Olivia
Online
This is not okay | Independent Provider
@MakeHCFairAgain
Independent healthcare provider getting screwed by the healthcare mafia. Fair competition & real patient choice shouldn’t be something we have to beg for.
Joined October 2025
493 Following
195 Followers
333 Posts
Humana is deliberately destroying my home health agency, which delivers high-quality care to patients.
They are my direct competitors, with over a dozen Humana-owned home health agencies in the same area. They refuse to allow us in-network at fair rates, even though our CMS star ratings are higher than those of 95% of the agencies listed on their provider list—which is 88% inaccurate.
This includes many 1- and 2-star rated agencies that do not accept Humana, as well as numerous ghost listings (agencies that do not exist). Several of their own agencies are listed with different addresses but ring to one central location, where the receptionist has confirmed that the listed addresses have been closed for years.
Humana is not about quality. Instead, they focus on eliminating competition and depriving patients of choice and access to quality care through unfair practices and abuse of power.
Current policies leave us without protection—both as honest, hard-working independent healthcare providers serving our communities and as patients who do not realize their choice and access to quality care have been taken from them until it is too late. By then, patients are trapped in the Humana ecosystem.
Their business model is to deny, delay, and destroy quality care offered by providers in order to increase profits for shareholders, funded by Medicare, Medicaid, and taxpayer dollars.
Vertical integration has never been about delivering better care or saving taxpayers' money. It is about a loophole to circumvent the MLR rules and protect profits at all costs—at the expense of patients’ health and thousands of jobs, by destroying quality care providers who stand in the way of ensuring their stocks grow each quarter.
@Humana, give us a contract with the same rates you pay your own agencies, and let us care for the patients who choose us for their recovery. We actually save you money by simply caring and putting patients first—keeping them out of the hospital, preventing infections, providing manual therapy, and more.
Fair competition should not even be something we have to ask for and beg for. Reimbursing us the same rates you pay your own agencies next door—with zero extra to offer—is not only unfair and un-American, but it also harms patients, destroys jobs, and wipes out small and mid-size businesses. This is done by blatantly violating anticompetitive laws in ways that are mind-blowing to know are allowed in America.
@DrOzCMS @VP @AFergusonFTC @KenPaxtonTX @POTUS Why are you continuing to allow this? I am a local business with 100+ dedicated employees who are passionate about care. We have a spotless record in both compliance and quality care, and we have served the community for over a decade. Why are you allowing Humana, UHC, and other insurance companies to destroy us and thousands of others in the same position—from pharmacies to clinics and more?
It has been proven to lower quality, cost far more, and harm millions.
If the goal is to destroy us all and help these few giant for-profit, careless corporations make a few more billions for stockholders while gaining full control over our health, then just be honest with us. (Which I want to believe is not the case, and prayed that this madness will end with the new administration.)
If not, then immediately change it, save the providers who remain, and give patients real choice.
Thousands of jobs that actually care about people and are committed to the highest quality care can still survive.
Let patients have a choice—please do it now. We cannot survive this much longer. They are rapidly eliminating us and stealing our patients.
I don't like to demand, so I ask. As a business, I am not blocked from serving the customers who choose my services—especially not by my direct competitors. How is that even possible in our great country?
What’s next? We can’t buy our groceries where we want from whom we want? We can’t get our hair cut where we want by whom we want? We can’t get an attorney we choose to represent us—it will have to be the one owned by the company that is suing us? We can’t get the car we want to buy from whom we want to buy it from?
I am a proud American who loves this country with all my heart, but I feel like I am living the stories my grandparents told me about living in Europe under communism—some of which I fear we are heading toward rapidly in healthcare and as a business owner.
If this spreads to other industries, the story of having only two types of cars to choose from and a 16-year waiting list may end up being the story of my children or grandchildren, too, as it was for my grandparents.
Please stop it now. I am not asking for charity or a handout. I am asking you to stop allowing my life’s work and my future to be stolen from me any more than they already have been, so I can rebuild before I am wiped out like dust on the Humana and UHC jets they fly to their cocktail parties.
