@DutchRojas Dutch Rojas

Dutch Rojas posts on X about health, insurance, systems, in the the most. They currently have [-------] followers and [---] posts still getting attention that total [-------] engagements in the last [--] hours.

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[--] Week [---] +59%
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Social Influence

Social category influence finance 35.77% stocks 9.23% countries 6.92% technology brands 1.54% cryptocurrencies 1.54% celebrities 0.77% social networks 0.77% travel destinations 0.38% automotive brands 0.38%

Social topic influence health #407, insurance #125, systems #163, in the #4851, money 9.23%, aca #372, this is 6.54%, ceo #788, market 5.38%, build 5%

Top accounts mentioned or mentioned by @drdigiorgio @heathveuleman @gopdoctors @cmsgov @realdocspeaks @physicianhosp @umich @edwards183 @mcuban @elonmusk @datarepublican @waysandmeansgop @repkevinhern @cogitator88 @nathanlevy10 @alexjung @seckennedy @doge @uhc @drozcms

Top assets mentioned Cigna Corp (CI) 69Coin (69) CVS Health Corp (CVS)

Top Social Posts

Top posts by engagements in the last [--] hours

"There are [----] organizations in the United States that bill Medicaid under code T1019 Personal Care Services. The top 1% of them just [--] entities collected $30.4 billion. Thats 42.5% of all T1019 spending nationally. Nine of those entities crossed the billion-dollar threshold individually. The top [--] alone absorbed $28 billion. And the geographic concentration will stop you cold: [--] of the top [--] are in New York State. Seven of them are in Brooklyn. This is not a story about healthcare. This is a story about industrial-scale wealth extraction from a system designed to serve the most"
X Link 2026-02-14T23:30Z 32.5K followers, 20.3K engagements

"Eight organizations on the OIG exclusion list continued billing Medicaid for personal care services. The HHS Medicaid data is a treasure trove. Join me as I go through it over the next few weeks. Combined: $28.4 million in payments they were legally barred from receiving. One has been excluded since [----]. Seven years. Payments are still flowing. State Medicaid agencies are responsible for checking the exclusion list before paying claims. They are supposed to do it monthly. The data says they are not. https://dutchrojas.substack.com/p/the-billion-dollar-club"
X Link 2026-02-15T00:30Z 32.5K followers, [----] engagements

"7000 bureaucrats at @cmsgov. Exposed by DOGE. And not a single one of them was looking out for you. [----] employees overseeing $1.52 trillion in spending 22.5% of the entire federal budget. Thats 0.3% of the federal workforce controlling nearly a quarter of all federal dollars. Where do they come from Insurance companies. Hospital chains. Consulting firms. Where do they go when they leave Right back. 53% of CMS appointees exit to private industry after their government stint. Only 15% came from industry. The pipeline flows one direction toward the money. Marilyn Tavenner ran CMS then became"
X Link 2026-02-15T22:20Z 32.5K followers, 29.1K engagements

"This investigation began with a single billing code. T1019. Personal care services. Bathing dressing meal prep. The data revealed findings that extend far beyond personal care. If this is what T1019 looks like what does T1020 look like What about home health codes DME codes and behavioral health codes The same structural incentives exist across the Medicaid billing landscape: low oversight easy entity creation geographic clustering and authorized official networks. Medicaid is the largest payer in the U.S. healthcare system covering [--] million people. It is also the least transparent. The HHS"
X Link 2026-02-15T03:00Z 32.4K followers, [----] engagements

"The HHS Data continues to bring light to the darkness Congress just hauled the Big [--] insurance CEOs in front of Ways and Means. Good start. Now do these five. Five people. Ten Medicaid billing entities. $11.8 billion. One operates from Suite [---] and Suite [---] in the same building. $2.3 billion. Another runs two companies with the same name. One comma different. Same address. $809 million. The insurance executives have lawyers and lobbyists. These five have something better: anonymity. Nobody in Washington knows their names. You do now https://twitter.com/i/web/status/2023025462910255259"
X Link 2026-02-15T13:23Z 32.5K followers, 27.6K engagements

"The largest [---] nonprofit hospitals are a danger to the United States of America. The Centers for Medicare and Medicaid assign them higher reimbursements for the same procedures and treatments performed in a non-hospital setting. You might say well they have to take everyone. Id agree. And then Id teach you a lesson on how they receive 80% of the $275 billion in taxpayer-funded government-assigned subsidies. And then I might talk about executive compensation that makes Wall Street blush jets trips and more extravagance all paid for by taxpayers. Of these [---] hospital systems only [--] contribute"
X Link 2026-02-16T03:17Z 32.5K followers, 27.3K engagements

"Your insurance company didnt raise your premiums. Your doctor didnt raise your premiums. In Massachusetts your health systems raised your premiums. And the state with federal dollars 😉 gave them the law to do it. Heres how. 🧵"
X Link 2026-02-13T14:17Z 32.5K followers, [----] engagements

"Colonoscopy with polyp removal. ASC: $1234. Hospital: $2122. 41% markup. Not for a better doctor. Not for a better outcome. 6/"
X Link 2026-02-13T14:17Z 32.5K followers, [---] engagements

"There are [----] organizations in the United States that bill Medicaid under code T1019 Personal Care Services. The top 1% of them just [--] entities collected $30.4 billion. Thats 42.5% of all T1019 spending nationally. Nine of those entities crossed the billion-dollar threshold individually. The top [--] alone absorbed $28 billion. Per OpenClaw: NY is two-thirds of all personal care aide billing in the entire country. And the top [--] zips nationally for T1019 per capita are almost entirely NYC zip codes with [-----] (Stoughton MA Tempus Unlimited HQ) and [-----] (Latham NY Public Partnerships HQ) at"
X Link 2026-02-14T21:49Z 32.5K followers, 118.7K engagements

"The HHS Medicaid Provider Spending dataset is now publicly available for the first time. I pulled every organization in the country that bills under code T1019 Personal Care Services. That's bathing dressing and meal prep for Medicaid beneficiaries. Non-medical. Delivered by home health aides. The national spend on this single code from [----] to 2024: $122.7 billion. [--] entities collected 42.5% of it. Nine of them crossed the $1 billion mark. Seven are in Brooklyn. Some share the same block. Some share the same authorized official. Some share the same address four doors apart. Physicians face"
X Link 2026-02-14T22:30Z 32.5K followers, [----] engagements

"@DredgeItUp Thank you I have not been able to sleep for a few days. The data is overwhelming"
X Link 2026-02-16T12:39Z 32.5K followers, [---] engagements

"Big news: A new bill supporting Physician-Owned Hospitals just dropped. It is a turning point. If passed this bill removes key restrictions on physician-owned hospitals especially those that serve rural and underserved areas. What can you do Contact your representative Join advocacy groups like the PHA. Share this post to spread awareness Build or partner with POHs in your region We dont need fewer hospitals. We need better onesphysician-led transparent efficient and community-focused. Lets bring healthcare back to the hands of those who deliver it. #physicianled #ruralhealth #POH"
X Link 2025-03-23T11:06Z 32.5K followers, 99.5K engagements

"The ACA was the greatest piece of legislation ever passed Spare me. Such a claim is not merely hyperbolic it is historically illiterate. The Affordable Care Act passed in [----] was not a triumph of reform but a masterpiece of political theatre and economic distortion. It did not fix the American healthcare system; it calcified its worst features. The ACA entrenched a reimbursement model that favors bloated health systems over independent medicine. Through CMS Medicare reimburses more for services rendered in hospitals and HOPDs than independent physician offices. The consequence A wave of"
X Link 2025-03-23T20:12Z 32.5K followers, 338.2K engagements

"Healthcare isnt broken. Its functioning exactly like a cartel: consolidated exclusionary and systematically hostile to price discovery. Independent physicians arent just participants theyre the only remaining counterforce. Everyone else has already sold their autonomy or been absorbed. This is about saving the independent practice of medicine and restoring competitive forces to a sector deliberately designed to suppress them. Opt out of the rigged game. Build your own plan. Set your own price. And never ask permission to do what the market requires. History doesnt reward the compliant. It"
X Link 2025-03-25T12:55Z 32.5K followers, 63.3K engagements

"One MRI. Two quotes: NYU Langone: $4800 Independent Imaging Center: $500 Same scan. Same value. 10x difference. This isnt about quality. Its about opacity. The health system profits from your confusion. One phone call saved Eric $4300. Watch this clip and tell mewhy are we still letting them set the rules #TheRojasReport"
X Link 2025-03-28T00:21Z 32.5K followers, 46.8K engagements

"Look around your city. That gleaming new hospital tower Tax-exempt. That land its sitting on Property tax-free. The municipal infrastructure: roads police fire utilities Youre paying for all of it. Meanwhile the not for profit health system charges $3800 for a CT scan and sues patients for nonpayment. See the University of Virginia and the University of Colorado for some of the most egregious collections efforts. We dont need more nonprofit logos. We need market discipline and transparency. Lets end the fiction. These are corporations and they must be treated accordingly. #healthcare End"
X Link 2025-03-30T11:06Z 32.5K followers, 25.7K engagements

"Physical therapy at a health system: $330 Same visit at an independent PT clinic: $95 There are [---] million PT visits every year. We dont have a cost problem. We have a cartel problem. #healthcare"
X Link 2025-04-05T02:05Z 32.5K followers, 22.3K engagements

