Just a guy looking for truth against tyranny.

Joined February 2022
Robbie Rockets retweeted
Follow up from today’s post I looked into the group whose video ad is running in the Root post, and what I found is concerning. The ad is titled "EXPOSED: Double Billing." Its disclaimer reads "Paid for by Patients for Safe and Affordable Health Insurance." It is a limited liability company. The only place its legal name appears is the website's privacy policy. There is no named executive director, no board, no staff, no spokesperson, and no press release. Its listed address is 712 H Street NE, Suite 1403, in Washington, DC. That address belongs to a FedEx and UPS shipping store. "Suite 1403" is a mailbox. Its website launched in January 2025. The files behind it are hosted on a WordPress network that also hosts campaign pages for Republican candidates. Most of its pages were written by an account called "Web Ops," not by anyone at the group. This isn't a patient organization that hired a web designer. It's a political vendor's product with a patient-sounding name on the front. In 18 months, its campaigns have covered oncology drug vials, out-of-network doctors, upcoding, hospital facility fees, a state-specific attack on a hospital system in Indiana, and now modifier 25. Every single one targets a doctor or a hospital. Not one targets an insurer. Not one mentions prior authorization, claim denials, or the profits of the companies that sit between patients and their care. Look at who it lets speak. Its "facts" page cites AHIP, the insurance industry's trade association. Its billing campaign is built on a Blue Cross Blue Shield Association report. Its surprise-billing pages repeat the insurer line that arbitration costs too much and doctors win too often. The op-eds it promotes are written by a former Florida Blue executive, a former chief medical officer of Regence Blue Cross, and a former chief medical officer of AmeriHealth Caritas. Not one practicing physician. Not one patient. A group that says it speaks for patients, has no patients, no leaders, and no address, and only ever points in one direction is suspicious at best. Notice the timing. The comment period closed September 14. More than 150 medical organizations told CMS to withdraw this proposal. CMS tried the same cut in 2019 and pulled it. The final rule is due within weeks. Nine influencers and a video ad showed up in exactly that window, with the same talking points, thanking the administration for a rule it hasn't finalized yet. That is a pressure campaign not a public awareness campaign. Why would an insurer care about a Medicare rule? Commercial plans already fight physicians over modifier 25 claims. Physicians push back because Medicare, the benchmark, pays in full. If CMS cuts it, every commercial contract in the country follows, and the cut stops being something a doctor can appeal. The savings won’t ever go to seniors. They will go to the plans and their shareholders. Who funds this and why are we hearing from a mailbox instead of a person? If you want to argue that Medicare should pay less for same-day services, make that argument. Put your name on it. Publish your data. Tell us who you work for. Defend it in the comment period and in the open. What you shouldn't do is fund a video from a mailbox, pay nine accounts to run the same script, and call it a grassroots movement. Patients do deserve transparency. That starts with knowing who is talking to them.
Between October 5 and October 7, nine social media influencers all posted the same Medicare argument about a relatively unknown coding modifier physicians use. A content creator, a commentary account, a MAGA account that rescues animals, a radio host, an Outkick writer, a comedian, a newsletter guy, a Townhall columnist, and a RedState columnist who used to carry the nuclear football all suddenly became experts in the minutia of healthcare billing. They don’t regularly discuss Medicare and physician coding in their posts. Their posts reach hundreds of thousands to millions of followers depending on the account. One was labeled “paid partnership”. Modifier 25 is not a scam. It’s not a loophole. It’s not some get rich scheme. Modifier 25 allows a doctor to indicate that a second, separately payable procedure was performed at the same time as another visit. What does that mean in real terms? It means an orthopedic surgeon had you on their schedule for “knee pain”. After careful examination and discussion (the clinic visit), they recognize that you would best be served with an injection (the procedure) to help with the symptoms. They then provide the injection and attach a 25 modifier to indicate that this is a separately identifiable treatment from the visit and requires its own payment for those services. CMS wants to pay the highest-priced service in full and cut every other same-day service by 50%. It is unclear how they came up with 50% and the agency even stated that they aren’t sure there is overlap in work for the two separate codes, but stated the overlap is “likely”. I’ve been clear in my opposition and why. When a plumber comes out to your house because your water supplier sent you a note that you might have a leak and then the plumber finds that leak, do they charge you half price for fixing the leak? Our own government doesn’t even follow these rules. If you go to the post office and have two packages to send to the same address, do they charge you half price for the second box since it is going to the same address? What will happen? First, we’ve determined that 80% of the impact of the -25 modifier will be on independent, private practicing doctors. We’ve created a new tax on independent physicians, pushing them further into consolidation. When doctors become employed, costs go up dramatically leading to increased premiums and increased out of pocket costs. The other impact will be on patient care. Doctors will refuse to be paid half for the same work. They will tell patients to come back on another day for the procedure. That’s another copay. That’s another day finding help with children or loved ones. That’s reduced productivity while waiting for needed treatment. And at the end of the day, the cost to the payer and patient will end up being worse as doctors consolidate.