P.S.: It is an additional slap in the face that they are doing this with taxpayers’ dollars. In Humana’s case, it is 100% Medicare, Medicaid, and its subsidiaries. I have been forced by my own government to pay for my own destruction.
Starting in July, I won’t even be able to afford health insurance for my own family (36K/yr), while being forced to pay over $250,000 for employee coverage — which many of them still choose to keep, even though it takes a huge portion of their paycheck, mostly because they have to.
The health insurance companies can steal billions of our tax dollars, raise forced health insurance premiums by 25%–30% every year, and pay providers little or nothing in return. How is this okay?
I have never been an angry person — actually the opposite — and I am grateful for everything in life. But I am angry now. I am trapped in a helpless situation that I have zero control over and zero protection against — a situation that I did not create for myself, my staff, or my patients.
It feels like my government has released the Hunger Games on independent healthcare businesses with no time limit — allowing the big insurance companies to attack, break in, destroy everything, and eventually finish us off with no consequences. And instead of protection, they have taken away every tool we could use to defend ourselves.
Dramatic? Yes, it is dramatic — because it is really happening. I want someone to hear me and stop it. We need a hero @elonmusk @mcuban or someone with whom they speak; people listen. I do appreciate all the fight against fraud, but please, at the same time, don't let the honest, hard-working providers be destroyed.
Special thanks to @nickshirleyy, fighting fraud, he may have to be the one who actually exposes this biggest fraud ever, and a legalized mafia (thanks to our politicians) that cost us trillions of dollars, our businesses, and in many cases, lives. ENOUGH!
@iluminatibot This breaks my heart
Pricing power in vertically integrated systems doesn't come from input costs. It comes from controlling the referral pathway, the pharmacy benefit, and the reimbursement rate simultaneously.
The UnitedHealth data makes this concrete. Optum pays affiliated providers 17% more than independents on average, and up to 61% more in markets where United holds 25%+ share. That spread gets counted toward MLR compliance under the ACA (the rule requiring 80-85% of premiums go to medical care), so the overpayment to owned providers isn't a cost leak, it's the mechanism. Lower drug acquisition costs don't compress margins when you control where the money flows inside the consolidated entity.
The Arkansas PBM-pharmacy separation case is the cleanest natural experiment I've seen on this. The state prohibited PBM-pharmacy co-ownership in 2025 and produced an estimated 7.1% drug price reduction. Transparency rules and rebate reform didn't move prices. Ownership separation did. That's the distinction that keeps getting lost in reform debates.
What I'd add to your point: the vertical structure is specifically designed to be price-inelastic at the input level. Cost efficiencies at the hospital or clinic level get captured by the parent, not passed downstream. The Break Up Big Medicine Act takes a structural separation approach to this, essentially Glass-Steagall logic applied to payer-provider integration, and I wrote about what that means for independent operators and the investment opportunity it creates on the divestiture side.
https://t.co/FLMRoZBYBW
More than 44,000 medical practices (physician practices/clinics) were acquired between 2019 and 2024 by hospitals/health systems, private equity (PE), health insurers, and other corporate entities.
This wave of consolidation accelerated around and after the COVID-19 pandemic (especially 2020 onward), as many independent practices faced financial pressures. Exact "right after COVID" numbers (e.g., strictly 2020–2022) aren't uniformly reported in one total, but available breakdowns show strong activity in that period.
Talking to independent physicians, it's obvious that the big insurance carriers are doing to them, what their PBMs are doing to independent pharmacies.
They deny, underpay, slow pay, clawback, and create administrative mazes, knowing their victims don't have the time or resources to fight.
Why ? By putting financial pressures on physicians and pharmacies, it makes them more likely to sell their businesses to them , close their doors, or refer the business to their captive pharmacy or provider. All benefitting the biggest insurance companies
We need to ditch the concept of "claims" and make every delivery of medications or care as a billable event that must, by law, be paid on a timely basis , with interest charges for any delays. If the physician or pharmacy doesn't deliver , the carrier has plenty of legal options already. As does the patient.