"Vanderbilt Health is not a nonprofit. Its a $7B tax-exempt corporation. Lets drop the pretense. Vanderbilt University Medical Center: Generated $6.9 billion in revenue last year Holds $5.8 billion in assets Paid its CEO $5.4 million Gave execs first-class and charter travel Reported insider transactions with affiliated parties And yet they pay no income tax no property tax and collect tax-deductible donations. How does that help the community Independent physicians pay full freight. Vanderbilt doesnt. Independent hospitals get paid less. Vanderbilt gets the premium. Private practices serve"
X Link 2025-04-14T01:04Z 32.5K followers, 26.5K engagements

". .%. Medicares physician payment formula (the Conversion Factor) Down 9.9%. Thats not fiscal responsibility. Thats institutional gaslighting. . But the doctors treating Medicare patients Theyre being asked to do more with less year after year because while the cost of running a practice skyrockets. If the American people want Congress to preserve access to care for aging Americans its time to speak up and tie Medicares payment formula to inflation just like their own salaries. . Theyre busy trying to survive the 20th century in the 21st. #HealthcarePolicy #Medicare"
X Link 2025-05-11T01:31Z 32.5K followers, 137.3K engagements

"1/ BREAKING: The Medicaid-insurer model is collapsing in real time. Centene: down 61% Molina: down 55% Humana: lost $300/share UnitedHealth: down 46% YTD and under federal investigation This isnt just a sell-off. Its the end of the myth. 🧵 Lets go"
X Link 2025-07-26T22:28Z 32.5K followers, 231.5K engagements

"UnitedHealth just wiped $100 billion in value because the DOJ is sniffing around their Medicare Advantage scam. Imagine how bad it looks on the inside"
X Link 2025-08-05T00:46Z 32.5K followers, 116.7K engagements

"Ruben May I take a shot at helping you understand You receive donations and have become a spokesperson for Banner Health and the University of Arizona teaching hospital Arizonas largest nonprofit health system. You say youre fighting to make sure insurance premiums dont go up by hundreds or thousands of dollars. Heres how your policies make that happen: CMS the federal agency running Medicare and Medicaid does not negotiate prices. It assigns reimbursement rates based on where care is delivered. Banner Health is assigned higher rates because it is classified as a hospital or hospital"
X Link 2025-10-05T10:28Z 32.5K followers, 429.7K engagements

"Who benefits from ACA subsidies Hint: Its not patients physicians or taxpayers. Every subsidy dollar moves through a predictable chain of custody and every stop on that chain earns yield before a single claim is paid. Lets follow the money [--] UnitedHealth Group (UNH) The largest beneficiary of all. ACA subsidies premium payments float investment income Optum integration. They profit on the insurance side the PBM side and the provider side. Result: $500B market cap. Sold by lawmakers. Funded by your taxes. [--] Centene (CNC) The Medicaid king. Over 70% of its revenue comes directly from government"
X Link 2025-10-09T02:19Z 32.5K followers, 54.4K engagements

"The entire U.S. healthcare system runs on one simple trick: youre not allowed to know the price. Price transparency isnt some radical new idea. Its already the law. Health Systems are just ignoring it. and Washingtons pretending thats fine. Because the second prices go public The whole $4 trillion industry collapses under its own nonsense. Heres what they dont want you to know:"
X Link 2025-10-12T19:19Z 32.5K followers, 35.3K engagements

"A physician billing $1200 for a procedure is greedy. A health system billing $18000 for the same CPT code is community benefit. Thanks @cmsgov"
X Link 2025-10-17T14:52Z 32.5K followers, 33.1K engagements

"If youre asking Why are my health insurance premiums so high this is for you The University of Michigan Health operates as a $6.9 billion revenue machine while enjoying complete tax immunity. Heres what that looks like: THE NUMBERS DONT LIE: $6.9B annual revenue (rivals major for-profit systems) $2.9M CEO salary (more than most Fortune [---] executives) -$348M fair share deficit (tax breaks exceed community benefit) $0 in property taxes paid (despite 2.5M sq ft of real estate) $3.4B in tax-exempt bonds issued since [----] THE PLAYBOOK: Tax Avoidance at Scale: Exempt from federal state local and"
X Link 2025-10-28T23:58Z 32.5K followers, 26.8K engagements

"The United States Government didnt make healthcare affordable with the Affordable Care Act it outlawed the only plan that made it affordable. Catastrophic plans protected families from bankruptcy. The Affordable Care Act made them illegal. I explain why in this short clip 👇 🤯 This is for self employed married parents in their 30s with [--] kids. Democrats did this with Obamacare [--] yrs ago and Johnson says Republicans have a mystery plan that is yet to be revealed to fix it. But no one knows what it is and were told to stay home in our districts. 🤯 This is for self employed married parents in"
X Link 2025-10-29T15:34Z 32.5K followers, 35.6K engagements

"Heres a puzzle: Why does health insurance work so differently from every other kind of insurance Your car insurance doesnt pay for oil changes. Your homeowners insurance doesnt cover paint. Insurance is supposed to protect against catastrophic unpredictable costs. But weve built a system where insurance pays for everything routine visits predictable care all of it. This divorces the consumer from the cost. Nobody asks what anything costs because nobody directly pays. The result Premiums rise. Deductibles rise. Coverage narrows. Weve turned insurance into a wildly inefficient payment system."
X Link 2025-11-02T22:00Z 32.5K followers, 122.6K engagements

"Every year the United States Government gives $40 billion to insurance companies. And thats just the start. The Official Story: When you buy health insurance on the Obamacare marketplace the government helps in two ways: [--]. They lower your monthly payment (premium subsidy) [--]. Theyre supposed to lower what you pay at the doctor (cost-sharing reduction) That $40 billion is for #2 to make your deductibles and co-pays smaller. The Real Dutch Story: The insurance companies get that $40 billion automatically. Every year. No matter what. Congress doesnt vote on it. Nobody can stop it. It just flows."
X Link 2025-11-08T12:33Z 32.5K followers, 352.5K engagements

"A group of physicians built a hospital in South Texas anyway and now its a 520-bed system with a Level [--] trauma center. Of course everyone said it couldnt be done. Dr. Carlos Crdenas joins The Doctor's Lounge to explain how they did it and why doctors must lead again. @physicianhosp @DHRhealth @DrDiGiorgio @sdixitmd @anish_koka @DRsLoungePod"
X Link 2025-11-08T13:25Z 32.2K followers, 27.4K engagements

"I dont know Professor. Because in Michigan its illegal to find out. Your employer @UMich lobbies the state to keep it that way. Michigan has Certificate of Need laws. Sounds bureaucratic. Its not. Its a permission slip system where health systems get to decide if their competitors can exist. Want to open a clinic Nursing home surgery center Imaging center You need permission from a state commission staffed by representatives from existing health systems and the carriers. Want to add an Operating Room to compete Same commission. Same conflicts. Want to offer a new service Youre asking your"
X Link 2025-11-08T19:48Z 32.5K followers, 112.9K engagements

"When independent practices fail it's not because of the market. It's because they: Pay full taxes Buy drugs at full price Receive lower reimbursement Can't access tax-free financing Can't open new hospitals The game is rigged"
X Link 2025-12-10T20:30Z 32.2K followers, [----] engagements

"The Five Families of Healthcare. UnitedHealth. CVS. Elevance. Cigna. Centene. 52% of the market. One-fifth of the economy. The full breakdown drops tonight at 5:30pm Central"
X Link 2025-12-14T17:08Z 31.1K followers, [----] engagements

". A ruling elite whose power is felt but rarely seen. : UnitedHealth. CVS. Elevance. Cigna. Centene. The Five Families of Healthcare. A thread🧵 "
X Link 2025-12-14T23:30Z 31.1K followers, 14K engagements

"The Nonprofit Architects Who Built the Castle the Five Families Inherited You know the Five Families. UnitedHealth. CVS. Elevance. Cigna. Centene. The for-profit giants everyone loves to hate. The publicly traded villains. The ones whose denials make the news. Yet there is a secret that 99.9% of the American populations does not know and I am going to reveal it to you today. The [--] families didnt build this system. They inherited it. The [--] Dynasties. 11:30am Eastern. https://twitter.com/i/web/status/2000573633660637361 https://twitter.com/i/web/status/2000573633660637361"
X Link 2025-12-15T14:28Z 31.1K followers, [----] engagements

". UnitedHealth. CVS. Elevance. Cigna. Centene. - . But they didn't build this system. They inherited it. Introducing: The Five Dynasties.🧵"
X Link 2025-12-15T16:30Z 31.1K followers, 12.1K engagements

"A nonprofit university hospital in Virginia sued a patient for $13000. She was a schoolteacher. They garnished her wages for [--] years. The university hospitals CEO made $4.2 million that year. Heres what nonprofit actually means in American healthcare: It means they dont pay property taxes. It means they dont pay income taxes. It means they dont pay sales taxes. It does NOT mean: They dont make money They dont hoard cash They dont sue you into poverty The [--] largest nonprofit hospital systems in America hold over $324 billion in assets. Read that again. $324 billion. They have legal teams"
X Link 2025-12-31T14:00Z 31.1K followers, 60K engagements

"$275 billion in annual subsidies. $29 million in lobbying. $33.2 million CEO paydays. This is what "good at business" looks like in American healthcare Not innovation. Not service. Rule capture"
X Link 2026-01-26T14:00Z 31.2K followers, [----] engagements