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Robbie Rockets retweeted
CMS and the insurance companies are lying to you…. Let me simplify this…. It’s the insurance companies own actions that are driving up costs. The No Surprises Act protects patients from unexpected out-of-network bills for emergency care and certain services at in-network facilities. Patients generally pay only their in-network cost sharing. Payment disputes remain between physicians and insurers. Physicians may be out of network because insurers offer inadequate rates or refuse to include them in their networks. Without a contract, there is no agreed payment rate. If negotiations fail after 30 business days, either side can use independent dispute resolution, or IDR. An arbitrator selects one party’s payment offer for care already provided. Initial payments can be zero, and physician organizations report that insurers sometimes submit offers of $1 or less. Their September 2026 analysis found that insurers defaulted on 24.5% of disputed service lines in 2025 and offered $1 or less on another 8.2%. When insurers refuse to negotiate reasonable rates, practices are forced into arbitration. Providers won approximately 85% of federal IDR determinations in the second half of 2025, including default decisions. Even winning does not guarantee payment. An emergency medicine association survey covering roughly 660,000 IDR claims won in 2025 found that 48% were not paid within the required 30 days. IDR is supposed to discourage insurers from refusing to negotiate and encourage reasonable agreements before arbitration. When insurers fail to participate or pay awards on time, practices incur additional collection costs. Removing those consequences would give insurers less incentive to negotiate and could create more disputes and opportunities for abuse by both sides. Insurers blame IDR costs for rising premiums. But people who pay for out-of-network benefits are already paying for that coverage, and NSA protections also apply to plans without routine out-of-network benefits. Insurers’ refusal to negotiate, failure to participate, and failure to pay awards can create avoidable disputes and administrative costs. Those costs should not be blamed on IDR without acknowledging the insurer conduct that drives them.
CMS brought together leaders from across federal agencies and all certified Independent Dispute Resolution (IDR) entities to address rising costs tied to out-of-network payment disputes and identify ways to strengthen the federal IDR process. We’re working together to improve the fairness and efficiency of the program while continuing to protect patients from surprise medical bills. Learn more: go.cms.gov/47DRUoV
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Robbie Rockets retweeted
It’s been awhile so here’s your reminder. Doctors are not the reason for a dysfunctional healthcare system. They are just as much a victim to a system built by bureaucrats as you and me.
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Robbie Rockets retweeted
Physician mood on X this morning …
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Robbie Rockets retweeted
I think the easy solution is what the lawyers do. Charge in 6 minute increments. A flat fee. The lawyers would have to support it or look like the hypocrites i suspect they are. Charting at night? Bill the time. Thinking of a complex patient. Dictate a quick note and charge for it. Pre round prep? Charge it. Records would have to be meticulously kept but out time as physicians is valuable! Dealing with insurance. Every six minutes another time unit. Responding to an email in the portal. That is patient care. It gets charged. It is time for us to behave like other professionals. Enough of undervaluing our time which is what leads to the abusive nature of physician reimbursement.
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The advertisement had nothing to do with women’s sports… it was for a gambling site. I find it hilarious that all these women are outraged by this ad saying it sets women back in sports but yet still support literal men playing in women’s sports. apple.news/AmGjF-C-XS-OY3DbN…
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Robbie Rockets retweeted
Replying to @RepGregMurphy
@RepGregMurphy knocks it out of the park on this post. IDR is absolutely fantastic for physicians. Payers are paying influencers and lobbyists to have their way. This is a fight all physicians ought to support.
Those who blame the Docs for the No Surprises Act issues are sadly misinformed. There are bad apples, and they need to be addressed, but when the IDR process rules for the Docs 80-90% of the time and the Insurance companies still don’t pay, ask Willie Sutton where the problem is.
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Those who blame the Docs for the No Surprises Act issues are sadly misinformed. There are bad apples, and they need to be addressed, but when the IDR process rules for the Docs 80-90% of the time and the Insurance companies still don’t pay, ask Willie Sutton where the problem is.
