Marion E Mass, M.D. #patientsfirst #scrubsnotsuits

Wife mom pediatrician gardener writer, speaker. Quality accessible sustainable medical care 4 less, sunshine4all co-founder @PPA_USA @free2care

[Marion E Mass, M.D. #patientsfirst #scrubsnotsuits @mass_marion]

This is the best Healthcare trend I have seen in a long time!
Optumserve, one of United HC's subsidiaries (they have 2000+ of them) has a history of getting hundreds of millions in government contracts, including some to to reduce fraud waste and abuse.

The @TheJusticeDept has an ongoing criminal investigation open on United HC for
1. fraud in Medicare Advantage,
2.billing practices at United's PBM Optum Rx and
3. How UnitedHC pays the 10% of USA🇺🇸 physicians they employ
It looks like they are getting less of our tax 💵 nowadays.

UnitedHealthcare now gets more than 77% of its revenue from taxpayer-funded programs like Medicare Advantage and Medicaid. I wonder🤔 what kind of 'connections' made that possible

From: https://t.co/ioT6jReq2W

[Marion E Mass, M.D. #patientsfirst #scrubsnotsuits @mass_marion]

Fraud in medicine is so curious. Here is a clip of @DrOz and @SenWarren agreeing that up-coding by the insurance companies that run Medicare Advantage Is fraud https://t.co/5mANSwYxKW 1/6 🧵

[American Economic Liberties Project @econliberties]

Express Scripts wants to claim the TRICARE program is run differently than its commercial business but, as @Greg_Reybold lays out, that's all smoke and mirrors:

"First of all, in federal pleadings, Express Scripts doesn't call themselves a PBA for TRICARE. They call themselves a PBM.

In court filings, Express Scripts has said that they manage the TRICARE retail pharmacy network in a manner that's indivisible and indistinguishable from their other networks, including the Federal Employee Health Plan.

That's Express Scripts' words. In court filings, there's no difference with how they manage that program. That's stunning, and it's damning."

[Marion E Mass, M.D. #patientsfirst #scrubsnotsuits @mass_marion]

@doctorwes @EndeavorHlth Congratulations, Wes! A well deserved retirement. Thank you for all you have done for patients and physicians. 💕

[Marion E Mass, M.D. #patientsfirst #scrubsnotsuits @mass_marion]

@doctorwes @EndeavorHlth Congratulations, Wes! No doubt you have been a blessing to your patients and staff and left an impact. Thank you for showing rare courage in fighting the corporate ABMS complex. You have been an inspiration and a mentor to many ( including me) 💕

[Marion E Mass, M.D. #patientsfirst #scrubsnotsuits @mass_marion]

@realdocspeaks @noahkaufmanmd @DrCorriel @HeathVeuleman @Laffincrow @HEALTHCOSTtruth @AtlasMD @crappiedoc Looks like a great episode!

[Real Doc Speaks @realdocspeaks]

https://t.co/0un2ycmAAZ The RealDocspeaks podcast with @noahkaufmanmd is live!
@DrCorriel @HeathVeuleman @Laffincrow @HEALTHCOSTtruth @mass_marion @AtlasMD @crappiedoc

[Chad Huntsman @rxengineer]

Hey @mass_marion , independent pharmacist here. We were just like you all 10-15 years ago. We were separated and siloed. But we realized that this economic crisis would affect us all so we began to band together. I work with my chain pharmacy and hospital colleagues now. You are right that the physicians need to do the same. We all have a common enemy and they are also the enemy of our patients that we serve.

[Marion E Mass, M.D. #patientsfirst #scrubsnotsuits @mass_marion]

Can you two go all Reese’s and discover that PB and chocolate are a great combo?
The big insurance conglomerates and the big corporatised hospital systems: Both have become a pestilence for the people, physicians and nurses.

[Mark Cuban @mcuban]

Everything in the hospital could cost $1, and the insurance companies conglomerates would buy them, raise prices, and make sure their top and bottom lines grew

I'm not saying hospital systems are innocent, far from it. But the big vertically integrated insurance companies create the annual plans that crush people's financial situation

[Marion E Mass, M.D. #patientsfirst #scrubsnotsuits @mass_marion]

@Laffincrow @realdocspeaks Yum! Love growing what I eat!

