Absurd Articles. If you’re not in Medicine, you’ll probably think they’re real. X comments are non-satirical or obviously exaggerated - My own thoughts.
Joined December 2025
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The Coverage Report™ retweeted
Could someone tell me what would happen to a doctor defrauded Medicare? Oh yea, loss of license and jail.
Yesterday, CVS-Aetna agreed to pay $117.7 million to settle whistleblower claims that they defrauded Medicare by submitting incorrect diagnosis codes to increase their Medicare Advantage payouts.
Obvious question: Why are companies with documented histories of defrauding government programs still allowed to participate in them?
Read more about the settlement: on.wsj.com/4lmV6LM
The Coverage Report™ retweeted
American was force to change her health insurance to Blue Cross Blue Shield
She says the have denied every prior authorization that was previously approved
Her 11 year old child’s treatments needed to keep her alive all have been denied, 100% of them
“Every single new prior authorization that we have to get again for continuation of treatment, not new treatment, continuation of treatment. You have denied a hundred percent of them”
“You are withholding life sustaining treatment from my 11-year-old child. You have denied the treatment that we need to keep her alive. Treatment that she has been on for years, not new treatment. Treatment she's been on. And I have spent hours, if not days on the phone with you”
“I have decided that you are the most vile insurance company on the face of the planet.”
The Coverage Report™ retweeted
Price transparency in healthcare: the price you see is not the price anyone pays. The price anyone pays is not the price anyone agrees to. The price anyone agrees to is confidential.
The Coverage Report™ retweeted
Your EOB says “amount billed,” “amount allowed,” “amount paid,” and “your responsibility.” None of these numbers are the price.
The Coverage Report™ retweeted
Press-Ganey would like to have a word
My favorite physician was a Jewish guy from New York who ran a concierge medicine practice. I took in all my labs and records from several years in a printed spreadsheet and he looked over it leaning back in his chair.
After a few moments, he said, “You know what your real problem is? You’re crazy.”
That was what I needed to hear. A healer understands intuitively the mind of his patients.
The Coverage Report™ retweeted
And we chose this because somehow it’s unconscionable for people to pay out of pocket for non-urgent medical problems
It’s preferable to give our money to a 3rd party who lets us know when or where we can spend it
🙄
The Coverage Report™ retweeted
The @UHC CEO testified in Congress in January 2026 under oath that “less than 2%” of their claims are subject to prior authorization. The other health plan CEOs while not citing a specific percentage sounded a similar theme.
The man and woman on the street knows that this is not true, let alone those of us in physician revenue cycle and practice management.
The Coverage Report™ retweeted
American Doctor Caleb Masterson reveals that 50% of patients that have been approved for a prior authorization before surgery, then have their coverage denied after the surgery is completed
He says UnitedHealthcare is the insurance carrier doing this scam
“Half of all united Surgeries that are prior auth approved get subsequently denied”
Americans health insurance companies are running a racket
He says they make them jump through more pointless hoops just to get the same approval they already had. The are dragging out the process hoping people give up
The Coverage Report™ retweeted
Reader question today: "If independent practice is the cheapest model, why is everyone pushing consolidation?"
Because the people pushing consolidation aren't optimizing for cost.
They're optimizing for control.
Lower cost doesn't fund a $30 million CEO package.
Lower cost doesn't justify a $2 billion campus expansion.
Lower cost doesn't fill 45% of a hospital's employed physician roster.
The system doesn't want to be efficient.
The system wants to be captured.
A bit more: 👇
buff.ly/XT0Kriq
The Coverage Report™ retweeted
Patients are starting to learn that #PBMs are inflating drug pricing. | @BucksCoHerald
ow.ly/eJKH50YmX0g
The Coverage Report™ retweeted
Today I will join WHYY's studio 2, to talk about potential big fixes for healthcare.
Dr Zeke Emmanuel and Wendel Potter will be on the show as well.
It's an honor to be asked next to these very big names in healthcare.
You can listen here: whyy.org/programs/studio-2/
They will take calls from the audience at 1-888-477-9499, or comments and suggested fixes sent to: [email protected]
I think this can be a robust and productive discussion.
IMO, we need:
1. Lower healthcare costs for Americans
2. Sustainability of the medical system including for those with true economic need
3. A Renaissance of 'scrubs' able to give patients what they need and WANT to remain in their jobs
4. A path to 🇺🇸 solvency because this is nearly 1/5 of our GDP.
The Coverage Report™ retweeted
How about loan forgiveness when working in same area as non-profit. Otherwise private practice cannot recruit these FP grads and costs continue to climb since their employee only cares about their downstream revenue production.
The Coverage Report™ retweeted
Can somebody tell me the difference between:
R79.89 low vitamin D &
E55.9 Vitamin D deficiency
Because only one in Epic covers the lab. This level of stupidity from the morons making the rules is endless.
The Coverage Report™ retweeted
Every independent physician I talk to has the same problems.
1) Payer contracts they’ve never fully analyzed. They also believe they can’t negotiate as a group.
2) Overhead they can feel but can’t pinpoint.
3) They pay insurance premiums as expenses and do not deploy captives or self-funding.
4) And zero competitive intelligence about what’s happening in their own market.
Not because they’re unsophisticated.
Ok, they are and they are busy seeing patients while the hospital system across town hires consultants to do the analysis for them.
AI eliminates that gap overnight.
Upload your payer contracts.
AI reads every fee schedule, maps it against your case mix, and tells you which procedures lose money with which payers.
That analysis used to cost $250,000 from a consulting firm.
Now it costs very little.
Pull your market data.
AI tracks which physicians in your zip code are independent vs. employed, which competitors are hiring, which service lines have gaps.
The intel that corporate strategy departments generate quarterly, you can generate on demand.
Independent medicine doesn’t die from clinical inferiority. It dies from information asymmetry.
AI closes that asymmetry permanently.
This is how independents win.
The Coverage Report™ retweeted
Medicaid is is 9.1% of the entire federal budget, and 15% of each state's budget.
We the people should have had this data all along so we can see what we are spending.
💰siphoned by fraud from the system eventually translates into even greater struggles than patients now have to find care in the Medicaid program.
I call on States and federal to dig in to what the data reveals on likely fraud, prosecute and claw back taxpayer money
bucksindependence.com/the-fr…
The Coverage Report™ retweeted
NC needs this. America needs this.
Check your email for TPA's latest Advocacy Alert to request your Senator's support of SB 2040 (Harshbarger) on Preventing PBM Ownership of Pharmacies. This bill will be heard on Feb 25 in Senate Health Committee. Let your voice be heard. #AdvocacyInAction #WeAreTNPharmacy
The Coverage Report™ retweeted
For the general audience:
Medicaid alone is 10% of our nations entire spend. ( defense is 13%)
It is joint federal state, the spend is an average of 15% of state budgets.
Looking for fraud doesn’t mean you want to defund Medicaid, it means you are keeping it economically solvent so you are able to pay for the care that is truly needed.
22% of Pennsylvanians are on Medicaid.
Tagging @GovernorShapiro @PAAttorneyGen @PAAuditorGen @ValArkooshPA
Indiana’s Medicaid spending on autism therapy (ABA) exploded from $21M in 2017 to $611M in 2023—a 30-fold increase.
HHS OIG found at least $56M in improper payments and major documentation failures.
Read more on fraud-vulnerable Medicaid services: t2m.io/3Kjv9AE
