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Our very own @kcarle_kim discusses payment integrity in medical claims with @RelentlesHealth you do not want to miss!
cc-lnk.com/EP480
#HealthcareReform #healthcarecrisis #claimsintegrity
US BEACON retweeted
That’s pretty funny. He is a genius financial engineer. The split is great for shareholders. Changes nothing for patients or anyone who pays for insurance or care.
He is posturing to be able to say “See, we broke up our company. “. Don’t fall for it @HawleyMO @SenWarren
We need to pass the bill now more than ever
CVS CEO David Joyner just said on CNBC that the Break Up Big Medicine legislation by @SenWarren and Josh Hawley (@HawleyMO) is one reason he is breaking up his company.
US BEACON retweeted
Mark Cuban wants to crack open the market for rare disease treatments statnews.com/2026/10/21/mark… via @statnews
US BEACON retweeted
If you run a company, you now have a fiduciary/legal responsibility to make sure your healthcare benefits actually benefit your employees.
If not , you are legally liable.
You have to learn how it all works. You can’t ask a broker or consultant to figure it out for you. The responsibility stays with you and never goes to them. Even if they lie, steal and cheat you.
It’s all on you.
I hope you’re sitting down for this.
hcamag.com/us/specialization…
US BEACON retweeted
You would never go shopping for a plane ticket, car, or groceries without having some idea of the prices you're going to pay.
Why should HEALTHCARE be any different?
Today’s new CMS rule gives Americans clearer information to compare healthcare costs and understand what their insurance will cover — before the bill arrives.
US BEACON retweeted
The @FTC is cracking down on hidden hospital prices, warning 24 large hospital systems to disclose their prices upfront or be taken to court.
As @AFergusonFTC said, “We demand nothing less than radical transparency.”
US BEACON retweeted
🚨 Oz WARNS: Socialized medicine always creates a TWO-TIER system.
@DrOz: “I don’t care where you try to use socialized medicine, you end up with a two-tier system.”
“You have what the rich people get because they buy it for themselves using their own money and then everyone else gets what’s left over.”
US BEACON retweeted
A hospital can be “nonprofit” and still behave like the most ruthless business in town.
One of my clients is a nun who desperately needs a joint replacement, so we offered to pay cash. Upfront.
The hospital is demanding $80,000.
Medicare would pay $16,000.
Ironically, she has no income and would qualify for the hospital’s financial assistance policy where federal law would limit what the hospital could charge her.
But because she has a health plan that wants to pay a fair price, the hospital is demanding five times Medicare instead.
“Nonprofit” is a tax designation. Not a commitment to charity.
Read the whole dirty story at the link in comments.
US BEACON retweeted
.@DrOzCMS brings down the hammer on insurers and hospitals that fail to comply with price transparency rules:
"When we find you, we will fine you."
US BEACON retweeted
So this keeps happening, patients denied transplants and being left to die waiting on hold because the Blues use ancient data to deny care. @BCBSIL @GovPritzker @BCBSAssociation
Hi @BCBSIL
Let’s do the right thing here and get a life saving liver transplant instead of a denial?
Can my followers please retweet so that we can save a life?
@JeremyRenner @mcuban
US BEACON retweeted
I have a medical procedure tomorrow and I have to cancel it after a long wait because the prep med was rejected by insurance due to the formulary. Or I pay over $200 for it OOP. And the doctor’s office is closed because it’s Sunday.
What is this absolute mess of a system.
US BEACON retweeted
Look at the healthcare industry. Multi hundred billion dollar conglomerates that get sued daily. Literally. Daily. Lose most suits. Against cities. States. Feds. Get fined hundreds of millions in individual suits.
They are too big to care.
Hello Mark, you correctly identify the problem and then propose another government committee.
If AI companies can make more from misconduct than government can extract from them, the answer is meaningful liability, disgorgement and penalties that exceed the gain. Existing laws should apply to the conduct and harm, whether AI was used or not.