[Marion E Mass, M.D. #patientsfirst #scrubsnotsuits @mass_marion]

@DutchRojas What happened to the tea?

[Marion E Mass, M.D. #patientsfirst #scrubsnotsuits @mass_marion]

Sec Stephen Bass re Tricare basically getting robbed by big PBM express scripts: “I'm not aware."
You are now, Secretary.
Past time for an audit.

Get busy, @PeteHegseth @RobertKennedyJr
Ty @SenWarren

[Forest Park Pharmacy @ForestParkPharm]

TRICARE got robbed in broad daylight and nobody at the Pentagon can be bothered to look up from their coffee.

Sen. Warren put the receipts on the table last week (5.22.26 hearing) and what came out of that room should be on the front page of every paper in the country.

According to The Lever / Fed. News Net., Express Scripts' own pharmacy charges the DOD an average of $484 EXTRA on every generic prescription compared to what independent pharmacies get reimbursed. On MILLIONS of scripts. Every year. Do the math and you start to see the size of the hole that's being drilled into the defense health budget.

Here's the trick they're running:

Express Scripts is the PBM that runs the TRICARE pharmacy network. They've held that contract since 2009. Cigna bought them in 2018. The same company that decides what every pharmacy gets paid… also owns its own mail-order pharmacy that competes in the same network. So they set the price, they pay the bill, and the check lands in their own pocket. Pentagon → Express Scripts → Express Scripts. Rigged.

Real example. Ezetimibe (generic Zetia, cholesterol med):

— Independent pharmacy fills the script: reimbursed $0. Not a typo. Zero. — Express Scripts' OWN mail-order pharmacy fills the exact same script: pays itself $1,000.

Same pill. $1,000 difference. Taxpayer funded.

The consequence is exactly what you'd expect: ~13,000 pharmacies have walked away from the TRICARE network since 2022. That's nearly 1 in 6 independent pharmacies in the entire country. Military families and veterans are watching their local pharmacy options collapse because Express Scripts offered terms so bad nobody could afford to stay.

When Sen. Warren asked Assistant Secretary Stephen Bass about the cost, his answer was basically "I'm not aware." Nine million TRICARE beneficiaries, billions of dollars, and the guy whose desk it sits on hasn't bothered to check the price. He'd notice real fast if it was his own credit card.

And in case anyone thinks this is just bad management — there's an active whistleblower lawsuit alleging BILLIONS in fraud against Express Scripts and Accredo. The federal government has paused payments to other vendors for far, far less.

So here's the message that needs to land on Secretary @RobertKennedyJr's desk:

Cancel the payments. The $4.3B TRICARE contract is up for revision annually until 2029. There is a lever. Pull it.

Demand a real audit. DOD has refused to check pricing since the 2021 contract. Warren got a commitment on 5.22.26 — now make it happen.

Criminal charges. If the whistleblower allegations hold up, this isn't a billing dispute. It's looting a military health program.

And @NickShirley — you exposed $9 billion in Medicaid daycare fraud in Minnesota and got the feds to freeze payments statewide off ONE investigation. 134M+ views. This is the same playbook, bigger target, bigger stakes — 9 million military families and vets, tens of billions a year, and a single address worth driving to: 1 Express Way, St. Louis, MO 63121. Go expose this.

People should be losing their minds over this.

[Westby Fisher, MD @doctorwes]

Recently quietly received this survey from @ABIMcert via snail mail asking which lipstick on a pig we should be forced to pay for to “maintain” my board certifications. An org sitting on $224M and “maintains” regulatory capture of US doctors at behest of hospitals and insurers.

[Marion E Mass, M.D. #patientsfirst #scrubsnotsuits @mass_marion]

Re #6:
I bet @SurgeryCenterOK knows what it costs to perform procedures in their hospital.
Bet many physician owned hospitals do.

@physicianhosp

[Mark Cuban @mcuban]

You aren't wrong that premiums are a healthcare tax, of which a too high percentage goes to the insurance conglomerates.