"$275 billion in annual subsidies. $29 million in lobbying. $33.2 million CEO paydays. This is what "good at business" looks like in American healthcare Not innovation. Not service. Just rule capture"
X Link 2026-01-26T16:30Z 31.1K followers, [----] engagements

"How do you lose $60 billion in [--] hours By breaking the one rule Wall Street still cares about. Dont lie to the market. And dont insult its memory. UnitedHealth did both. For years they grew their Medicare Advantage empire by selling simplicity: $0 premiums. No deductibles. Everything included until it wasnt. In [----] they flipped the script: Raised out-of-pocket maxes. Introduced new deductibles. Assumed seniors wouldnt notice or wouldnt bother to leave. They were wrong. They didnt just lose patients. They lost trust. And when trust disappears so does valuation. Heres what happened next:"
X Link 2026-01-28T13:16Z 31.2K followers, 132.8K engagements

"Many want to blame Private Equity. Well you are wrong and have been wrong. Private Equity has gotten smoked for getting into healthcare. It is the non-profit health systems. It has always been the non-profit health systems. Everything the government does is wrong. Non-profit doesn't mean no profit. Thank you to my friends and hosts Drs. Montero-Baker and Ferrer. Medicine is the field where experts are restricted from owning the tools of their own trade. Private firms have tried to run healthcare like a startup company but theyve overlooked one important detail: the model is failing because"
X Link 2026-01-31T17:07Z 31.1K followers, 15.9K engagements

"I have written about the ripoff Medicaid tax sixteen times since [----]. CMS shuts it down in [----] and gives the guilty parties until [----] to resolve it A infamous non-physician doctor on X told me I was full of 💩 and blocked me last year when I wrote this. She has 157k followers. Follower count does not make you right or correct. Im certain I will not hold my breath waiting for her to tell me I was 100% spot on. Provider Taxes: The Most Elegant Grift in American Healthcare Its not a tax. Its a laundering operation. Heres how it works: [--]. A health system voluntarily agrees to a provider tax"
X Link 2026-02-01T15:11Z 31.2K followers, 10.4K engagements

"A thought experiment: What happens when you convert a taxpaying entity into a tax-consuming entity The buildings don't change. The beds don't change. The patients don't change. What changes: who pays and who gets paid. HCA paid taxes. OU Health receives $463-493 million annually. Same hospital. Opposite economics. https://twitter.com/i/web/status/2018780301263011963 https://twitter.com/i/web/status/2018780301263011963"
X Link 2026-02-03T20:15Z 31.2K followers, [----] engagements

"What $825 million bought: $1.5 billion in debt (June 2023) Ba3 credit rating (junk status January 2023) $96 million appropriation increase (FY2024) The court approved $750 million. The state paid $825 million. The debt exceeded $1.5 billion. The math. It maths. https://buff.ly/CzcR5bi https://buff.ly/CzcR5bi"
X Link 2026-02-03T23:15Z 31.1K followers, [----] engagements

"Before: HCA owned it. Paid federal state and property taxes. Zero state subsidies. Corporate balance sheet risk. Outpacing peers nationally. After: OU Health. Tax-exempt. $245.8M in state appropriations. $1.5B debt load on taxpayers. Junk credit rating. Same beds. Same patients. Completely different financial model. 1/ https://twitter.com/i/web/status/2018858507114565761 https://twitter.com/i/web/status/2018858507114565761"
X Link 2026-02-04T01:25Z 31.1K followers, [---] engagements

"The credit rating tells the story. 2018: Deal closes at Baa3 lowest investment grade. 2022: Downgraded to Ba3. Junk status. March 2023: [--] days cash on hand. FY2024: $96M appropriation increase. De facto bailout. Weve had conversations about bailing them out. Rep. Kevin Wallace House Appropriations Chairman. 2/ https://twitter.com/i/web/status/2018858512332296699 https://twitter.com/i/web/status/2018858512332296699"
X Link 2026-02-04T01:25Z 31.1K followers, [---] engagements

"HCAs exit strategy: Leave a low-margin high-indigent market. Escape $400M bed tower cost. Take premium price ($1.06M per bed) and walk. The buyers narrative: Goals of a private company dont mesh with teaching hospitals. The warning sign everyone ignored: SSM Health spent [--] months in due diligence and walked away in [----]. 3/"
X Link 2026-02-04T01:25Z 31.1K followers, [---] engagements

"$1.3 Billion bond issuance anatomy: $825M: HCA buyout (base layer) $400M: New patient tower $30M: Proton therapy equipment $45M: Fees and reserves Risk factors: 50-year maturity. Initial Baa3 rating. Current debt: $1.5B outstanding. 5/"
X Link 2026-02-04T01:25Z 31.1K followers, [---] engagements

"What a wonderful thought it is that some of the best days of our lives havent even happened yet. - Anne Frank"
X Link 2026-02-04T12:08Z 31.2K followers, [---] engagements

"Had a chance to present our Co-Opetition model to my friends in commercial real estate this morning. 40+ building owners including multi-family office and retail. They were individually negotiating their property work comp liability and benefits. [--] things happen when they cooperate + compete = co-opetition [--]. Expenses go down dramatically. [--]. You move from expenses in your P&L to assets in your balance sheet. https://twitter.com/i/web/status/2019063985320972733 https://twitter.com/i/web/status/2019063985320972733"
X Link 2026-02-04T15:02Z 32.2K followers, [----] engagements

"People think price transparency is about patient shopping. Its not. Once healthcare becomes computable with machine-readable prices and structured data markets will form whether consumers ever looked or not. Benchmarks. Arbitrage. Capital reallocation. Opacity was the moat. Data killed it. Thats 🔥🔥🔥🔥 https://twitter.com/i/web/status/2019486197446218128 https://twitter.com/i/web/status/2019486197446218128"
X Link 2026-02-05T19:00Z 32.3K followers, [----] engagements

". . Path 1: Private Equity. They acquire your practice at 6-12x EBITDA. You solve the economics. You lose autonomy. They flip you in five years. Path 2: Health System Employment. They employ you. You solve the economics. You lose ownership. You become a badge number. Notice the pattern Both paths solve the same problem: you pay 30% more than the hospital down the street for the same insurance the same benefits the same everything. Both paths solve it the same way: by demanding you surrender what you built. PE takes your equity. Health systems take your autonomy. Both take your independence."
X Link 2026-02-06T12:04Z 32.3K followers, [----] engagements

"$71.8 million. That is how much one 50-employee independent practice loses to insurance carriers over a 30-year career. It is insane The grift is real Not to malpractice. Not to bad management. To the middleman. I did the math. Today I published the receipt. Full breakdown here: 60000+ healthcare professionals read The Rojas Report. https://buff.ly/DelccH9 https://buff.ly/DelccH9"
X Link 2026-02-06T15:30Z 31.9K followers, [----] engagements

"A Walmart manager may out earn a pediatric subspecialty surgeon. And everyone acts shocked. And its a question @HeathVeuleman @GeBaiDC and I have discussed. Why is a surgeons value determined by a committee instead of a market In every other domain of human expertise the extraordinary practitioner captures extraordinary value. The lawyer who wins the impossible case. The architect whose buildings define skylines. The entrepreneur who sees what nobody else sees (me 🫡). They dont earn 2x their peers. They earn 50x. Medicine is the only profession where a central planning committee the RUC with"
X Link 2026-02-07T10:06Z 31.2K followers, 40.8K engagements

"When a practice pays an insurance premium four things happen. The carrier pays claims. The carrier covers operating costs. The carrier keeps underwriting profit. The carrier invests the float. Warren Buffett built Berkshire Hathaway on that fourth one. Your premiums built it for him. https://twitter.com/i/web/status/2020135488498106796 https://twitter.com/i/web/status/2020135488498106796"
X Link 2026-02-07T14:00Z 32.1K followers, [---] engagements

"- . Academic "non-profit" Centers are the most expensive. Non-Profit Health Systems are next. For-Profit Health Systems are third. Independent practice of medicine is the lowest cost. The entire economic structure of American healthcare is designed to eliminate the cheapest model and protect the most expensive one. Would someone let Dr. Oz and Secretary Kennedy know they're in charge of a cartel"
X Link 2026-02-07T15:00Z 31.1K followers, [----] engagements

"When physicians leave independent practice for hospital employment Medicare costs per patient per year increase by $1327. When they move to models that preserve the practice structure costs decrease by $963. Consolidation does not reduce spending. It increases it. The data is not ambiguous. https://buff.ly/rWTFJY4 https://buff.ly/rWTFJY4"
X Link 2026-02-07T17:45Z 31.9K followers, 28.6K engagements

"This is insane. Major Nonprofit Health Systems admit: They own the hospitals clinics urgent caresbasically the entire map of your town They employ your doctors nurses and specialists (who are expected to hit RVU targets like sales reps) They run their own insurance plans (yes nonprofits with insurance subsidiaries let that marinate) They own the labs imaging centers surgery centers and sometimes even the janitorial services Their obligation Expanding the health system brand and executive bonuses not patient care They admit ALL of this: Weve established on the record that the largest nonprofit"
X Link 2026-02-08T20:43Z 32.3K followers, 30.5K engagements

"@realdocspeaks Thank you sir Churches are listening Manufacturers are listening Universities are listening The largest VC are listening My largest audience is healthcare folks"
X Link 2026-02-08T20:47Z 31.1K followers, [---] engagements

