Paul H. Flowers Jr.

Fiduciary Healthcare Advisor | 3x Best-Selling Author | Speaker | Helping CEOs eliminate healthcare waste and reduce employer benefit costs.

[Paul H. Flowers Jr. @PaulHFlowersJr]

🚨 CEOs, CFOs, benefits leaders & investigative journalists tracking U.S. employer healthcare costs and ERISA fiduciary risk:

The “Hidden Tax” I detailed in my recent National Law Review press release — where fully-insured carriers quietly pocket massive surpluses on your premiums with zero transparency — is only half the story.

The other half is the conflicted-broker compensation model that steers plans, hides pay, and now creates direct personal liability for the executives who sign off on the plan.

Attaching the full **Conflicted-Broker Playbook** — my 12-page fiduciary-liability case file that compiles the actual court records, settlements, regulatory findings, and recent lawsuits.

Inside you’ll find the documented record on:

• Spitzer-era contingent commissions & bid-rigging that produced $1B+ in settlements (PROVEN)

• CAA 2021 disclosure rules that turn undisclosed broker compensation into a prohibited transaction on the employer’s desk

• The December 2025 Schlichter Bogard ERISA wave naming Mercer, Willis Towers Watson, Gallagher & Lockton — alleging 22–40% commissions on voluntary benefits and participants paying 30–600%+ more than market

• Stern v. JPMorgan Chase (prohibited-transaction claim survived dismissal March 2026) — first in the new wave of employer health-plan fee cases to clear the hurdle

• Oregon Potato Co. v. Marsh & McLennan (motion to dismiss denied March 2026) — “we are not a fiduciary” contract language rejected; function controls under ERISA

• BUCA carrier practices (AI denials, cross-plan offsetting, PBM spread pricing with markups in the thousands of percent) that spend plan assets — while the broker paid by the carrier has zero incentive to challenge any of it

• FTC findings: top PBMs generated $7.3B+ above acquisition cost on specialty generics alone

These same dynamics are playing out right here in Gary, Indiana — with city government and local businesses facing opaque renewal surprises, hidden costs, and growing fiduciary exposure.

The one question that opens every meeting:
“Can your current broker hand you their complete written compensation disclosure — every dollar, direct and indirect — today?”

If the answer is no, that’s a prohibited transaction sitting on the CFO’s desk right now.

Full NLR press release on the carrier-side “Hidden Tax”:
https://t.co/NPdUepxAPV

Attaching the complete Conflicted-Broker Playbook PDF here (Google Drive Link) for journalists, plan sponsors, and decision-makers who want the primary-source record.

https://t.co/4oRbqkQIV4

An independent, flat-fee, fiduciary-aligned advisor with full transparency isn’t just a better deal anymore — it’s the documented prudent process the law now requires and the litigation defense the conflicted model cannot provide.

Tagging top investigative journalists and outlets who cover healthcare costs, insurance practices, ERISA fiduciary duty, PBMs, and corporate accountability (in no particular order):

@propublica @charlesornstein @sarahkliff @caitlinnowens @jrovner @bobjherman @IRE_NICAR @gijn @RowanPhilp @awinston @AHCJ

#ERISA #FiduciaryDuty #HealthPlanCosts #PBM #BrokerConflicts #GaryIN #NorthwestIndiana #EmployerBenefits #HealthcareTransparency

[Paul H. Flowers Jr. @PaulHFlowersJr]

@ajdezelan You nailed the incentive problem. When the profit lives in the spread, a lower price is no win for the middleman. Public bodies spend public money, so should their PBM contracts be open records by default? #PBMReform

[Paul H. Flowers Jr. @PaulHFlowersJr]

Cost Plus Drugs just cut generic dicloxacillin 500mg, 60 capsules, from $56.60 to $40.88. A 27% drop, posted in public. When did your PBM last tell you a drug price went down? Can you even see the price?
#CostPlusDrugs #DrugPrices
https://t.co/n0M735ODtQ

[Mark Cuban Cost Plus Drug Company @costplusdrugs]

Another day, another price drop! 👀

We're keeping the price drops coming, and this time it's Dicloxacillin Sodium 500mg (generic for Dycill).
https://t.co/W13A2pxXZp
💊 60 capsules
📉 Was: $56.60
🎉 Now: $40.88

That's a 27% price drop!!

At https://t.co/HixgZoTxWB, we're constantly working to find better pricing for the medications we carry. 🔎 Find your medication and see the price upfront at https://t.co/HixgZoTxWB

Valid prescription required.

[Paul H. Flowers Jr. @PaulHFlowersJr]

@Shiningcity Making the estimate automatic moves the burden off the patient, right where it belongs. If plans and providers had a firm clock to deliver it, what feels like a fair window, a full week before a scheduled service or just a few days? #PriceTransparency

[Paul H. Flowers Jr. @PaulHFlowersJr]

@mcuban @bot Luka plan??? @bot what’s that?!?