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Robbie Rockets retweeted
Politicians, Employers, and insurance companies seem to love capitalism until a physician wants to retain their freedom or negotiate. If I choose not to join your network, I should be able to negotiate payment for my services. You should not get to impose the terms of a contract I never signed. You want to sell out of network coverage while controlling what physicians outside your network are paid. All the benefits of a negotiated contract without actually negotiating one. And then there are all the times those services are reimbursed at zero dollars and zero cents. The physician provides the care, and the insurer pays nothing. Patients should be protected from surprise bills. Physicians and insurers should resolve payment between themselves. Stripping physicians of bargaining power is anti capitalist. It concentrates power, undermines independent practices, and risks leaving patients with fewer choices and less access to care. It is stupid and dangerous policy. Healthcare will suffer for it.
The physician and supporting communities should be very clear eyed regarding the legislative efforts that the health plans will be attempting in this Congress in ‘26 & the next Congress. Employer, consumer groups urge Congress to reform NSA's IDR fiercehealthcare.com/payers/…
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Robbie Rockets retweeted
Congress loves to reform “healthcare” during the lame duck sessions. Independent physicians using IDR will be on the chopping block. Take action. Tax exempt hospitals, especially those that own insurance companies, to mandate in-network participation just as they mandate manufacturers to give tax exempt hospitals 340b discounts. It’s free money for them. This trend will continue until members of Congress stop making money by passing and supporting these laws. Remember the number one job of a politician is to raise money for their party.
The physician and supporting communities should be very clear eyed regarding the legislative efforts that the health plans will be attempting in this Congress in ‘26 & the next Congress. Employer, consumer groups urge Congress to reform NSA's IDR fiercehealthcare.com/payers/…
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Completely false. Physicians, more specifically private practice physicians, are the only ones getting screwed from all sides. Reimbursements decline every year and now the government claims that because we’re more efficient and surgery takes less time (which is completely false demonstrated by multiple studies) they have decreased value of every procedure across the board by 3% plus the 3% decrease in actual reimbursement. Meanwhile the hospitals have seen an increase in payment for every service they provide (the facility fee) by at least 5% years over year. If you see a private physician and then an doctor employed by the hospital the bill for the exact same procedure in the same zip code the cost of the employed doc doing procedure will be more than double than that of the private doctor because the hospital gets to charge a facility fee on top of the professional fee. So let’s be clear it’s not the doctors, it’s the hospital systems. apple.news/AS7VcANNQT-6iWKU1…
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Robbie Rockets retweeted
For the first time in 15 years, physician-owned hospitals are in a congressional package. The hospital lobby has spent $906 million to stop this moment. Today I tell you what that money bought. 🧵....
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Politicians and administrators love the term “vertical integration.” When hospital systems and insurers consolidate services—imaging, surgery, rehab, and follow-up—it’s called innovation. They claim it streamlines care, reduces fragmentation, and boosts efficiency. Regulators applaud it. Consultants praise it. But when a physician builds the exact same model in independent practice, it’s suddenly “self-referral.” Now it’s Stark Law territory. Now it’s abuse. Now it’s a compliance risk. Never mind that it may be cheaper, faster, and more accessible for the patient. Never mind that it keeps care coordinated and centered on outcomes. The structure is identical. The difference is who controls it. If a hospital buys a PT group, radiology center, or ASC, it’s “integrated care.” If a doctor owns the same, it’s flagged as suspect. This has nothing to do with protecting patients—and everything to do with protecting market share. Independent physicians are punished for efficiency while systems are rewarded for consolidation.