And calling a panel “tri-partisan” doesn’t make it nonpartisan. It just gives three political camps seats at the table.
US BEACON retweeted
Patients were fighting for treatment. UnitedHealth executives were allegedly cashing out.
UnitedHealth shareholders allege company executives sold more than $237 million in stock while serious risks remained hidden from investors—including accusations of Medicare fraud, and denials of medically necessary care.
US BEACON retweeted
Thank you @TateReeves and @GovStitt for your assistance!
Mississippi and Oklahoma are stepping up to help our state fight this ongoing wildfire.
US BEACON retweeted
When the state of Montana’s TPA refused to share what it was paying hospitals, administrator Marilyn Bartlett switched vendors and moved to transparent, Medicare-indexed direct contracts.
The result: up to $47.8 million saved in just three years. 📉
That’s price transparency at work.
US BEACON retweeted
Chalk one up for press freedoms. A federal judge on Wednesday denied a temporary restraining order that would have barred the Arkansas Democrat-Gazette from publishing more information on Entergy's secret arrangement with Google.
arktimes.com/arkansas-blog/2…
US BEACON retweeted
Replying to @mcuban
I use Costplus to get my prescriptions, so I thank you for getting the prices down. The imitanib for my stage 4 cancer regular price is around $9000, at Costplus it's $39.50 shipped to my door. Unfortunately, they're about to change my prescription and I might not be able to afford it.
US BEACON retweeted
My testimony today at the Texas State capital
I’m the co-founder of CostPlusDrugs.com.
We started Cost Plus Drugs because the prescription drug market is too complicated, too opaque and too expensive.
Our model is simple: we show what we pay for a drug, add a transparent markup and pharmacy fee, and show the customer the price.
No games. No hidden spread.
And a large percentage of our customers already have insurance.
They come to us because our cash price is often lower than what their insurance plan asks them to pay.
That tells you something is wrong.
Here are five things Texas can do about it.
1. Let patients shop for cheaper drugs
If someone's insurance says a prescription costs $500, but they can buy the exact same drug for $100 cash, let them buy it for $100.
Then credit that $100 toward their deductible and out-of-pocket maximum wherever Texas has authority to do so.
Patients should be rewarded for saving themselves and their health plan money.
They shouldn't be punished for it.
That's how you create something healthcare desperately needs:
Price competition.
2. Standardize PBM and TPA contracts
Texas should require the state, cities, counties and school districts to use standardized model contracts and mandatory terms for PBMs and TPAs.
I've reviewed these contracts.
They routinely run hundreds of pages.
I've seen contracting packages longer than a thousand pages.
There is no human being—or group of human beings—on this planet who can stay awake and understand every provision in contracts that complicated.
I don't care how much coffee they drink.
I call it contractual terrorism.
The vendor only has to sneak a couple of tricks through hundreds of pages.
The employer has to find every one.
It can't.
I've developed a model PBM contract designed to eliminate the major tricks and hidden economics we've identified.
Texas can have it for free.
Use mine. Improve it. Open source it.
I don't care.
Just stop making every government entity negotiate these contracts from scratch.
3. Make the economics public
If taxpayers are paying the bill, taxpayers should know the price.
Pricing. Fees. Rebates. Guarantees. Pharmacy reimbursement. Affiliate compensation. Audit rights.
Make them public.
I'm not talking about patient information or legitimate security information.
I'm talking about the money.
You cannot have an efficient market without price discovery.
Without price discovery, you get information asymmetry.
And when one side knows dramatically more than the other, guess who wins?
Not taxpayers.
Not employers.
Not patients.
Open the contracts up and let competitors see what they have to beat.
That giant sucking sound you hear will be money moving away from healthcare conglomerates that are too big to care and back toward taxpayers, employers and patients.
In the immortal words of Charles Barkley:
I guarantee it.
4. Kill the gag clauses
PBM contracts are like Fight Club.
The number one rule of Fight Club is that you can't talk about Fight Club.