But you left out a lot of important information
1. Who would run M4A, and how would that person(s) be selected and how often? Right now the Sec of HHS has discretion over everything, and we appoint a new one every 4 to 8 years, or more.. The implications are obvious.

2. What is not covered ? Is every $4m therapy going to be covered ? Even when you negotiate, it won't be cheap. What about the most expensive life saving equipment? It's not like the feds are good at negotiating healthcare

3. Who gets paid less ? Doctors ? Nurses? Specialists?

4. You assume employers will pass along what they don't pay for their share of benefits, to the employee. Do you live in the USA ? This assumption is unfortunately laughable and nothing in an M4A bill can change that

5. Much of medicare/medicaid is run by outside companies. Many of whom are the very worst actors in the healthcare industry. How do you replace them all ? How many years do you think that will take ? or Do you expect them all to become good actors and do the right thing rather than try to maximize earnings?

6. Hospitals don't know what their procedures cost them to perform. They use derivative cost accounting like cost to charge ratios, or, only show Medicare Cost Reports, and basically just look at how much cash they have on their books. Which is one of the reasons they are able to say they don't make money from Care/Caid patients. I don't think many understand what the concept of margin contribution is. If they don't know what their costs are, and you don't know what the actual costs are, how are you going to be able to work from a budget to determine total costs ?

That said, Im for Universal Coverage. But till you know what it actually costs to deliver care in this country, its going to be near impossible to make work

How do other countries do it ? Most started on this 30 years or more ago. Pre MRI machines. Pre Cell and Gene Therapies. They were able to start at a time when healthcare was much simpler, and evolve, some successfully, some less so, from that point.

This is my opinion. If you disagree with any of it, happy to read it here

[Marion E Mass, M.D. #patientsfirst #scrubsnotsuits @mass_marion]

@alt_w_v_g A book to read to your son while he is in the age of dinosaur. 🦕
From a mom of 3 public school K-12 grads, now in their 20’s and prospering in the ways that matter.
Cheers

[Paleoncologist @PaleoOnc]

Congressman Murphy,

Thank you for sharing my post.

As a fellow physician, I was disappointed by your comments on physicians leaving practice early.

While dedication to the field is essential, blaming those leaving ignores deeper problems.

The practice of medicine has changed dramatically since we graduated—especially post-HITECH and ACA. The recent Permanente Journal study I referenced (May 2026) shows physicians are now exiting clinical practice at an average age of 48 (down from 57 in 2011). Roughly 20% leave within the first five years, with similar losses every five years thereafter. These are outstanding students who endured grueling training; they're not "unmotivated." The field simply isn't what they signed up for.

Data from the Annals of Internal Medicine (link below) also show the annual rate of physicians leaving practice has roughly doubled in recent years, from about 1.6% to 3.1%. Out of a million physicians, that is 30,000 - the equivalent of approximately 200 graduating med school classes lost, every single year.

Additional surveys indicate that a substantial portion plan significant reductions in work or early exit in the coming years. What a tremendous loss of talent and investment.

We can do better. The issues are well known and not the doctors. We’ve lost autonomy - most doctors are now employees with little influence over their practice. We battle insurance prior authorizations, click through EMRs late into the night, and pay for unproven maintenance of certification amid stagnant RVUs.

No one excelled in premed and med school to spend their career fighting the system and archaic EMRs instead of treating patients.

I know your record includes strong support for physicians—Medicare reimbursement protections, reducing regulatory burdens, and highlighting burnout. I urge you to double down on fixing these systemic issues rather than questioning the commitment of those voting with their feet.

And physicians who quit tell only half the story. Many more surveys show that as many as a third of physicians plan to retire in the coming years.

Physicians like you are uniquely positioned to lead.
Don't blame the victims. Let's fix the system.

Respectfully

https://t.co/8vMWQaQpfo 0pubmed

https://t.co/dI6Z0Y3CCV

https://t.co/Gy9lD5kUKr

https://t.co/AP1h3u1Ovg

https://t.co/KkiSqB5fLM

https://t.co/8UOcK5lpdO

[Angry Dad @angrydadwi]

Just landed in Houston for the premiere of Side Effects May Include.

I shared the trailer earlier today, but seeing this movement grow in person is something different. More voices. More stories. More pressure for real PBM reform.