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Robbie Rockets retweeted
I promised to come back to @X after I investigated the facts concerning @EPotterMD's video post about @UHC and its health insurance subsidiary, UnitedHealthcare. To review, I made an @X post in response to Dr. Potter's videos and X posts about an overzealous representative of United Healthcare ("UNH") that had apparently interrupted her while in the operating room, and denied coverage for her patient's treatment. In response to her January 7th video about the experience, Clare Locke, defamation counsel to UNH, sent a six-page demand letter to Dr. Potter, which begins: "We are writing to demand you correct your knowingly false, misleading, and defamatory social media posts regarding UnitedHealthcare." In the second paragraph of the letter, UNH demands that: "You must promptly correct the record by removing your videos, posting a public apology to UnitedHealthcare, and condemning the threats of violence aimed at our client result from your posts." The six-page demand letter can be found here: ackman-public.s3.us-east-1.a… Before I get into the details, I want to emphasize that regardless of the facts of this situation that there is no justification whatsoever for violence and/or threats of violence against company officers or their legal or other representatives. This is particularly poignant in this case as we all know that the CEO of UnitedHealthcare was murdered in cold blood on the streets of New York, a horrendous tragedy for all involved, and for society at large. I understand the emotions of those who have felt harmed or been harmed by a failure of their insurer to pay for healthcare that was needed. I get it, but violence is not the solution to solving this problem. Getting back to my post about United Healthcare, I said that if I still shorted stocks, I would short UNH because based on Dr. Potter's experience I believed that UNH's "profitability is massively overstated due to its denial of medically necessary procedures." I also encouraged the @SECGov to do a thorough investigation of the company. UNH responded to my post by releasing a public statement that said: "Health insurance has long been subject to significant regulatory oversight and earnings caps. Any claims that health insurers, which typically have low- to mid-single digit margins, can somehow over-earn are grossly uninformed about the structure and strong regulatory oversight of the sector." UNH also stated that it had contacted the SEC because of its concerns with my post. Contemporaneously, a partner at Clare Locke contacted our firm, and said that Dr. Potter's claims were false, and that I should therefore take down my post. I took down the post, not wanting to have an inaccurate post on X. We have used the Clare Locke firm and respect their work, so I took their request seriously. My CLO was also contacted by the general counsel of UNH who told her that the underlying facts in Dr. Potter's posts and videos were false, and that UNH employees were under considerable stress due to the murder of their CEO -- which is understandable to say the least, and for which I greatly empathize. The UNH GC also asked to speak with me directly. When my CLO reported the call to me, I said that before I would agree to speak with the UNH GC, I would like him to provide a detailed explanation of what Dr. Potter had said that was wrong in her videos. Our CLO then contacted the UNH general counsel who said that he would send this information to her, and he took her email address. After days went by and we did not receive anything from UNH, our CLO again reached out to the UNH GC. He explained that he understood that we now had a copy of the Clare Locke demand letter, and that the letter provided all of the information we needed in order to understand what Dr. Potter had gotten wrong. Since my post, I have had the opportunity to speak with Dr. Potter and her counsel numerous times. Dr. Potter and her lawyer have sent me supporting documentation of the statements she made in her video, which I have reviewed carefully and about which I have had the opportunity to ask any questions that I have had. I have also reviewed the defamation claims that UNH made in the letter from Clare Locke. Based on all of the above, I believe that Dr. Potter told the truth in her initial video and in her statements and advocacy since that date. I also believe that UNH's threatening defamation letter to Dr. Potter and its public statements about my post and SEC complaint are simply brazen attempts to silence UNH's critics. Bear in mind that I have extensive experience with companies that attempt to silence and bully their critics. Herbalife and MBIA, in particular, were expert in shutting down criticism and regulatory interest through their aggressive approach to public relations and the media, by threatening and bringing litigation, by asking regulators to investigate market participants who questioned their accounting and business methods, by using their political influence, and by other more unseemly methods. I believe that you can learn a lot about a company by how it responds to its critics. UNH's response here parallels how Herbalife attacked its critics through its public statements, threatened litigation, SEC complaint, and other activities. Let's first examine all of Dr. Potter's statements in her January 7th video that triggered UNH's response here: "It's 2025 and insurance keeps getting worse." This is a statement of opinion by Dr. Potter and free speech permits it. She continued: "I just did two bilateral DIEPs and two bilateral tissue expanders for patients and I've never had this happen before." I believe Dr. Potter is telling the truth, which explains why she was inspired to do a video in the first place, and which I explain further below. She continued: "But during the second DIEP I got a phone call um into the operating room, saying that United Healthcare wanted me to call them about one of the patients who was having surgery today, who's actually asleep having surgery. And um you know said I had to call right now." Dr. Potter is referring to a representative from UNH who called the hospital operating room front desk and asked to speak to Dr. Potter. When the nurse on duty explained that Dr. Potter was unavailable because she was in the OR, the UNH representative explained that he had to speak Dr. Potter right away. This caused the nurse on duty to escalate the