal increases that exceed 30%. The way things are shaping up, any 2027 renewal offer from BC under 20% may be considered acceptable, especially for groups of 50 or less.

Government Backed TPAs to Compete With Legacy TPAs?

“The time has come for Congress to give employers a more accountable and affordable option to administer their medical benefit plans. We call this system disruptor the Fair Pay, Fair Play TPA”.

This article says Congress should gift employers a more affordable option to administer their medical benefit plan by competing with greed driven, plan gouging, for profit legacy TPAs.

Humberto Zamora

Humberto Zamora was one of the first entrepreneurs in the Lost & Found Money business who saw an opportunity well before anyone else did. From humble beginnings he earned millions helping hospitals collect Found Money.

IDR Awards Turbocharge Toilet Paper Numbers

“Awards usually land at 3–10× the toilet-paper number. But sometimes it’s 100× or 150×”

Large Texas School District Seeks Insurance Consultant

The United Independent School District is soliciting proposals from qualified consultants to serve as a strategic partner providing expertise, guidance, and administrative support for the District’s employee benefit programs.

School District’s Travel Expenses Called ‘Jaw-Dropping’ Amid District Budget crisis

“Sen. Lindsey Tichenor pressed the superintendent on the district’s credit card statements, calling its travel expenses “jaw-dropping.”

2 Texas Financial Advisers Found Guilty in $80 Million Ponzi Scheme

By Christopher Hoffman – August 19, 2026

SAN ANTONIO – Two Lubbock financial advisers have been found guilty of running a massive Ponzi scheme that federal officials say took in about $80 million from investors, leaving roughly 500 victims with millions of dollars in losses.

Crystal City ISD’s New Health Plan Won’t Survive The Light of Day

At their August 19 board meeting trustees of the Crystal City Independent School District awarded the district health plan to Curative Insurance Company effective October 1.

Is Your Premium Only Cafeteria Plan Compliant?

ATTENTION PLAN SPONSORS: There’s not too many compliant POP Cafeteria Plans out there. The good news is we haven’t seen any badge heavy, gun toting Cafeteria Plan police raiding worksites either. But it’s always good to err on the side of caution so take this as an unsolicited Public Service Announcement intended to keep your butt out of trouble.

90 Degree Benefits GP90 Plan

Discover how pairing a high-deductible health plan with a GAP90 plan can deliver significant savings for employers without sacrificing value.

Brownsville ISD To Entertain Presentations Even Though Top Ranked Vendor Has Been Decided

Could 50 People Be Wrong………………………? All vendors except the anointed one stubbornly cling to hope ……..“It ain’t over until it’s over…………..”

August 18, 2026 at 6:30 PM – Watch Employee Benefits, Insurance and Risk Management Committee Meeting Live………………

Could this be a case of Musical Chairs? Will United HealthCare keep the account or will Blue Cross get it back? Or…….. as they are coming around the corner here they come………. will Dark Horse Curative Insurance Company come from behind for the win? Fifty insurance committee members know the answer. Can they keep a secret?

Why Healthcare’s Future is Direct

By Manny Pastreich, President, 32BJ SEIU and Nick Stefanizzi, CEO, Northwell DirectPosted on May 14, 2026

American healthcare is dynamic and lifesaving – while also becoming unattainable for too many Americans at a price they can afford. For decades, the standard response to rising costs has been to shift costs to workers by raising deductibles, raising premiums, cutting services or shrinking access. The primary payers of American healthcare, employers and workers, now face a staggering $18,500 per employee cost.

Sangamo Therapeutics, Inc.

Sangamo Therapeutics, Inc. is a clinical-stage biotechnology company headquartered in Brisbane, California, that specializes in the development of genomic therapies based on its proprietary zinc finger nuclease (ZFN) technology.

THE ICHRA SHOP

Live it, love it, and wear it! New ICHRA t-shirts coming soon……………..

Brick & Mortar Auto Insurance Agents Face Death By A 1,000 Clicks

More insurance companies have decided retail brick and mortar agents are less relevant these days. There’s a better more economical way to distribute their products.

DPC Malpractice Insurance

We are the program administrator of the only true DPC-specific malpractice insurance policy available.

$10,000 Dental Plan

“With NCD Complete by MetLife, your clients get a high quality dental plan backed by a trusted name, a nationwide provider network, and exclusive savings.”

Mob Rule

By Bill Rusteberg

“Mob rule or ochlocracy or mobocracy is a pejorative term describing an oppressive majoritarian form of government controlled by the common people through the intimidation of authorities.”