"Stood before a room of physicians this week. Specialists. Decades of training in every chair. I wanted them to see their own story in a story three thousand years old. Samuel anointed two kings. One received the crown in weeks. The other waited two decades. The one who waited lived among the enemy. Lied to survive. Gathered [---] broken men in a cave. Had two chances to seize the throne by force. Refused both times. A physician does not become a physician the day the degree is conferred. That is the anointing. The wilderness is everything after. Saul received the throne. David became the"
X Link 2026-02-08T22:45Z 31.1K followers, [----] engagements

"Four Field goals. Lame Super Bowl gets lamer. A national icon telling girls that great nutrition and training are not enough you need Big Pharma. This is where we are. Go NFL"
X Link 2026-02-09T01:57Z 31.2K followers, [----] engagements

"@edwards183 @KeithManleyjr Walmart pays market rates. Healthcare delivery does not. The system is second principle thinking. The way to reduce spend and generate cash is by first principle execution. And when we discuss CMS rates Id like to know which of the few schedules we are referring to"
X Link 2026-02-09T20:45Z 31.1K followers, [--] engagements

"@DaveBondyTV 340B is the beginning. I dont recommend the rabbit hole. Its deep and once you see it youre responsible. @DrDiGiorgio @HeathVeuleman"
X Link 2026-02-10T13:21Z 32.2K followers, [----] engagements

"Jessica has a deep understanding of the CON laws and healthcare in West Virginia. Absolutely brilliant. Counties with the highest medical debt in West Virginia are often the same places receiving the least charity care from local hospitals. Are non-profit hospital systems serving communities with the greatest need https://t.co/5C7AXBY5PO Counties with the highest medical debt in West Virginia are often the same places receiving the least charity care from local hospitals. Are non-profit hospital systems serving communities with the greatest need https://t.co/5C7AXBY5PO"
X Link 2026-02-10T14:06Z 31.2K followers, [----] engagements

"The most expensive thing in healthcare is not any particular drug. It is the absence of a market. Every industry that built an exchange got cheaper. Agriculture. Energy. Telecom. Finance. Healthcare skipped this step entirely. Then everyone appeared surprised when costs increased"
X Link 2026-02-10T15:30Z 31.2K followers, [----] engagements

"A GoodRx coupon does not lower drug prices. It arbitrages the gap between two fake numbers and takes a cut. The company went public at $12.7 billion. Its entire business model depends on the system staying exactly as broken as it is. That is not a bug. That is the product"
X Link 2026-02-10T17:15Z 32.2K followers, [----] engagements

"Ah yes nothing screams affordability like crushing independent docs and handing the keys to corporate hospitals. Warren and Hawley out here cosplaying reformers while their states are graveyards for private practice. Premiums sky-high Thats not a mystery thats math. UPPs are cheaper. The data screams it. But instead we feed the hospital-industrial complex like its Thanksgiving every day. You want affordable healthcare Try not vaporizing the only model that actually saves money. Are politicians this organically dumb Or are they paid to feign stupidity Sens. Elizabeth Warren and Josh Hawley are"
X Link 2026-02-10T17:18Z 31.2K followers, [----] engagements

"Imagine if grocery stores worked like pharmacies. You would never see a price tag. A third party would "negotiate" on your behalf. You would pay a different amount each time you visited for the same loaf of bread. And someone would build an app that finds you a "coupon" and go public at $12.7 billion. You would call that insane. Americans call it healthcare. https://twitter.com/i/web/status/2021298262913831312 https://twitter.com/i/web/status/2021298262913831312"
X Link 2026-02-10T19:00Z 32.3K followers, [----] engagements

"I would never support two Senators that encourage healthcare consolidation in their own states. They dont understand healthcare much less know how to reform it. And I want to lower expenses and costs and actively do so. Hell Ive personally done more for patients than Warren and Hawley combined. Mark CMS the hospital associations and lawmakers in government want to shut down private industry and make everyone bow the knee to government. Great job @HawleyMO & @SenWarren LOVE THIS. Anyone in Congress that doesnt support this doesnt want lower cost healthcare for Americans. This is a no brainer."
X Link 2026-02-10T19:26Z 31.4K followers, 43K engagements

"@HeathVeuleman And he loves the university of Missouri"
X Link 2026-02-10T19:34Z 31.2K followers, [---] engagements

"@HeathVeuleman Oh yeah And their support of the moratorium is lovely. MO did give an exemption for ASCs. Immediately ortho left all advocacy groups"
X Link 2026-02-10T19:36Z 31.2K followers, [--] engagements

"Two senators that support consolidation by non profits despise independent medicine and Mark who on two occasions has said to me Dutch get with it healthcare is a right. Their solutions are fascism and control. Cant support it. The way to lower prices is competition removal of subsidies site neutral payments etc (which you know well). https://twitter.com/i/web/status/2021313079351652860 https://twitter.com/i/web/status/2021313079351652860"
X Link 2026-02-10T19:59Z 31.1K followers, [--] engagements

"TrumpRx dropped Ozempic from $1028 to $350. People celebrated. Nobody asked the uncomfortable question: what happens if the next President does not want to call pharmaceutical CEOs personally A price that requires the White House to exist is not a price. It is a favor"
X Link 2026-02-10T20:15Z 31.2K followers, [----] engagements

"Markets are as a general matter seperated into three segments. 1) retail 2) business 3) institutional Today governments around the world set medical treatment prices by central planning. Exchanges solve the challenge to pricing hundreds thousands and millions of services in real time. https://twitter.com/i/web/status/2021320183160402296 https://twitter.com/i/web/status/2021320183160402296"
X Link 2026-02-10T20:27Z 31.2K followers, [--] engagements

"What isnt logical Buyers would never again need renewals. Consumer apps could be built in the pricing data. Analyst could advise on value versus brokers selling products. Exchanges are an excellent mechanism for exchange. There are 350+ exchanges for energy lumber currency metals etc. https://twitter.com/i/web/status/2021322372297433490 https://twitter.com/i/web/status/2021322372297433490"
X Link 2026-02-10T20:36Z 31.2K followers, [--] engagements

"@cogitator88 Mark believes healthcare is a right"
X Link 2026-02-10T20:56Z 31.2K followers, [--] engagements

"The Amsterdam Bourse opened as a commodity exchange in [----]. Grain. Herring. Spices. Tulips Middlemen became optional. Costs came down. Every modern exchange on earth followed. Five hundred years later American healthcare still has no exchange. The middlemen are doing extremely well. https://twitter.com/i/web/status/2021351013894979943 https://twitter.com/i/web/status/2021351013894979943"
X Link 2026-02-10T22:30Z 31.2K followers, [---] engagements

"Cost Plus sells drugs at cost plus 15%. Transparent. Honest. Admirable. It also covers roughly 12% of total drug spending. The other 88% has no transparent pricing mechanism at all. Building an honest calculator inside a rigged casino is noble. It is not a solution. It is a proof of concept"
X Link 2026-02-10T23:15Z 32.3K followers, 20.1K engagements

"@WildWildArrest @mcuban @Alva5915George @DrDiGiorgio @HammondOnHealth Are you retarded The United States government gives $300 billion to the health systems in subsidies and that doesnt include the accounting for tax free donations"
X Link 2026-02-11T09:55Z 31.2K followers, [--] engagements

"Two Senators Want to Break Up Big Medicine. Their States Perfected It First. One represents a state that regulates [--] healthcare services through Certificate of Need. The other represents a state that banned new surgery centers for [--] years. Mark Cuban called it a no brainer. [----] of his [---] million followers agreed. Thats 0.08%. They are not fighting the monopoly. They are the monopolys landlords. https://open.substack.com/pub/dutchrojas/p/two-senators-want-to-break-up-bigr=3mc0ds&utm_medium=ios&shareImageVariant=poster"
X Link 2026-02-11T12:07Z 31.2K followers, [----] engagements

"@NathanLevy10 @HeathVeuleman @elonmusk 48%"
X Link 2026-02-11T12:27Z 31.2K followers, [--] engagements

"@tencentdress Not surprising West Virginia is bought"
X Link 2026-02-11T13:15Z 31.2K followers, [--] engagements

"The man single handily destroyed Vermont Healthcare. And then wonders why its expensive. 😂 https://t.co/5WqtuI9Nov 😂 https://t.co/5WqtuI9Nov"
X Link 2026-02-11T13:16Z 31.8K followers, [----] engagements

"$275 billion. Thats how much the federal government takes from hard working Americans and hands to hospital systems every year in subsidies tax breaks and payment advantages. Independent physicians receive $0 of it. The Break Up Big Medicine Act touches $0 of it. Not a coincidence. Warren and Hawley love the American Hospital Association. And where are the @GOPDoctors Nowhere"
X Link 2026-02-11T14:00Z 31.9K followers, [----] engagements

"The Break Up Big Medicine Act targets: Insurer-PBM-physician conglomerates The Break Up Big Medicine Act ignores: Medicaid fraud 275B hospital subsidy apparatus Certificate of Need laws in [--] states Physician-owned hospital ban Nonprofit tax exemptions ($37.4B) 340B program expansion ($81.4B) Site-neutral payment violations ($14.1B) One column got a press conference. The other got nothing. Surprising Nothing good comes out of Washington D.C. https://twitter.com/i/web/status/2021622787484324285 https://twitter.com/i/web/status/2021622787484324285"
X Link 2026-02-11T16:30Z 32.2K followers, [----] engagements

"@alexjung Bingo Its an appearance win. It will change nada"
X Link 2026-02-11T18:25Z 31.2K followers, [--] engagements