This is not an efficient market. This is the big guy abusing the little guy. It needs to change to better the care we get in this country
Exactly! One of my ex-neighbors, an ex-con and non-American citizen from Columbia, owned several rural hospitals that he easily bought and ran into the ground. They served only as fronts to launder his drug money. We didn’t know him, but read about his story in the newspaper. He later fled the country. So scary he lived so close by!
But physicians are the ones feds look at suspiciously and forbid from owning hospitals. Make it make sense!🤦♀️
Politicians figured this out long ago, which I wouldn't be surprised is why they chose that for their career—for sure not because they want to make our lives better. We're just a small bonus to help pay their salaries until they reach the level where their salaries are just pocket change.
They don’t comply with anything because they don’t have to... and nothing will happen if they don’t. It’s just another thing for us to complain about that they don’t follow for the next 5-10 years, when nothing ever happens again. Well, maybe not — because by then they will probably own the entire healthcare system with us in it, so the theater of “doing something to protect us” will no longer be necessary. I pray 🙏 I am wrong..
Why can the biggest fraudsters give us and the government the biggest middle finger with the attitude “We are TBTF with”? And then they give them a few extra billions of our tax dollars to reward them, screw us over, and make us pay for the lawsuits and the fines — which they then collect double by raising our premiums 30% each year. I know I’m not the only one tired of this crap. Why are they above the law and controlling our politicians and government? How the hell did they become so powerful that no one in a decade has been able to pass even one bill to stop them from destroying us and stealing trillions of our tax dollars? And who the hell approved to make Medicare and Medicaid a for profit billionaire maker machine to health insurance giants 100% paid by the American people? Not the people that's for sure!
🚨 Massachusetts sues UnitedHealth insurance unit for alleged Medicaid fraud
✔️ A patient was coded as requiring extensive assistance despite being largely independent, resulting in roughly $133K in excess payments over five years.
https://t.co/4hlIe2oDB0
Or as for Medicare Advantage, you are not even allowed to ask for it—or you can ask, but they don’t have to provide it to you, and they won’t. You pay for it your entire life, with the money deducted from every single paycheck. Who do you think you are to have the right to know what you’re paying for and who you’re paying it to? You can guess by checking the health insurance companies’ stock prices and their earnings calls, where they brag to shareholders to give you some idea of where the money goes. Taxpayers’ dollars are their biggest revenue source. Medicare and Medicaid aren’t supposed to be for-profit? Well, that boat sailed a long time ago.
Soon, we may be tricked into the illusion that insurers are denying care less often than they used to. In reality, they have simply bought up the providers they now control and can direct them not to order the care they refuse to cover.
As a home health provider, I’ve seen this firsthand. When a patient switched to a Humana Medicare Advantage plan effective January 1st, both her longtime physician and I were no longer allowed to care for her — Humana blocked us entirely. We lost a total of 37 patients on that single day in the same way.
Her care was abruptly interrupted and transferred to a CenterWell clinic owned by Humana. The new doctor quickly determined that she no longer needed home health services or several treatments she had been receiving.
This created enormous savings for Humana. Under the Medicare Advantage capitated model, they receive Medicare dollars upfront and keep the full payment regardless of whether the patient actually receives care. It was a significant loss for the patient and for the two independent providers who genuinely cared about her recovery — providers operating on very thin margins, barely covering costs.
Now Humana doesn’t even need to issue formal denials. Their own employed providers simply know not to order too much care. This model is coming on a much larger scale.
The public will hear that insurance companies are denying less care and think progress has been made, when in reality, most patients will never know the full range of options they could have had to recover.
Always advocate for your loved ones and yourself. The providers who truly care and have been advocating for you and your family are being punished for doing so — or pushed out of jobs entirely — leaving no one there to help you fight for the care you need, deserve, and have already paid for. The ability to choose your own provider, to go elsewhere if you’re unhappy with the care, and to get a true second opinion — all of those best options are being eliminated very quickly.