We keep going. For Cole. For the next family. #PBMReform #HealthcareTransparency @mcuban @mass_marion

[Marion E Mass, M.D. #patientsfirst #scrubsnotsuits @mass_marion]

@DutchRojas It’s more like common sense tied to a sensitive 🐂 💩 detector.
I leave the brilliance to our kiddos.
Incidentally, the last one just graduated college. It’s celebration 🎉 time!!!!

[Marion E Mass, M.D. #patientsfirst #scrubsnotsuits @mass_marion]

Our medical mess can start to heal when enough Americans understand what is broken and how to fix it. I’d think even 15% could make a difference.
Dutch knows.
Follow him.
PS: it’s vapid to hurl a slogan such as ‘Medicare for all’ or blame a single event such as the ACA.

[Dutch Rojas @DutchRojas]

𝐈𝐦𝐚𝐠𝐢𝐧𝐞 𝐢𝐟 𝐫𝐞𝐬𝐭𝐚𝐮𝐫𝐚𝐧𝐭𝐬 𝐨𝐩𝐞𝐫𝐚𝐭𝐞𝐝 𝐥𝐢𝐤𝐞 𝐡𝐞𝐚𝐥𝐭𝐡 𝐬𝐲𝐬𝐭𝐞𝐦𝐬.

You’d be seated by a broker your employer chose. The menu would have no prices. The bill would arrive three months later, itemized in a language only the restaurant speaks. And if you complained, a lobbyist would explain that food is too important to be left to the market.

The absurdity sounds like satire because every normal industry would reject it immediately. In healthcare, it is the operating model.

The patient never sees the price. The physician rarely sets it. The employer outsourced the choice to a broker paid by the carrier.

The bill is adjudicated by 🐂💩against a chargemaster and then reverse engineered from a Medicare schedule written by a private committee, the RUC, the government rubber-stamps.

Every layer between the person eating and the person cooking is a regulated rent.

We’ve spent 50 years debating whether healthcare is too capitalist or too socialist. The better question is: who benefits from making comparison impossible?

CON laws.
Facility fees.
Opaque chargemasters.
Laws protected by paid politicians.
Broker-controlled benefits.
Gag clauses.
Non profit / tax exempt nonsense accounting.
GME caps.
$257 Billy in subsidies!

Each one is defended as protection. Each one functions as inventory control.

The fix is restoring the basic conditions of exchange: a buyer who can see the price, a seller who can set it, and a shelf the law permits to exist.

All I want is freedom from tyranny!

[Marion E Mass, M.D. #patientsfirst #scrubsnotsuits @mass_marion]

One of the worst features of American healthcare, and likely other industries, is that rules are not applied equally or some segments have exceptions or special rules made just for them. The health insurance and hospital conglomerates enjoy such favors, granted by government.
For instance:
-the FTC seems to have ignored horizontal near monopolies and vertical consolidation for decades.
-PBM, the biggest of whom are owned by the biggest ‘insurers’ and their hospital middlemen counterparts the GPO have a special exemption and are allowed to accept kickbacks.
-the biggest of the PBM have been accused of lying under oath, yet there is no one with the courage to do something about it.
-Transparency of cost and price, even when laws or rules have been created is rarely enforced.

Naturally, this creates significant wealth for the industries that have all the special goodies. They are able to take the 💰 and lobby hard across the aisle to ensure that things stay just the way they are. They can sponsor advocacy groups, and conferences. They can donate to think tanks. I’m sure you can think of other ways that they keep their special favors and full honey pots.

[Mark Cuban @mcuban]

If insurance companies can deny care and call it "medically unnecessary", why aren't they required to have malpractice insurance doe when they get it wrong and someone gets sicker or tragically dies ?

[Mark Cuban @mcuban]

If insurance companies can deny care and call it "medically unnecessary", why aren't they required to have malpractice insurance doe when they get it wrong and someone gets sicker or tragically dies ?

[Real Doc Speaks @realdocspeaks]

@noahkaufmanmd Thank you, and any lists you present are always a starting point.

The truth is that the system needs physicians like the airlines need pilots.

Pilots are organized and refuse to be bullied by suits.