message to the head nurse on duty who delivered a sticky note message into the operating room to Dr. Potter. The note said the first name of the UNH representative, included a phone number and the words 'United Healthcare Pt. JL for Dr. Potter.' While UNH denies that its representative insisted on speaking to Dr. Potter right away, the facts on the ground suggest otherwise: First, the UNH representative called the operating room front desk at the hospital, rather than Dr. Potter's office and/or staff or billing department. Second, the nurse on duty believed it was sufficiently urgent that she gave the message to the head nurse on duty. The head nurse in turn also thought it sufficiently urgent that she delivered the message into the operating room. All of the above actions are consistent with Dr. Potter's statements in her video. According to Dr. Potter, the head nurse said that in her 15 years of experience she never had an insurance company seek to speak with a surgeon in the operating room so she assumed it had to be urgent. Dr. Potter continues in the video: “…so I scrubbed out of my case and I called UnitedHealthcare, and the gentleman said he needed some information about her, wanted to know her diagnosis, and whether um whether uh her inpatient stay should be justified. And I was like do you understand that she’s asleep right now and she has breast cancer?” [Dr. Potter of course did not leave the patient alone during the two-minute call. There was another surgeon, nurse, etc. in the operating room.] I believe what Dr. Potter is saying is true. But before we go further, why did Dr. Potter 'scrub out of her case' and call UNH? The answer is that Dr. Potter is an advocate for her breast cancer patients, not just for their health, but also for their financial well being. As we all know, many families have been financially wiped out by their healthcare bills that are not covered by insurance. It's bad enough to have breast cancer and have a double mastectomy, but imagine then being wiped out financially after the surgery. [For context, challenges to insurance coverage for modern breast reconstruction have been increasing. In 2021, CMS (Medicare) announced a coding change that threatened access to modern breast reconstruction techniques. United Healthcare was the first to adopt the change in April 2022. Recognizing the danger to patients and the practice of breast reconstruction through insurance, Dr. Potter started a national effort to reverse the change. She used her own savings to fund this effort. The change was reversed by CMS in August of 2023. I have a lot of respect for activists generally and for Dr. Potter's work on behalf of patients.] Receiving a note to call an insurer mid surgery was a first for Dr. Potter, and she stepped out to call UNH because she was afraid for her patient that UNH was going to deny coverage. She had to believe the call was urgent, otherwise there is no credible reason for her to have scrubbed out and called back the UNH representative on her cell phone. When you read the transcript of Dr. Potter's video remarks or even better when you watch the video, you can hear the emotion and exasperation in her voice, which is of someone frustrated with big insurers and very concerned about her patients. I have also found Dr. Potter to be extremely credible in all of my communications with her. Dr. Potter continues: “And um the gentleman said actually I don’t that’s a different department that would know that information. And I was like well um she does need to stay overnight tonight and um you have all the information with you because I got approval for this surgery, and I need to go back and be with my patient now.” Again, here I believe Dr. Potter when I examine all of the facts and documents that were made available by both parties. UNH was apparently calling to create a record that it had discussed the case with Dr. Potter and to make the case that her patient should not have an inpatient overnight stay in the hospital. I am not an expert in the insurance law here, but this is my understanding. Dr. Potter required the patient to stay overnight because her patient had a lung infection on the morning of the surgery, i.e., histoplasmosis that required a strong anti-viral medication. [Dr. Potter's patient has permitted Dr. Potter to share her medical information.] When the infection was considered along with the surgery, Dr. Potter believed an inpatient overnight stay was required because of concerns she had with potential interactions between the antiviral and post-surgical medications, as well as the stress to the patient from the surgery. That was her judgment as the patient's surgeon, and that is why she placed an order for the overnight stay with UNH before she did the surgery. [If I get any of these details wrong, I am sure Dr. Potter will correct the record.] In the demand letter, UNH accuses Dr. Potter of making an error in ordering an inpatient stay. Dr. Potter disputes this vociferously and as simply gaslighting by UNH. Why was UNH trying to speak to Dr. Potter so urgently? The difference between a one-day, in-patient stay, and the patient being released the same day from surgery was a bill to the insurer of more than $100,000, in this patient's case $110,356, coverage that was denied by UNH. [As a side note, the amount of this inpatient overnight stay is absurd and speaks to the fundamental problems with the system. The $100k plus charge is typically if not always dramatically negotiated down by the insurer, but when the insurer does not pay, the individual can get stuck with the face amount of the bill and without the negotiating leverage of a large insurer. These absurd large invoice amounts remind me of what it is like buying a prescription when you don't have your insurance card and CVS tells you the $25 drug will cost $3,000. This system is broken and fundamentally corrupt, and hopefully @RobertKennedyJr and the @realDonaldTrump and @DOGE will do something about it.] Under Texas law (the surgery took place in Austin, Texas) according to the Clare Locke letter, an insurer apparently has one day to discuss the plan of treatment with the physician before issuing a denial. Therefore, apparently, if UNH didn't reach the doctor before the end of the day, it would not have had as credible an argument to deny coverage. UNH did deny coverage in writing later that same day of the surgery, before the patient even left the hospital. The above explains