"Who is NOT threatened by the Break Up Big Medicine Act: Largest nonprofit hospital system in America. Every state Certificate of Need board. Lobbyist who helped write Section [----]. The American Hospital Association. The Federation of American Hospitals. The entire $275 billion annual subsidy apparatus. Who IS threatened: The insurer-PBM-physician conglomerates that make good headlines. One group funds campaigns. The other gets regulated. Do you really trust the politicians"
X Link 2026-02-11T20:15Z 32.2K followers, 34.1K engagements

"Its 7:05am EST. Healthcare still not fixed. Solutions already exist. Your health insurance premium went up again this year. Your doctor cant get OR time because one system controls every surgical suite in town. Your employer was quoted $28000 per employee for family coverage. This is the story of the 60-year-old law that made all of it inevitable. Its the law responsible for more unnecessary death than any other I have studied. https://twitter.com/i/web/status/2022282037025997042 https://twitter.com/i/web/status/2022282037025997042"
X Link 2026-02-13T12:09Z 32.2K followers, [----] engagements

"@TrentDJ023 Certificate of Need"
X Link 2026-02-13T15:45Z 32.1K followers, [--] engagements

"The Most Elegant Monopoly in American Healthcare The most effective monopolies dont ban competition. They simply require competitors to ask permission. Massachusetts offers a masterclass in how to do this politely. A Friday Happy Hour 🧵"
X Link 2026-02-13T23:16Z 32.3K followers, [----] engagements

"The Massachusetts ASC Deficit. All data cited here comes from the Massachusetts Health Policy Commission itself. This isnt conjecture. Its arithmetic. 2/"
X Link 2026-02-13T23:16Z 32.2K followers, [---] engagements

"Nationally there are [----] ambulatory surgery centers per million people. Massachusetts has [--]. The state ranks 4th lowest in the country. There are no demand anomalies. Its structural. 3/"
X Link 2026-02-13T23:16Z 32.2K followers, [---] engagements

"While most states decentralize routine surgery into lower-cost outpatient centers Massachusetts concentrates it inside huge health systems. Decentralization diffuses margin. Concentration preserves it. 4/"
X Link 2026-02-13T23:16Z 32.2K followers, [---] engagements

"Operating rooms per million: Massachusetts: [--] National average: [--] A 59% structural gap. When supply is restricted high utilization can look like necessity. 5/"
X Link 2026-02-13T23:16Z 32.2K followers, [---] engagements

"Boston arguably the most prestigious medical city in the world has exactly one ambulatory surgery center within city limits. Scarcity in this context is not geographic. It is policy-defined. 11/"
X Link 2026-02-13T23:16Z 32.2K followers, [---] engagements

"Massachusetts has: 4th fewest ASCs per capita A 59% operating room gap vs. national average Up to 57% price differentials favoring hospital settings When incumbents participate in rulemaking outcomes tend to favor incumbents. 12/"
X Link 2026-02-13T23:16Z 32.2K followers, [---] engagements

"@EdithaTogo @EricCrampton @DrDiGiorgio Legibility and a single-payer agenda by the administrative state"
X Link 2026-02-13T23:18Z 31.2K followers, [--] engagements

"@Jtfawver BOOOOOOMMMMM I was up all night the kiddos were sick and I thought I'd start poking around on this medicaid data. Jaw-dropping doesn't begin to explain the things I saw"
X Link 2026-02-14T22:01Z 32.2K followers, [----] engagements

"Two MRI machines. Same specs. One in a health system hospital. One in an independent center. Price for Health system hospital: $3719 Price for independent center: $688 Whats the difference Zero niks and nada Stop ripping off patients. Not #healthcare"
X Link 2023-06-10T16:58Z 32.5K followers, 91K engagements

"Heres a fun party trick: ask ten Americans whether we have free market healthcare and watch nine confidently say yes. Then show them this: - Employer Coverage: 160M Americans - Medicare: 67M (seniors + disabled) - Medicaid / CHIP: 72M (low-income + kids) - ACA Marketplace: 21M enrolled - Military / VA: 9M - Uninsured / Other: 25M I know what youre thinking: But Dutch employer coverage is private Is it though Last I checked employers receive a massive tax deduction for buying your health insurance a subsidy so large that if we removed it tomorrow the entire system would collapse by next"
X Link 2025-10-09T12:36Z 32.5K followers, 31.2K engagements

"We dont need another replace the ACA white paper. We need to remove the rules that make competition illegal and prices invisible. 1.Repeal the physician-owned hospital ban so specialists can build and expand facilities again. 2.Abolish CON laws so incumbents cant veto their future competitors. 3.Enforce site-neutral payments equal pay for equal care. [--]. Fix 340B: sunset it or open it to independent practices on equal terms. 5.Tie nonprofit tax exemptions to audited patient-level charity care. 6.Let DSH UPL and GME dollars follow patients and training wherever they actually happen. Then"
X Link 2025-10-24T01:50Z 32.5K followers, 82.5K engagements

"A restaurant in Minneapolis called Safari. Seats [--] people. Claimed to serve [-----] meals a day to hungry children. The federal government paid them for every single one. The children didnt exist. The meals didnt exist. The money did. And its gone. This is just one piece of a $9 billion Medicaid fraud in Minnesota the largest in American history. Today Im publishing the whole investigation. The fraud. The cover-up. The whistleblowers who were ignored. https://twitter.com/i/web/status/2005644231168196962 https://twitter.com/i/web/status/2005644231168196962"
X Link 2025-12-29T14:17Z 32.5K followers, 1.8M engagements

"@ebon_geist"
X Link 2025-12-30T22:45Z 32.5K followers, [----] engagements

"Dear Mr. Axelrod: As you know there are real solvable structural issues in healthcare that deserve serious discussion. For example: Repealing Section [----] of the ACA Moving to site-neutral payments to eliminate site-of-service arbitrage Reducing reliance on centralized pricing mechanisms like the AMA RUC Encouraging transparent market-based pricing models Reforming or eliminating outdated CON laws None of these are abstract theories. They are policy choices. CMS and Congress have the authority to address many of them some by end of this week and all of them by end of Q1-2026. If the US"
X Link 2026-02-12T13:15Z 32.3K followers, [----] engagements

"MedPAC told Massachusetts directly. States with Determination of Need laws have fewer surgical centers. Massachusetts heard that. Then weaponized licensure to protect hospital market share anyway. 7/"
X Link 2026-02-13T14:17Z 32.3K followers, [---] engagements

"The obsession with a plan is the problem. It presupposes that [---] million peoples healthcare needs can be centrally managed. Imagine if we had a national food plan. The solution isnt a better plan; its a better marketplace. One where the price of a knee replacement is as knowable as the price of a Kia. House Republicans should come up with a healthcare plan that reduces the outrageous costs of health insurance instead. House Republicans should come up with a healthcare plan that reduces the outrageous costs of health insurance instead"
X Link 2026-02-14T07:23Z 32.3K followers, [----] engagements

"The article is live. https://dutchrojas.substack.com/p/the-billion-dollar-club The HHS Medicaid Provider Spending dataset just went public for the first time. I pulled every organization in the country that bills under code T1019 Personal Care Services. Thats bathing dressing meal prep for Medicaid beneficiaries. Non-medical. Delivered by home health https://dutchrojas.substack.com/p/the-billion-dollar-club The HHS Medicaid Provider Spending dataset just went public for the first time. I pulled every organization in the country that bills under code T1019 Personal Care Services. Thats bathing"
X Link 2026-02-14T21:13Z 32.4K followers, [----] engagements

"@Markroot14 @TwoEaglesMom2 @Why45huh Mark with the Flamethrower"
X Link 2026-02-14T21:25Z 32.4K followers, [--] engagements

"@DrDiGiorgio @DataRepublican 🔥🔥🔥🔥🔥🔥🔥"
X Link 2026-02-14T21:26Z 32.3K followers, [----] engagements

"@dr_hamill Yes physicians live in fear And the billing offices in the worst neighborhoods in the country bill for billions and there is not oversight"
X Link 2026-02-15T10:07Z 32.4K followers, [---] engagements

"@pr0650 @DrOz He says that from his $40M home in West Palm Beach"
X Link 2026-02-15T17:15Z 32.3K followers, [--] engagements

"@DrDiGiorgio @chrissyfarr Oh you're going to get in trouble now. There is no way he spent $2M. I was told he had benefits via the union. Let's have that discussion. It is right and appropriate"
X Link 2026-02-15T17:18Z 32.4K followers, [---] engagements

"@clnuponaisle5 Its con"
X Link 2026-02-16T03:37Z 32.3K followers, [--] engagements

"Congress outlawed physician-owned hospitals in [----]. The American Hospital Association and the Federation of American Hospitals lobbied for it. CMS data shows [--] of the top [--] hospitals for quality access and cost are physician-owned. Charges are one-third lower than traditional hospitals for the same procedures. Congress banned the best model and now wonders why healthcare is expensive. And youre wondering why your premiums are high Kennedy and OZ could fix it tomorrow"
X Link 2026-02-11T18:45Z 32.5K followers, 12.5K engagements

"The real reform agenda is five items: Repeal the physician-owned hospital ban Eliminate Certificate of Need laws Enforce site-neutral payments Condition nonprofit tax exemptions on actual community benefit Separate insurer-PBM-physician conglomerates This bill does one of five and calls it a revolution. Do all of it or admit the rest is theater. https://buff.ly/k2aHceS https://buff.ly/k2aHceS"
X Link 2026-02-11T19:00Z 32.4K followers, [----] engagements