The number one rule of many PBM contracts seems to be that you can't talk about your PBM contract.
That's insane.
Let employers compare pricing, rebates, fees, guarantees and reimbursement terms.
Markets work better when buyers know what other buyers are paying.
5. Make enforcement hurt
If a healthcare company commits a serious violation, give them one mulligan.
But after a second material federal or Texas enforcement action within a defined period, make them ineligible for new Texas government contracts for a period of time.
Two strikes.
You're out.
Today, some of these companies can make billions, get caught, pay a fine and write it off more easily than I wrote off an NBA fine.
That's not deterrence.
That's a cost of doing business.
And Texas should spend more on enforcement.
If Texas spends $10 million auditing contracts and analyzing claims and prevents $100 million in unnecessary spending, that's not overhead.
That's a 10x return on investmen
US BEACON retweeted
🏛️ 𝐌𝐚𝐫𝐤 𝐂𝐮𝐛𝐚𝐧 𝐓𝐞𝐬𝐭𝐢𝐟𝐢𝐞𝐬 𝐭𝐨 𝐓𝐞𝐱𝐚𝐬 𝐋𝐚𝐰𝐦𝐚𝐤𝐞𝐫𝐬 𝐀𝐛𝐨𝐮𝐭 𝐭𝐡𝐞 𝐍𝐞𝐞𝐝 𝐟𝐨𝐫 𝐀𝐝𝐞𝐪𝐮𝐚𝐭𝐞 𝐃𝐢𝐬𝐩𝐞𝐧𝐬𝐢𝐧𝐠 𝐅𝐞𝐞𝐬
Thank you to @mcuban for saying out loud what independent pharmacy has been saying for years.
💬 “I personally believe that your local pharmacy going out of business is more expensive to the community and the state than any amount of fee that we could pay to the pharmacy,” Cuban said.
🤝 Cuban explained that his company, Cost Plus Drug Co., pays pharmacies a $12 dispensing fee because preserving local pharmacies and the pharmacist-patient relationship has value. As he put it, one of the most important connections in healthcare is those “last five feet” when the pharmacist is face-to-face with the patient, providing guidance about their medications.
His comments came during a discussion focused on some of the biggest questions facing healthcare today: how we lower healthcare costs through better delivery and financing models, encourage innovative health plans without sacrificing access, help small and mid-size employers afford coverage, and give consumers better information about healthcare cost and quality.
That is exactly where community pharmacy belongs in the conversation.
🏘️ A meaningful professional dispensing fee isn't simply another healthcare expense. It is an investment in access, prevention, medication safety, and keeping healthcare available in the communities that need it.
👏 Thank you, Mark Cuban, for recognizing that losing the local pharmacy ultimately costs communities far more than paying pharmacies fairly to keep their doors open. Thank you Chairman Frank for exploring paths for affordable and effective healthcare for all Texans!
Watch and Listen: aprx-public-static-assets.s3…
US BEACON retweeted
.@realartlaffer hails healthcare price transparency as “the biggest economic deal there is.”
"We are losing $1 trillion a year because of healthcare price transparency not being there in hospitals fully right now. That is the biggest economic deal there is.”
US BEACON retweeted
🚨 BREAKING: The FBI has ARRESTED Democrat Massachusetts State Rep. Francisco Paulino for PANDEMIC FRAUD
Paulino faces SEVERAL DECADES in prison.
DOJ alleges the disgraced Rep. scammed taxpayers out $700,000 in pandemic relief funds for personal use, using it real estate expenses, loan payments, and transfers to his campaign account
To make matters worse, Paulino also LOANED OUT taxpayer dollars at a SIGNIFICANTLY higher interest rate than he was paying, just to line his own pockets.
He faces an 11-count indictment: eight counts of wire fraud (or aiding and abetting wire fraud) and three counts of unlawful monetary transactions/money laundering
