why I believe UNH's representative was urgently trying to reach Dr. Potter. Dr. Potter finishes the video by saying: “But um yeah, it’s out of control. Insurance is out of control. Uh I have no other words.” The above is a statement of opinion, and based on Dr. Potter's experience here it is entirely accurate. Now, let's examine UNH's statement in response to my initial post, which among other things, said that: “I would not be surprised to find that the company’s profitability is massively overstated due to its denial of medically necessary procedures and patient care.” UNH's statement: "Health insurance has long been subject to significant regulatory oversight and earnings caps. Any claims that health insurers, which typically have low- to mid-single digit margins, can somehow over-earn are grossly uninformed about the structure and strong regulatory oversight of the sector." The statement begins by saying that health insurance is subject to 'strong regulatory oversight' and 'earnings caps.' This statement is meant to give the reader the impression that I must be wrong because regulators are watching the insurers closely, and that earnings are somehow 'capped.' UNH states that I must be 'grossly uninformed' for how can UNH's earnings be overstated if health insurers have low- to mid-single digit margins? While the above statements from UNH are true, they are highly misleading. First, the fact that UNH is subject to strong regulatory oversight does not mean that the company is properly adjudicating claims. As we all know, regulators often fail to do their jobs. In fact, I have personal experience with regulators failing to do their jobs (See MBIA and Herbalife) because regulators can be intimidated by powerful companies and the big law firms that represent them. That is why regulators often shy from going after big targets, and it is only after the problem companies collapse that the regulators step in and punish the people responsible. I can't think of an example where a regulator found fraud at a large company before it collapsed. It is usually the short sellers who find fraud, and the regulators who come in afterwards to clean up the mess. MBIA collapsed six years after we brought our concerns to the company's insurance regulator and the SEC. Herbalife stock collapsed years after the FTC failed to shut the company down. The facts about MBIA and Herbalife were manifestly true when we shared them with the regulators, but still the regulators did not do their jobs. Second, the fact that insurers have low- to mid-single margins is not evidence that they are properly adjudicating claims. Rather, the fact that UNH has low profit margins gives it a huge incentive to minimize the claims that it pays. When a company has low margins, it by definition has high operating leverage. This means that small changes in revenues up or down have a huge impact on bottom line profits. Public company management teams are compensated based on meeting and exceeding profit targets which drive earnings-per-share growth and long-term stock price increases. If management can drive revenues up slightly in a low margin business, profits can explode upwards because of operating leverage. So the fact that an insurer has low margins does not in any way prove or support the fact that its earnings are not overstated, but it clearly creates an incentive to minimize claims paid by an insurer. When you step back and look at this situation, it gives you better perspective on what likely transpired. A surgeon posted a video about her frustration with a healthcare insurer. When she posted it, she did not know it would go viral. When it did go viral, the company responded by having its defamation counsel send a threatening letter accusing the doctor of making "knowingly false, misleading, and defamatory" social media posts, and demanded that she take down the posts, retract her claims, and post a public apology. [UNH did so in my view for two principal reasons: (1) because it wants to minimize negative press and the risk of regulatory inquiries into its business, and (2) it wants to minimize negative press to reduce the risk to its executives in light of recent events, an important and legitimate concern.] In response to a threatening letter from UNH's defamation counsel, the doctor, rather than taking down her posts, makes more posts, and then sits down for an upcoming interview on a major TV show. Why would she double down and expose herself to more legal and career risk unless what she said was true? When a market observer, in this case me, reposts the doctor's video and criticizes the company, the company responds by issuing misleading statements to the public, and contacts the SEC, our principal regulator, in an attempt to intimidate me even though I have publicly stated that we have no investment in UNH long, short or otherwise. When you look at the above facts and watch Dr. Potter's videos, I strongly believe that a jury of Dr. Potter's peers would conclude that she is telling the truth. What is her incentive to make "knowingly false, misleading and defamatory" statements about UNH? She has none. In fact, she has the opposite. She is a breast cancer surgeon with a small, not particularly profitable practice, going up against a publicly trading insurance holding company with a $482 billion market cap, the 16th most valuable U.S. company. She has no incentive to lie and double down and go on network television unless she is telling the truth. Dr. Potter put herself at significant personal and financial risk by going public about her experience with UNH because of her passion for protecting her patients and her frustration with our healthcare system and its insurers. There is no other credible explanation for her video and other social media posts. Now what about UNH? I suspect that the employees and other representatives of UNH that help manage its insurer's claim expenses are given large financial incentives to keep claims payments as low as possible. That would explain the tenacity with which the UNH representative operated when he called the operating room front desk, and the urgency with which he expressed a desire to speak to Dr. Potter. That, in my view, is the only credible explanation for why the front desk nurse gave the message to the head nurse who brought the message into the operating room, and explains what has transpired here. Occam's razor. And according to Dr. Potter, all of the nurses and other