"About time. The US government needs to get serious about misuse of 501(c)(3) status. And it ought to start with nonprofit health systems: $300B+ in annual tax advantages Executive compensation rivaling private equity Aggressive consolidation of independent physicians Facility fee arbitrage protected by regulation Minimal charity care relative to subsidy Tax exemption was meant for community benefit. Not market dominance. Lets see where this goes. The IRS will launch a dedicated fraud task force focused on targeting the misuse of funding by 501(c)(3) tax-exemptentities. Lets start with the"
X Link 2026-02-14T01:43Z 32.4K followers, 11.3K engagements

"@no_stp_on_snek 🫡"
X Link 2026-02-15T02:03Z 32.5K followers, [---] engagements

"@DrDiGiorgio 🔥🔥💩🔥🔥💩🔥🔥 We are going to win Dr. G"
X Link 2026-02-16T16:28Z 32.5K followers, [---] engagements

". . Every hospital in America is being forced to publish prices. Most people hear that and think: Cool. Patients can shop now. Thats not the real story. Heres the Dutch insight Healthcare is crossing a line it has never crossed before: Its becoming computable. That matters far more to entrepreneurs and data scientists than to patients. Because once prices exist a chain reaction starts: Markets form Benchmarks emerge Arbitrage appears Bundles can be built Risk can be priced Forward contracts become possible (yes my SurgeryFutures) This is how every modern industry was rebuilt. Not with"
X Link 2026-02-05T12:21Z 32.4K followers, 174.2K engagements

"James Van Der Beek passed away today. Im a healthcare guy and I post about healthcare. Now I want to talk about James. He was special he was [--] years old a Father of six a Husband. He was man who spent his final chapter teaching the ultimate guide to real life. James was part of my growing up. Dawsons Creek. Varsity Blues. The 90s. He was just there woven into the background. What he did over the last few years was bigger than any of that. He recorded a video on his last birthday. Cancer had taken everything he used to define himself. He couldnt be the husband who helped around the house. He"
X Link 2026-02-11T21:19Z 32.5K followers, 476.3K engagements

"Calling this a scandal is like calling a casino a charity that occasionally takes your money. The PBM model isnt broken; its doing exactly what it was designed to do. It creates opacity and extracts value. The most expensive part of a prescription isnt the drug; its the series of invisible hands it passes through. 🚨 SCANDAL IN TENNESSEE: How a PBM "Stole" $30000000 from Taxpayers 🚨 A bombshell audit by the Tennessee Department of Commerce and Insurance has just exposed the shady underbelly of Pharmacy Benefit Managers (PBMs). The target Express Scripts. The findings are a wake-up"
X Link 2026-02-14T07:27Z 32.5K followers, [----] engagements

"The numbers are so large they lose all meaning. $12.1 billion in profit for one insurer. The problem isnt the number itself but the fact that these profits are generated not by creating health but by navigating a regulatory maze of their own design. Theyre not in the health business; theyre in the complexity business. https://buff.ly/AkILaui https://buff.ly/AkILaui"
X Link 2026-02-14T14:00Z 32.5K followers, [----] engagements

"The HHS Medicaid Provider Spending dataset just went public for the first time. I pulled every organization in the country that bills under code T1019 Personal Care Services. Thats bathing dressing meal prep for Medicaid beneficiaries. Non-medical. Delivered by home health aides. The national spend on this single code from [----] to 2024: $122.7 billion. [--] entities collected 42.5% of it. Nine of them each crossed a billion dollars. Seven are in Brooklyn. Some share the same block. Some share the same authorized official. Some share the same address four doors apart. Physicians face prior"
X Link 2026-02-14T17:00Z 32.5K followers, 127.3K engagements

"And you guys wonder why I respect @DataRepublican so much. She is a brilliant researcher and a great collaborator. Thank you Check out her thread below. @DutchRojas I promise I didn't see this post before I posted this thread https://t.co/BGN34fcS5c @DutchRojas I promise I didn't see this post before I posted this thread https://t.co/BGN34fcS5c"
X Link 2026-02-14T21:20Z 32.5K followers, 25.5K engagements

"@mburkhold @DOGE @DOGE_HHS DME.Oh Lord please help us"
X Link 2026-02-14T21:59Z 32.4K followers, [---] engagements

"Five individuals are listed as the authorized official for ten separate Medicaid billing entities. Combined T1019 billing: $11.8 billion. And you're wondering why I am always complaining about the high cost of insurance premiums Two entities operate out of Flushing. Same building. Four doors apart. $2.3 billion combined. Another operator has two entities. Same addresses. $809 million. Entity proliferation is one of the oldest structures in healthcare billing. You split operations across multiple NPIs to stay below audit thresholds create the appearance of competition or maintain billing when"
X Link 2026-02-15T01:45Z 32.5K followers, 14.5K engagements

"@RecoveryDoctor Ill know for sure in the next few days. Its a copious amount of data"
X Link 2026-02-15T02:15Z 32.5K followers, [---] engagements

". T1019. Personal care services. Bathing dressing and meal prep. $+ . If this is what T1019 looks like what does T1020 look like What about home health codes DME codes and behavioral health codes The same structural incentives exist across the Medicaid billing landscape: low oversight easy entity creation geographic clustering and authorized official networks. Medicaid is the largest payer in the U.S. healthcare system covering [--] million people. It is also the least transparent. The HHS dataset is now public. https://dutchrojas.substack.com/p/the-billion-dollar-club"
X Link 2026-02-15T07:26Z 32.5K followers, [----] engagements

"$978 million a month. That was Medicaid T1019 home care spending before COVID. Today its $1.93 billion a month. The Medicaid data set released Friday is a treasure trove. This is my second day of digging in. The Covid emergency ended in May [----]. The spending hit its peak in May [----]. You can learn how entitlement baselines get permanently reset. Are these actions the result of a responsible government Todays article: https://tinyurl.com/ycy87xvn https://tinyurl.com/ycy87xvn"
X Link 2026-02-15T12:31Z 32.5K followers, 11.2K engagements

"Congress says theyve known for years. Good. Then explain this. Across the HHS Medicaid dataset more than $120B has been paid under this single code. [--] entities collected $30.4B. Seven billion-dollar entities in one state. $28.4M paid to organizations barred from billing. If this is legal the structure is broken. If its illegal enforcement is broken. Where was: HHS OIG CMS Program Integrity DOJ Civil Division State Medicaid Fraud Units Oversight or admission. Which is it https://twitter.com/i/web/status/2023077508443242585 https://twitter.com/i/web/status/2023077508443242585"
X Link 2026-02-15T16:50Z 32.5K followers, [----] engagements

"Why are your health insurance premiums high Whenever I want to build a new hospital or clinic I have to beg for permission from other hospitals and the insurance carriers. Thats not capitalism. Thats called Certificate of Need. Before you can build. Before you can expand. Before you can buy equipment. The FTC and DOJ have already said it: CON laws fail to contain costs and pose anticompetitive risks. Eight states score a perfect [---] for restrictiveness. Five Democrat governors. Five Republican governors. This is definitely not left vs right. Its incumbents vs competition. When competition"
X Link 2026-02-15T19:01Z 32.5K followers, [----] engagements

"@no_stp_on_snek @RepJasonSmith @RepGregMurphy @RepRichardNeal @RepTomSuozzi @RepAOC @GovKathyHochul Thank you sir Amazing what happens when the government sets data free"
X Link 2026-02-15T21:11Z 32.5K followers, [---] engagements

"We put out article [--] of [--] we have prepared with the HHS Medicaid data. https://open.substack.com/pub/dutchrojas/p/the-billion-dollar-clubr=3mc0ds&utm_medium=ios&shareImageVariant=split https://open.substack.com/pub/dutchrojas/p/the-billion-dollar-clubr=3mc0ds&utm_medium=ios&shareImageVariant=split"
X Link 2026-02-15T22:20Z 32.5K followers, [----] engagements

"Why is mainstream media ignoring the HHS Medicaid data release Great question. After [--] years speaking with reporters heres my experience: [--] in [---] understands Medicare Medicaid CMS insurance or healthcare economics at all. Thats not an insult. Its a structural problem. Second question: How much advertising revenue do major media outlets receive from: Pharma Insurance Device manufacturers Health systems CMS-related programs Healthcare is a trillion-dollar ecosystem. Media runs on advertising. Is this incompetence Or incentive alignment Looking around for mainstream media stories on this. I"
X Link 2026-02-16T01:32Z 32.5K followers, [----] engagements

"A physician needs prior authorization to prescribe a $40 medication. A home health agency in Brooklyn needs nothing to bill $1.27 billion. Same Medicaid system. Same taxpayer dollars. One of them faces audits board certification peer review and utilization management. Guess which one. https://twitter.com/i/web/status/2023230903690895502 https://twitter.com/i/web/status/2023230903690895502"
X Link 2026-02-16T03:00Z 32.5K followers, 109.3K engagements

"The credential for billing Medicaid $68 an hour to treat a child with autism is a high school diploma and [--] hours of training. The HHS released Medicaid data. It is a treasure trove of improper payments potentially fraud and more regulatory capture. Whats certain The American taxpayer is being completely screwed. And in the worst way. The requirements and licensing standards for cutting hair in most states requires [----] hours. The regulators built a system that trusts a barber with your hair more than it trusts a behavioral technician with your child. Thats the business model. ABA therapy"
X Link 2026-02-16T12:47Z 32.5K followers, [----] engagements