[Paul H. Flowers Jr. @PaulHFlowersJr]

@FACR_WW13 Persistence really is the strategy. A denial system built on people giving up loses ground every time someone keeps going. Do you find a second appeal or a call from the doctor's office moves things faster? #PriorAuth

[Paul H. Flowers Jr. @PaulHFlowersJr]

CHROs: when the renewal lands wrong, you're the one standing in the all-hands. Not the broker. Not the carrier.

Ask one question first: "Does your pay change if we stay?"

Text RENEWAL to 844-513-5433 for the rest.

[Paul H. Flowers Jr. @PaulHFlowersJr]

@mcuban @elonmusk Now this is what you call a great partnership. Looking forward to ours gentlemen.

[Paul H. Flowers Jr. @PaulHFlowersJr]

@chelleds01 @foxandfriends @kilmeade Nothing in healthcare is truly free. Every plan gets paid for somewhere, through premiums, taxes, or out of pocket. The more useful debate is total cost per family and who controls those dollars. What number would you want both sides to put on the table? #HealthCosts

[Paul H. Flowers Jr. @PaulHFlowersJr]

@bitcoinbabyswfl The smart ones do.

Especially when they realize that they have the fiduciary duty to do so.

I just did a LinkedIn live earlier today discussing just that.

[Paul H. Flowers Jr. @PaulHFlowersJr]

53% of employers with 100+ workers cover GLP-1s for weight loss, down from 57%, per WTW. 16% cover them but may drop them. Coverage runs mid-$500s to mid-$600s per user a month. Did you fix the price before you cut the benefit?
#GLP1 #EmployerBenefits
https://t.co/0hDq9soljl

[Paul H. Flowers Jr. @PaulHFlowersJr]

A Chicago man got 20 years for a Medicare brace scheme. Sham telemedicine. Over $365 million in claims, $199 million paid, per DOJ. If you're self-funded, who checks your equipment claims?
#HealthcareFraud #SelfFunded
https://t.co/6zgWnTEMet

[Paul H. Flowers Jr. @PaulHFlowersJr]

@bitcoinbabyswfl That’s exactly what I was thinking.

Earlier you asked what the plan would be if that letter came to me…

As an advisor of companies in this space, I’d ask for a “second opinion” from a fiduciary advisor who’s not paid by the carriers.

#FoodForThought

[Paul H. Flowers Jr. @PaulHFlowersJr]

@Samboomer1 @UHC Going through them is the right move. Service varies a lot by region and even by plan, so a brand name alone won't tell you much. Ask HR for each option's network list and how claim disputes get handled. Which matters more, keeping your doctors or lower costs? #OpenEnrollment

[Paul H. Flowers Jr. @PaulHFlowersJr]

@CrazyOnMyWay_ No borders on this one. Families everywhere wrestle with what care costs. Glad you stopped by. How does it work where you live, mostly public coverage or a mix with private plans? #HealthCosts

[Paul H. Flowers Jr. @PaulHFlowersJr]

@bitcoinbabyswfl That ripple is the part people miss. One coverage cut reaches whole households, and walking away from progress you earned with real effort is a gut punch. Has HR said whether anyone can appeal or ask for an exception? #GLP1

[Paul H. Flowers Jr. @PaulHFlowersJr]

@DCookBenefits Data rights first is the right sequence. Without claims-level access, the employer is checking the PBM's math with the PBM's own spreadsheet. Do employers get pushback on audit rights at renewal, or later when they actually try to use them? #PBMReform

[Paul H. Flowers Jr. @PaulHFlowersJr]

@Anonemuss Smart order. If the visit price is clear up front, a patient can ask what tests might follow before saying yes. Should clinics have to give a total estimate when the appointment is booked, or is check-in soon enough? #HealthcareCosts

[Paul H. Flowers Jr. @PaulHFlowersJr]

@Avaiae_TheGod That's a real difference. Better negotiated rates and a lower deductible can save more over a year than a cheaper premium. Worth checking if the Aetna plan's in-network prices for your usual care come close. Which costs do you run into most? #OpenEnrollment

[Paul H. Flowers Jr. @PaulHFlowersJr]

@bitcoinbabyswfl I'm sincerely sorry that that's taking place. How many people do you think that's actually impacting at your job?

[Paul H. Flowers Jr. @PaulHFlowersJr]

@wendellpotter People facing a coverage decision are often at their most vulnerable, and they deserve to know who's shaping it. Self-funded employers can ask their administrators the same questions, and more daylight now can build a fairer system ahead. #PriorAuth