witnesses involved have offered to testify on her behalf. With respect to my thoughts on shorting UNH from my first post, I don't recommend shorting stocks, but I wouldn't recommend anyone invest in UNH, certainly at this valuation. Since my post, I have heard many other bad stories about the company's approach to paying claims so I don't think Dr. Potter's experience here is a one off. Based on all of the above, in my opinion, there is likely something systematically wrong with this company. Compare UNH with the other top 20 U.S. companies by market cap. When you do so and you consider each of these companies contributions to humanity, does it cause you to question a bit why UNH is so valuable compared to the others? Yet, another reason, I would argue, why one might question the company's reported profitability and valuation. And UNH's earnings don't appear to in any way be 'capped.' Certainly, the company's shareholders and analysts are not valuing the stock assuming 'capped earnings' for otherwise you could not justify a half of a trillion dollar market cap. With respect to Dr. Potter, I think she is a hero. I have offered to pay her legal expenses, but her lawyer was already handling her case pro bono, such was his confidence in her case and her character. If she needs funding to bring her own defamation case, she knows where to find me. UNH owes Dr. Potter a public apology for defaming her and accusing of her lying. And if I were on the UNH board, I would launch an immediate investigation of the company's approach to paying claims, the incentives it gives the employees and agents who work on its behalf, and the approach it takes in attacking the critics who challenge it. I am sure that Dr. Potter is not the first person to receive a threatening letter from UNH. I look forward to hearing from others on X about their experiences with the company good and bad. In summary, the whole thing smells very bad to me. And yes, the SEC should take a very close look at UNH.
Yesterday, I made a critical post about @EPotterMD and her experience with United Healthcare. I took it down when my office heard from the Clare Locke firm which represents UNH which called and stated that the doctor’s claims were not true. We have used Clare Locke and think highly of the firm. Later, the general counsel of UNH contacted our CLO and stated that Dr. Potter’s claims about being contacted during surgery and UNH denying coverage for a patient overnight post surgical stay in the hospital were false. We have asked both the Clare Locke firm and UNH for support for their claims and I have done the same with Dr. Potter. When I get to the bottom of this issue, I will report back. UNH complained to the @SECGov about my post. To be clear, we have no position of any kind, long, short or otherwise in UNH. I do, however, care about cases when insurers act inappropriately in denying coverage which is why I took interest in this issue.
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Robbie Rockets retweeted
Physicians aren’t leaving Medicare. Medicare is leaving physicians. Medicare’s pay cuts aren’t about saving taxpayer money they’re about shifting power to corporate health systems. Health systems are paid 2–3x more than independent physicians for the same care. Medicare increases payments to health systems while cutting payments to the doctors who actually deliver care. The result? More physicians forced out. More patients stuck with fewer options and higher prices. The Fight Isn’t About Pay. It is About Access. Every year, more independent physicians stop taking Medicare. Not because they want to but because they have no choice. The real question: When your doctor leaves, where will you go? Keep medicine independent. Demand better. #healthcare
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Robbie Rockets retweeted
CVS Pharmacy merged with Caremark (PBM - middleman) then acquired Aetna an insurance company to form the golden trifecta of vertical integration. Caremark their PBM facilitates over 20% of all the prescriptions filled in America. By controlling reimbursements in over 1 out of every 5 prescriptions in America they've been able to underpay competitors (independents, Walgreens, etc.) and overpay themselves to grow exponentially. The persistent underwater reimbursements have led to the closure of thousands of independent pharmacies and as we've seen lately Walgreens as well. It's not a coincidence that right after Walgreens was acquired by a private equity firm and closed hundreds of stores, that CVS unveils the final chapter of their plan. Now with so many pharmacies having closed, they will move into those areas and put in their own mini pop-up pharmacies. CVS is an oligopoly that controls the majority of the market. Once they're in control of these rural areas in our country where they assisted in forcing independents to close, who will stop them from doing whatever they want? Limiting access to healthcare, overcharging prices, poor customer service, etc. There will be zero accountability and no one to compete against them. Healthcare overall has suffered tremendously due to the corrupt practices of PBMs and will continue to do more damage with this move. When will congress step up do something? @RepThomasMassie @RepHarshbarger @RepJamesComer @RepBuddyCarter @RepAuchincloss Check out this article: cnn.com/2025/03/10/business/…
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Think about how bad medicine must be for this to happen. You make it into medical school—already a top 20% applicant, hardworking and dedicated. You take on six figures of debt and endure the brutal demands of medical training, where many drop out. You work tirelessly to match into residency, often sacrificing years for research and extracurriculars. You survive residency’s grueling hours, sleepless nights, and punishing schedule—losing relationships, health, and sometimes yourself. And after all that, you practice for a few years and say, “Nope, not worth it.” Doctors are still well-paid. The profession still carries some societal respect. Yet people willingly endure physical, intellectual, and financial hell—only to realize the job is miserable and leave. That should tell you everything. Restore independent physician practice and we can reverse the doctor shortage. Give doctors ownership in healthcare delivery and you’ll see higher retention. Make us under appreciated employees, drones, and we start looking for an exit.