"$4.6 million to $85.6 million. One state. One billing code. Four years. Nebraska didnt have an autism epidemic. It had a reimbursement rate that was among the highest in the country and zero accreditation requirements for the companies billing it. Out-of-state operators set up shop. Individual clinicians billing Medicaid grew from [---] to over [----]. The state had no system to verify whether therapy actually happened. Indianas federal audit sampled [---] months of ABA claims. Every single one contained at least one improper payment. Not [--]. All [---]. Nap time billed as treatment. Group therapy"
X Link 2026-02-16T16:30Z 32.5K followers, 54.6K engagements

"Going to medical school is stupid. Thats the narrative right now. And as usual the well-intentioned people spreading it are wrong. The jobs AI is eliminating are not in the operating room. They are in the C-suite. CEO. COO. CFO. The white-collar administrative layer that hospital systems spent decades building between the physician and the patient. AI does not need a neurosurgeon to click an EMR [--] times to place an order before a trauma procedure. AI will review the case and handle the administrative work itself. I hope the largest hospital administrators in America read this here first."
X Link 2026-02-16T20:25Z 32.5K followers, 24.1K engagements

"I asked my doctor the price for the procedure. She looked at me like I'd asked her to explain the plot of 'Inception' using only interpretive dance. Apparently in the medical world asking for prices is like asking for the secret menu at a fancy restaurant. It exists but they'd rather you didn't know about it. Maybe we start a movement. Occupy Billing Department.' We'll sit in waiting rooms demanding itemized receipts. It'll be fun. Bring snacks. Not #healthcare"
X Link 2024-10-20T01:09Z 32.5K followers, 408.6K engagements

"Anyway the Dems shut down the government in order to safeguard their $40B/yr Obamacare slush fund that funnels our money to UnitedHealth and other multinational for-profit business corporations while U.S. citizens choke on $25K premiums for trash coverage. They all hate you"
X Link 2025-11-07T18:16Z 917.6K followers, 743.2K engagements

"The government is killing Americans by withholding monoclonal antibody treatments"
X Link 2021-12-31T18:15Z 32.5K followers, [----] engagements

"I know it can feel like a different era sometimes. But fifteen years ago I signed the Affordable Care Act into law. Now nearly [--] million people have received health care through the ACA. With everything going on right now its easy to feel like regular folks cant make a difference but the Affordable Care Act is a reminder that change is possible when we keep fighting for progress"
X Link 2025-03-23T14:23Z 119.1M followers, 37.7M engagements

"Physicians in the United States are banned from owning hospitals. Thats not a conspiracy theoryits Section [----] of the Affordable Care Act (ACA) passed in [----]. Heres how it happened: Congress needed votes for the ACA. The American Hospital Association (AHA) made a deal: Theyd back the law if Congress banned new physician-owned hospitals. Why To protect big hospital monopolies from competition. With insurers taking a larger cut under the ACA hospitals wanted a guarantee theyd get theirs too. The result No new physician-owned hospitals for over a decade. Patients are stuck with fewer choices"
X Link 2024-12-08T12:23Z 32.5K followers, 247.8K engagements

"$24000 a year for health insurance premiums. Add a $7500 deductible and youre $31500 out-of-pocket before insurance even begins to pay. This isnt healthcare. Its financial ruin disguised as protection. Heres the truth: free market capitalism drives competition innovation and pricing transparency. Healthcare doesnt need more government intervention or monopolized health systems. It needs choicedirect contracts transparent pricing and the freedom for physicians to compete on quality and price. The US doesnt lack resources; it lacks accountability. Open the markets and prices will come down. Let"
X Link 2024-12-13T13:41Z 32.5K followers, 176.7K engagements

"They made it illegal for doctors to compare prices. Called it price fixing. Said it would hurt consumers. Then they let insurers and health systems sit in a room and set everyones prices. Called it managed care. So now: Doctors cant collaborate. Employers cant see prices. Insurers dictate payments. And the DOJ calls that competition. Did the US government nationalize collusion"
X Link 2025-10-23T14:29Z 32.5K followers, 57.6K engagements

"Groceries. Rent. Utilities. Everything is too expensive. And Republicans plan Jack up your health insurance premiums by hundreds maybe thousands of dollars. Im fighting to make sure that doesnt happen"
X Link 2025-10-04T20:56Z 207.2K followers, 408.2K engagements

"Show me one Democrat Leader who has apologized for lying about the ACA. Keep your doctor. Lie. Keep your plan. Lie. Premiums will drop. Lie. They sold it like a Costco membership and vanished when it blew up. Roll the tape:"
X Link 2025-10-12T23:11Z 32.5K followers, 38.8K engagements

"Obamacare promised you could keep your plan. You lost it. They said premiums would drop. They spiked. You called it health reform. They called it recurring revenue"
X Link 2025-10-12T13:50Z 32.5K followers, 25.9K engagements

"Imagine billing $40000 for a hospital colonoscopy and still putting nonprofit in your mission statement. Thats not healthcare. Thats theater"
X Link 2025-10-17T00:19Z 32.5K followers, 42.5K engagements

"A physician I know performed a complex surgery at a hospital. Health System billed: $78000 Health System Paid: $40000 Physician Reimbursement: $1100 Health Systems take the lions share. Physicians take the hit. No physician wants to be employed. #healthcare"
X Link 2025-02-22T12:43Z 32.5K followers, 437.4K engagements

"Republicans have had [--] years since Obamacare was passed to offer a credible alternative for healthcare. And they've still got nothing. That should tell you something America"
X Link 2025-10-23T03:09Z 234.8K followers, 267.1K engagements

"You have a card. You have coverage. But your deductible is $8000 and your specialist requires prior auth that takes six weeks. Congratulations. Youre functionally uninsured. This is the cleverest trick in modern healthcare: Sell coverage thats too expensive to use then call it access. Its insurance in name only financial exposure with paperwork"
X Link 2025-10-31T22:16Z 32.5K followers, 61.1K engagements

"Did you know 90% of Americans never reach their deductibles That means most healthcare is paid out-of-pocket. And with [--] billion treatments annually the market for cash-priced services under $6000 is ripe for disruption. Imagine knowing upfront that an MRI costs $400 at one facility and $4800 at another. Transparency saves money builds trust and gives patients real power. Its time to demand it. #PatientPower #TransparentHealthcare #healthcare"
X Link 2024-12-07T15:20Z 32.5K followers, 74.9K engagements

"Imagine youre an Academic Health System CEO. Suddenly doctors start building their own hospitals and they are faster cheaper and have better outcomes. What do you do If you answered improve service youre adorable. The real answer Lobby Congress to ban them. Which is exactly what happened in [----]. The ACA prohibited new physician-owned hospitals. If health systems are so superior let doctors compete. The ban reveals theyre terrified of the answer. The ban reveals Congress can be bought"
X Link 2025-11-01T01:42Z 32.5K followers, 59.2K engagements

"The craziest part of American healthcare isnt that an MRI can cost $8000. Its that the $8000 MRI survives right next to the $400 MRI and nobody can trade the spread. Thats not a market. When prices become data and data becomes tradable the charade ends. Capital hunts the inefficiency. Volume follows value. And the overpriced version either proves its worth or meets reality. Roll the clip:"
X Link 2025-11-15T21:30Z 32.5K followers, 147.3K engagements

"Econ [---] midterm question: Based on what you know about risk pools and adverse selection in healthcare markets will giving people money instead of giving them money to buy health insurance lead these markets to function more effectively or will it just lead more people to be uninsured"
X Link 2025-11-08T18:10Z 292.6K followers, 850.9K engagements

"Bill Ackman is a LEGEND Bill Ackman lays out a damning case against UnitedHealthcares tactics strong-arming physicians denying medically necessary care and then attempting to silence critics through legal threats. @EPotterMD Dr. Potters experience is not an anomaly; its a systemic issue. Physicians have known for years that insurers manipulate claims adjudication to maximize profits at the expense of patient care. This isnt a mistakeits the business model. UNHs response to Dr. Potter isnt about defending the truth; its about suppressing it. Independent physicians employers and patients need"
X Link 2025-02-18T01:20Z 32.5K followers, 58.8K engagements

"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"
X Link 2025-02-17T18:00Z 2M followers, 4.8M engagements

"UnitedHealth just posted its worst trading day in [--] years. This wasnt a market fluke. It was a reckoning. For years they bought Medicare Advantage market share by dangling low premiums and minimal out-of-pocket costs. It worked until they changed the rules. In [----] UnitedHealth doubled the max out-of-pocket and introduced new deductibles. Seniors noticed. One broker told me More than 70% of my MA book switched from United to other carriers. UnitedHealth assumed Seniors wouldnt switch. That they could squeeze the very patients they promised to protect. Thats not just a miscalculation. Thats"
X Link 2025-04-17T21:03Z 32.5K followers, 120.5K engagements

"UnitedHealth just lost $288 billion. The CEO vanished. The DOJ is circling. But sure tell me again how essential they are. A thread 🧵on the implosion of Americas biggest health insurer @UHC and what it says about our system: 1/"
X Link 2025-05-15T23:18Z 32.5K followers, 148.4K engagements