Support independent local providers and local pharmacies, and help them fight for fair competition. Call your insurance company and demand that your chosen provider be added to the in-network list and reimbursed at a fair rate. Fight for the care you paid for and deserve to receive… or soon you won’t even have the choice to do so.
It’s a dirty world out there in healthcare — once you see it, you can’t unsee it. My daughter’s recent ER visit that ended in admission was a terrifying and heartbreaking experience. As a mother and a nurse, I couldn’t believe how much decision-making control had shifted away from families since the last time I had a loved one in the hospital. The attitude was almost, “Who do you think you are?” — as if I had no right to be involved in my 19-year-old daughter’s care, especially after she had just lost her father suddenly following three forced COVID shots. I was literally treated like I should just get out so they could do whatever they wanted with my child.
It’s my child. Who do you think you are when you can’t even pronounce the rare disease that caused her three strokes as a child?
I am angry — as a patient, as a parent, and as a provider. I’ve seen how much better it used to be. Fifteen years ago, my daughter’s brain surgeries by an amazing doctor, therapists, and nurses saved her life. They went above and beyond; they cared about her, about me as her mother, about our family, and about her full recovery. That experience is the reason I found my “why” in healthcare — to give back as a provider.
The health insurance company still managed to bankrupt me back then, but I didn’t care — I was grateful my daughter survived and recovered, even though there is no cure for her disease.
Now they are destroying everything I rebuilt for my family from a different angle — as a provider helping patients recover from surgeries and illnesses.
What is most disturbing and frightening are the dramatic changes I’ve observed both as a provider and as a patient: the decline in quality of care, the shift in culture, and the growing delusion that somehow the people paying for every lightbulb in the million-dollar hallways of nonprofit hospitals are not the true customers.
I’m told I cannot stay past 8 p.m. with my daughter, even though I’m a nurse with far more knowledge of her rare disease than even the doctors in that hospital.
The doctors were not the problem; we actually had 5 doctors come by at once, eager to learn and see a patient with a disease they had never seen before, as it is so rare... The hospital policies that staff are forced to follow or else, and the quality that is clearly being replaced for savings and more profit, is what was dangerous and disturbing. They automatically give all patients blood thinners daily, which could have killed my daughter if I had not interfered to stop it.
While it can save another patient, in her condition, it can be deadly...
My $30,000 in annual health insurance premiums for my family, plus the taxes deducted from all our paychecks for Medicare and Medicaid, somehow don’t qualify me as a customer they need to please and deliver the care I expect.
It’s getting very scary where healthcare is headed — the people they hire, the training they receive, the way healthcare professionals and patients are treated, and the dramatic loss of choice and control over our own care.
The more power and control the giant non-profit healthcare systems and health insurance companies take, the fewer choices we have, THE WORSE it will become. Yet we are forced to pay more and more for it, like it or not...
Most industries compete on offering a better price, faster service, status, lifestyle, you name it. Not Big Healthcare. They increase revenue by delaying and denying care.
Humana is deliberately destroying my home health agency, which delivers high-quality care to patients.
They are my direct competitors, with over a dozen Humana-owned home health agencies in the same area. They refuse to allow us in-network at fair rates, even though our CMS star ratings are higher than those of 95% of the agencies listed on their provider list—which is 88% inaccurate.
This includes many 1- and 2-star rated agencies that do not accept Humana, as well as numerous ghost listings (agencies that do not exist). Several of their own agencies are listed with different addresses but ring to one central location, where the receptionist has confirmed that the listed addresses have been closed for years.
Humana is not about quality. Instead, they focus on eliminating competition and depriving patients of choice and access to quality care through unfair practices and abuse of power.
Current policies leave us without protection—both as honest, hard-working independent healthcare providers serving our communities and as patients who do not realize their choice and access to quality care have been taken from them until it is too late. By then, patients are trapped in the Humana ecosystem.
Their business model is to deny, delay, and destroy quality care offered by providers in order to increase profits for shareholders, funded by Medicare, Medicaid, and taxpayer dollars.