Replying to @DrDiGiorgio
The new doctor we are hiring at our medical practice said that only 6of 8 residents in her residency class practice full time after only being out 6 years. These are doctors that are 35 years old. I was shocked when she told me this.
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Robbie Rockets retweeted
🚨🇺🇸DOJ INVESTIGATES UNITEDHEALTH FOR MEDICARE BILLING FRAUD The Justice Department has launched a civil probe into UnitedHealth’s Medicare billing practices, scrutinizing how diagnoses triggered extra payments. Investigators are examining whether the healthcare giant inflated records to maximize Medicare Advantage payouts, including at its physician-owned groups. This adds to the growing scrutiny of UnitedHealth, which is already facing a separate antitrust probe. With billions at stake, regulators are ramping up oversight of corporate healthcare profiteering. Source: WSJ
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Robbie Rockets retweeted
Ever wonder why independent physicians are fighting to stay afloat while health systems are swimming in cash? It’s not because they deliver better care, it’s because they’ve stacked the deck in their favor. Health systems have engineered a system of subsidies, tax breaks, and hidden fees that funnel billions into their pockets while independent physicians get squeezed. They don’t just get paid more for the same work, they collect government handouts, dodge taxes, and manipulate the rules to eliminate competition. Want to see how deep it goes? Direct Government Payments & Subsidies: •Disproportionate Share Hospital (DSH) Payments •Graduate Medical Education (GME) Payments •340B Drug Pricing Program •Medicare & Medicaid Facility Fee Differentials •Indirect Medical Education (IME) Payments •Upper Payment Limit (UPL) Funds •Critical Access Hospital (CAH) Payments •Hospital Quality Payment Programs Tax Advantages: •Property Tax Exemptions •Sales Tax Exemptions •Income Tax Exemptions •Tax-Free Donations & Endowments •Municipal Bond Issuances •Government-Supported Loan Forgiveness Programs Financial Advantages & Market Manipulation: •Site-of-Service Differentials •Facility Fees •Certificate of Need (CON) Protections •Exclusive Payer Contracting •Cost-Plus Reimbursement •Preferred Network Inclusion •Hospital-Employed Physician Subsidies •Self-Referral Loopholes Hidden Revenues & Kickbacks: •Commercial Insurance Markups •PBM Rebates •Medical Device Markups •Hospital-Based Coding Upcharges •Emergency Department (ED) Visit Upcoding •Outpatient to Inpatient Status Manipulation •Research Grants & NIH Funding •Hospital-Owned Specialty Pharmacy Profits •Hidden Administrative Charges Strategic Market Power & Anti-Competitive Behavior: •Monopoly Pricing Power •Group Purchasing Organizations (GPO) Kickbacks •Vertical Integration •Cross-Subsidization Strategies •Land Banking & Real Estate Tax Loopholes •Political Lobbying & Influence •Hidden Executive Bonuses Tied to Market Consolidation •Charity Care Manipulation •Debt Collection Privileges The playing field isn’t just uneven, it’s built to ensure large health systems win and independents lose. Not #healthcare
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CEO’s of United, BCBS, & Aetna all took home 7-8 figure bonus ever year. god forbid we actually pay the people taking care of patients. When we gonna wake up & realize that that insurance companies including Medicare have been fucking the public for years apple.news/AdaDOURU2T_6cOm1m…
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