"THE CASE AGAINST NONPROFIT UHEALTH (UNIVERSITY OF MIAMI HEALTH SYSTEM) Exhibit A: Tax Status 501(c)(3) since [----]. Pays no federal income tax on $6.49 billion in annual revenue. Pays no state income tax in Florida. Pays no property tax on billions in real-estate holdings. Files Form 990-T only for trivial unrelated business income. Verdict: Structural tax immunity. No shareholders. No taxes. Just surplus. Exhibit B: Public Benefit vs. Private Gain $6.5 billion in revenue $4.8 billion in assets $12.8 million to executives (CEO/COO) $0 in federal state or property taxes Not-for-profit is the"
X Link 2025-10-25T10:48Z 32.5K followers, 93.4K engagements

"You want to know where $125 Billion Dollars of non profit tax subsidies go Marble floors exquisite art and their very own piano man. Just opened @UMiamiHealth Sole Mia Medical Center: The definition of FIRST CLASS We are growing and growing https://t.co/vonnL8LbVc Just opened @UMiamiHealth Sole Mia Medical Center: The definition of FIRST CLASS We are growing and growing https://t.co/vonnL8LbVc"
X Link 2025-10-24T00:46Z 32.5K followers, 53.3K engagements

"In [----] Congress made it illegal for doctors to open new physician-owned hospitals. Illegal. The few that existed were frozen. They cant expand beds. They cant add services. Theyre locked in place by law. Meanwhile large non profit health systems can merge buy and expand without limit. So when people say doctors should just compete understand the United States Government banned their ability to compete. That wasnt an accident. That was policy. And policy can be reversed. @cmsgov @VP @DrOzCMS @SecKennedy"
X Link 2025-10-14T17:05Z 32.5K followers, 83.5K engagements

"Healthcare execs: We need more subsidies. Independent surgeons: We can do the same surgery for 60% less with 30% margin. Wall Street translation: Incumbents arent scared of losing money. Theyre scared youll finally see how much theyve been taking"
X Link 2025-10-12T15:31Z 32.5K followers, 24.2K engagements

"MEDICARE doesnt pay. United Healthcare doesnt pay. Blue Cross Blue Shield doesnt pay. Cigna doesnt pay. Aetna doesnt pay. 100% of the funds spent on healthcare thats $5 Trillion Dollars in the US comes from the money taken out of paychecks. For every dollar in reduced healthcare spend citizens families and elderly get to use their money for something else Like retirement. Its time to stop the grift. Not #healthcare"
X Link 2025-02-10T01:33Z 32.5K followers, 38K engagements

"Warren Buffett just put $1.6 BILLION into UnitedHealth. Not to fix healthcare. Not to make it cheaper. But to profit from the system exactly as it is broken bloated and impossible to escape. This is anti-American behavior. 1/"
X Link 2025-08-14T21:57Z 32.5K followers, 57.1K engagements

"Medicare doesnt pay. United Healthcare doesnt pay. Blue Cross Blue Shield doesnt pay. Cigna doesnt pay. Aetna doesnt pay. 100% of the funds spent on healthcare thats $4000000000000.00 in the US comes from its citizens. For every dollar we decrease the healthcare spend citizens families and elderly get to use their money for something else Like retirement. Not #healthcare"
X Link 2023-02-21T11:56Z 32.5K followers, 152.8K engagements

"Dear @AOC: I watched your video. You want healthcare to be affordable and accessible for everyone everywhere. May I ask a few questions Why does your area of New York make it illegal for physicians to build new hospitals surgery centers radiology centers urgent cares and nursing homes unless the existing health systems give permission through CON laws Why do you support closing hospitals while banning independent physicians from opening new ones Why do you support paying NYU Langone Columbia and the other nonprofit health systems 23X more per procedure than the tax-paying doctor down the"
X Link 2025-10-16T13:25Z 32.5K followers, 52.6K engagements

"Unlike Trump I don't care if someone likes me or not. That will never change the fact that I'm going to fight for them to have health care. I want MAGA to have health care. I want MAGA to be paid a living wage"
X Link 2025-10-16T03:43Z 751.9K followers, 1.3M engagements

"I appreciate your medical expertise and insights Let me share something crucial from [--] years in healthcare finance. Most physicians I've worked with haven't been exposed to the coverage side of healthcare - and that knowledge could really strengthen private practices and physician-owned hospitals. Quick breakdown on how coverage works: Yes denials DO generate revenues. Here's why: Carriers must spend 80-85% on patient care (except self-funded plans) Each denied claim helps them hit these ratios and generate revenues. PBMs aren't bound by these rules so drug denials = revenues. Different"
X Link 2024-12-04T23:50Z 32.5K followers, 405.1K engagements

"850 million denied claims. Less than 1% appealed. Health insurers process [--] billion claims a year and deny [---] million of them. Most patients never fight back. Denials arent just paperwork. Theyre deliberate barriers to care and reimbursement. Carriers bet that physicians and patients wont challenge them. And theyre right 99% of the time. Physicians: Are you tracking how many claims your practice is losing to denials Its not just revenueits your ability to deliver care. Its time to fight back. Whats your denial rate"
X Link 2025-02-22T23:17Z 32.2K followers, 136.9K engagements

"The U.S. healthcare system isnt broken. Its an engineered scam legalized corruption wrapped in non profit labels lab coats billing codes and suits. Heres the one stat that proves itand why youre broke sick and still on hold with your insurer. A thread.🧵"
X Link 2025-05-11T22:39Z 32.5K followers, 33.3K engagements

"Heres what a real market would look like: Every hospital and clinic posts real all-in prices. Certificate-of-Need laws are repealed so new entrants can compete. Nonprofits lose tax exemptions if they hide prices or hoard profits. Employers and patients contract directly with physicians no rent-seeking intermediaries. Subsidies stop flowing to insurers and health systems that game risk pools and call it reform. Free enterprise isnt the problem. Price opacity is"
X Link 2025-11-10T15:13Z 32.5K followers, 28K engagements

"When an independent doctor makes money its called greed. When a St. Health System CEO makes $12M at a nonprofit its called mission alignment"
X Link 2025-10-12T23:07Z 32.5K followers, 17.5K engagements

"The DOGE is Finally Looking at CMS And Its About Time For the past [--] years the Centers for Medicare and Medicaid Services (CMS) has systematically overpaid health systems 3x to 10x more than independent physicians for the exact same tests and procedures. This isnt an accident. Its a built-in incentive for consolidation. Private equity firms investment bankers and people like me have capitalized on this pricing distortion buying up independent practices and rolling them into larger health systems. The result Every time an independent practice is acquired expenses; including insurance premiums"
X Link 2025-02-07T12:54Z 32.5K followers, 62.2K engagements

"Blaming physicians as overpaid is not only misguided but also a blatant misunderstanding of reality. Physician compensation has decreased in real terms over the years even as their workloads and administrative burdens have skyrocketed. Meanwhile journalists and reporters like Vox guy below rarely go after the real culpritsinsurance companies and health systemsbecause thats where their bread is buttered. Advertising revenue from these entities keeps their publications afloat so instead of holding the true power players accountable they target doctors. Its easier its sensational and it deflects"
X Link 2024-12-06T20:01Z 32.5K followers, 77.6K engagements

"NC med students: I studied [--] years. NC Health Systems: Cute. The guys from overseas are cheaper"
X Link 2025-08-23T13:37Z 32.5K followers, 36.3K engagements

"Heres the funny thing about American healthcare policy The Democrats keep saying they want to make healthcare affordable. Yet every policy lever they actually pull does the precise opposite. Its rather like claiming you want to reduce traffic congestion while simultaneously banning bicycles and subsidizing Hummers. Consider Medicare reimbursement rates possibly the most boring topic in politics which is precisely why nobody notices whats happening. The government pays hospital outpatient departments (HOPDs) MORE for the exact same procedure than it pays ambulatory surgery centers (ASCs). And"
X Link 2025-10-01T21:53Z 32.5K followers, 83.1K engagements

"House Democrats are fighting to reopen the government and save health care"
X Link 2025-10-01T14:24Z 1.2M followers, 99.4K engagements

"Healthcare isnt expensive. Bureaucracy is. Physicians nurses and clinical staff are underpaid relative to the value they deliver. The real cost drivers Health system monopolies bloated administrative salaries and vertical consolidation that forces employers and patients into higher premiums and worse care. Break the monopoly. Restore competition. Bring back physician autonomy. #healthcare"
X Link 2025-02-12T13:55Z 32.5K followers, 75.9K engagements

"Health insurance premiums in America could start dropping by Wednesday. Not someday. Not after the next election. Today is Monday By this Wednesday it could be done All it would take is CMS changing one rule:"
X Link 2025-10-13T18:03Z 32.5K followers, 33.7K engagements

"Im usually the first person to smash any so called "healthcare expert" who doesnt understand how healthcare actually works. This weekend was no exception. I eviscerated several Democratic senators including Senator Gallegos of Arizona whose response was charitably pathetic. But this isn't about Democrats. It's about Republicans specifically @willchamberlain who as a self-proclaimed free-market capitalist should know the Republicans have done nothing to fix what's broken. Case in point: since taking office @drozcms has been photographed eating cake with Martha Stewart while ignoring every"
X Link 2025-10-06T22:32Z 32.5K followers, 53K engagements

"Everyone pays absurd amounts of money for terrible health insurance because Obama and the Democrats permanently screwed up the health insurance system We're going to have to figure out how to make healthcare a normal market again"
X Link 2025-10-06T19:22Z 419.5K followers, 599.2K engagements

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