Vertical integration has never been about delivering better care or saving taxpayers' money. It is about a loophole to circumvent the MLR rules and protect profits at all costs—at the expense of patients’ health and thousands of jobs, by destroying quality care providers who stand in the way of ensuring their stocks grow each quarter.
@Humana, give us a contract with the same rates you pay your own agencies, and let us care for the patients who choose us for their recovery. We actually save you money by simply caring and putting patients first—keeping them out of the hospital, preventing infections, providing manual therapy, and more.
Fair competition should not even be something we have to ask for and beg for. Reimbursing us the same rates you pay your own agencies next door—with zero extra to offer—is not only unfair and un-American, but it also harms patients, destroys jobs, and wipes out small and mid-size businesses. This is done by blatantly violating anticompetitive laws in ways that are mind-blowing to know are allowed in America.
@DrOzCMS @VP @AFergusonFTC @KenPaxtonTX @POTUS Why are you continuing to allow this? I am a local business with 100+ dedicated employees who are passionate about care. We have a spotless record in both compliance and quality care, and we have served the community for over a decade. Why are you allowing Humana, UHC, and other insurance companies to destroy us and thousands of others in the same position—from pharmacies to clinics and more?
It has been proven to lower quality, cost far more, and harm millions.
If the goal is to destroy us all and help these few giant for-profit, careless corporations make a few more billions for stockholders while gaining full control over our health, then just be honest with us. (Which I want to believe is not the case, and prayed that this madness will end with the new administration.)
If not, then immediately change it, save the providers who remain, and give patients real choice.
Thousands of jobs that actually care about people and are committed to the highest quality care can still survive.
Let patients have a choice—please do it now. We cannot survive this much longer. They are rapidly eliminating us and stealing our patients.
I don't like to demand, so I ask. As a business, I am not blocked from serving the customers who choose my services—especially not by my direct competitors. How is that even possible in our great country?
What’s next? We can’t buy our groceries where we want from whom we want? We can’t get our hair cut where we want by whom we want? We can’t get an attorney we choose to represent us—it will have to be the one owned by the company that is suing us? We can’t get the car we want to buy from whom we want to buy it from?
I am a proud American who loves this country with all my heart, but I feel like I am living the stories my grandparents told me about living in Europe under communism—some of which I fear we are heading toward rapidly in healthcare and as a business owner.
If this spreads to other industries, the story of having only two types of cars to choose from and a 16-year waiting list may end up being the story of my children or grandchildren, too, as it was for my grandparents.
Please stop it now. I am not asking for charity or a handout. I am asking you to stop allowing my life’s work and my future to be stolen from me any more than they already have been, so I can rebuild before I am wiped out like dust on the Humana and UHC jets they fly to their cocktail parties.
P.S.: It is an additional slap in the face that they are doing this with taxpayers’ dollars. In Humana’s case, it is 100% Medicare, Medicaid, and its subsidiaries. I have been forced by my own government to pay for my own destruction.
Starting in July, I won’t even be able to afford health insurance for my own family (36K/yr), while being forced to pay over $250,000 for employee coverage — which many of them still choose to keep, even though it takes a huge portion of their paycheck, mostly because they have to.
The health insurance companies can steal billions of our tax dollars, raise forced health insurance premiums by 25%–30% every year, and pay providers little or nothing in return. How is this okay?
I have never been an angry person — actually the opposite — and I am grateful for everything in life. But I am angry now. I am trapped in a helpless situation that I have zero control over and zero protection against — a situation that I did not create for myself, my staff, or my patients.
It feels like my government has released the Hunger Games on independent healthcare businesses with no time limit — allowing the big insurance companies to attack, break in, destroy everything, and eventually finish us off with no consequences. And instead of protection, they have taken away every tool we could use to defend ourselves.
Dramatic? Yes, it is dramatic — because it is really happening. I want someone to hear me and stop it. We need a hero @elonmusk @mcuban or someone with whom they speak; people listen. I do appreciate all the fight against fraud, but please, at the same time, don't let the honest, hard-working providers be destroyed.