PBM Deception

By Eric Bricker, MD

In this ten minute video Eric explains how PBMs take the art of deception to new levels while claiming 100% of rebates are passed on to plan sponsors – the key is three letters: G-P-O

Employers Chase Cost Cuts, Leaving Benefits Brokers At A Crossroads

“When cost becomes the only lever a client is asking about, the broker’s role narrows to running RFPs and comparing quotes, work that’s increasingly easy for a client to benchmark and easy for a competing broker to replicate.”

More Large Employers Are Turning To ICHRA As Group Costs Climb

ICHRA adoption jumped 53% in 2026, but the real story is that applicable large employers are now the fastest-growing segment

How Much Will You Pay Me For My Life Insurance Policy If I Sold It Today?

As life circumstances change, a policy that was purchased for protection may also provide liquidity during the insured’s lifetime. Whether you are facing rising premiums, changing retirement goals, or no longer needs the same level of coverage, your policy could hold more value than they realize.

Become A Published Author For Only $149 (and you may become famous too)

We’ve seen a few in our industry become published authors to good effect. They expose the truth about American health care finance, industry secrets that average plain ole everyday plan sponsors are clueless about. Now here’s your chance to do the same for only $149……………….

Robert Kennedy Jr. Exposes Anti-Fraud Failure

When I came in, there’s only 6 people who are in charge of all program integrity for my department!”

They Hated Health Insurance. So They Started Paying For Each Other’s Care

“What resonates with people is that they’re just tired of health insurance. They’re tired of these bills and these claims getting denied……………..”

Do You Wonder What FY2027 MS-DRG Rates Do To Medicare Inpatient Revenue At Your Hospital?

“This (Free) DRG-Impact tool is designed to quantify the revenue impact of the final FY2027 MS-DRG rates by hospital and DRG. I hope you find this helpful and I welcome your feedback.” – Brian Cotter

The Future of Community Pharmacies

“To survive, community pharmacies are evolving beyond the traditional “product-dispensing” revenue model. The future of local pharmacy relies on diversifying revenue away from product margin alone—shifting toward clinical service delivery, point-of-care testing, specialized compounding, disease state management, and direct-care service contracts with local employers and health plans” – Erin Albert

ICHRA Stories

Watch Real Experiences and Insights from Employers, Employees and Brokers

Wondering what ICHRA looks like in practice? Hear testimonials directly from employers, employees, and brokers as they share real experiences with Individual Coverage Health Reimbursement Arrangements (ICHRAs), offering practical insights, lessons learned, and perspectives on personalized health coverage, employee choice, and cost control.

The Life of a Prescription in the USA in 2026–Drug Formularies, Pricing, and Money at the Pharmacy Counter

This is Part 6 of a 6 Part Series By Erin L. Albert, MBA, PharmD, JD, DASPL

“To understand why a medication costs $10 for one person and $1,000 for another under the exact same plan design, one must examine how drug formularies handle money at the counter—and how modern pricing structures, like the Mark Cuban Cost Plus Drug Company (MCCPDC) bolt-on model, attempt to disrupt that framework.”

100 Best Health Insurance Blogs to Follow in 2026

Psssst……RiskManagers.us is NUMBER TWENTY!

The best Health Insurance blogs curated and ranked based on multiple factors, including content relevancy, subject expertise, posting frequency, and freshness of content.

Greenback Health – Simplifying Healthcare Costs Through Innovative Technology

Greenback Health is a healthcare technology company that partners with insurers, PBMs, and health plans to analyze thousands of drug prices in real time and identify the most cost‑effective payment options at the point of sale.

Amazon Pharmacy RxPass Program

SOURCE: Amazon Pharmacy: RxPass

RxPass has you covered

While other savings programs charge for each individual medication, RxPass is always $5 a month—no matter how many meds you take.

Navigating Cash-Pay Prescriptions: A Guide for Pharmacies

Written byEmily Smith – Product Marketing Manager, RedSail Technologies – April 9, 2024

We know the prescription drug supply chain is complex, shaping medication pricing in complicated ways. As prescription costs continue to rise, and insurance coverage fluctuates, cash-pay prescriptions have emerged as a viable option for many people seeking affordable medication.

Return of Cash Pay for Drugs

Why on earth do we use insurance to pay for a $4 benefit? That makes no sense………

Cash price Rx plans already exist producing significant savings for consumers. Why aren’t more employer sponsored health plans moving to cash pay Rx plans? Do they not understand the economic value or are they welded to status quo strategies fueled by lack of critical thinking skills?

Ruben Cavazos, Willacy County Treasurer Appointed To NACO Committees

Ruben Cavazos is the Willacy County Treasurer in Raymondville, Texas, serving since January 1, 2007 when he became the youngest country treasurer in Texas ever to win office.

Iran’s Healthcare Crunch Forces Patients To Cut Treatment

“One person undergoing tests for an abdominal and pelvic mass said CT and MRI scans, with and without contrast, cost 210 million rials ($113) despite having Social Security insurance.”