Special thanks to @nickshirleyy, fighting fraud, he may have to be the one who actually exposes this biggest fraud ever, and a legalized mafia (thanks to our politicians) that cost us trillions of dollars, our businesses, and in many cases, lives. ENOUGH!
Stunning, isn’t it?
A bill to shield politicians, their cronies, and the fraudsters running state-funded NGOs can fly through the California Assembly in days (57-19, “Stop Nick Shirley Act” ✅).
But for over a decade, we can’t pass even one meaningful bill that truly protects patients, taxpayers, independent providers, pharmacies, and real patient choice from the healthcare mafia — hospital monopolies, Big Pharma, insurance gatekeepers, and the whole rigged reimbursement racket.
Regardless of whether you are a Democrat or a Republican, fraud against taxpayers is fraud against us all.
Quality care, anticompetitive practices, unchecked premiums, laws, and policies in healthcare harm us all.
No one asks if you are a Democrat or a Republican when your care gets denied, and no one asks your party affiliation on a reimbursement contract either.
Fraud is fraud — and unless you’re a fraudster, you don’t want to make it easy to steal from you and your family. What we want are laws and policies that actually protect you and your loved ones. Too many politicians on both sides have lost sight of who they are supposed to represent.
WOW 🚨 California Democrats put in the Stop Nick Shirley Act that they can actually PUT JOURNALISTS IN JAIL for investigating fraud
It’s not just video takedown requests, fines and legal fees, you can go to jail
I looked into this and they can actually file criminal charges against journalists
They can file these charges for what they consider “aggressive tactics”
This would fall under
- Repeated visits to private property
- Confronting staff
- Filming in ways that disrupt operations
- Doxxing addresses (Meaning literally just mentioning the facility)
You could face civil suits, restraining orders, fines, or CRIMINAL HARASSMENT CHARGES if prosecutors stretch the law
@Brookerteejones “This bill says that if anyone investigates fraud taking place in immigrant communities and state-funded NGOs, they actually can go to jail, be fined up to $10,000, spend a lot of money defending themselves, And if they post a video about it, well, the video will have to come down.”
Democrats are the real criminals for criminalizing the exposing fraud
Don't forget that they are almost 100% subsidized by taxpayer dollars for their drug research.
What other business would be actively persuading people to take their business elsewhere?
Imagine a small business selling a $500 product, but telling the customer to go to a larger competing company to purchase that product instead.
By purchasing the $500 product elsewhere, it would prevent the smaller company from losing money selling it to the customer.
Also, the larger competing company makes a significantly higher profit than the smaller company.
Sounds extremely dumb, right?
It happens multiple times a day owning/operating a small pharmacy.
I refuse to believe that employees at Best Buy would be telling customers to go to Walmart to buy their next TV, but maybe I’m wrong.
Insane.. starting sooner than I thought.. Guess who would profit the most from this?! That will help you connect the dots..
HUGE WIN for Florida seniors and healthcare providers!
For over two years, I have led the effort to fix Florida’s unfairly low portable x-ray Medicare reimbursement rate, including leading a Florida delegation letter with 11 Members of Congress.
After years of fighting to get this issue addressed, Florida’s rate is now increasing by 72%.
This will help protect access to bedside imaging services for seniors, nursing home residents, and rural communities across Florida.
This is the same situation in home health and clinics. They bought up a bunch of home health agencies and clinics, paying themselves 3-4 times more while paying independent providers below cost or not letting us in the network. Basically, they are free to destroy competition and take away patient choice. @DrOzCMS @AFergusonFTC @KenPaxtonTX
3 PBMs have 80% of pharmacy business
Same 3 run mail order and specialty
Same 3 owned by healthcare conglomerate
Result:
They control competitor access to insurance networks
Offer competitors take or leave contracts
They pay competitors below cost, below what they pay themselves
They charge back, clawback fees and audit competitors
They use competitor dispense data to market their mail order
They bill payers 10X, 100X, 1000X what they pay competitors
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