12/06/2025
🚨 Everyone talks about “healthcare fraud”… but no one talks about the REAL fraud happening in plain sight.
We constantly hear about “investigations” into providers and patients supposedly scamming the system.
But what about the unions, insurance companies, and third-party administrators (TPAs) who have been silently underpaying, manipulating, and ripping off both providers AND members for decades?
Where are the investigations for THAT?
Why is the government wide awake when it comes to chasing small providers…
…but conveniently asleep when massive organizations freeze reimbursement rates for 10, 15, even 20 years — with NO transparency, NO adjustments, and NO accountability?
Let me be clear:
This is not a minor issue.
This is a systemic, deliberate pattern that hurts:
👉 Patients, who are denied fair benefits they pay for
👉 Providers, who can barely survive on outdated rates
👉 Communities, which lose access when clinics close
And yet… nothing happens.
💥 Let’s talk numbers — the truth nobody wants to say out loud:
🔴 GHI still pays around $36 for a physical therapy visit.
Not in 2005. Today. 2025.
No change. No adjustment. No justification.
🔴 1199SEIU pays around $50 a visit.
Again — frozen in time.
🔴 Many union/managed plans pay roughly $80 a visit, unchanged for years.
How is that possible when everything else has gone up?
📈 Inflation has gone up nearly 50%.
📈 Minimum wage has nearly doubled.
📈 Rent, insurance, admin costs, compliance burdens — all skyrocketing.
But reimbursement?
Stuck in the Stone Age.
And no one explains why.
No actuarial analysis.
No methodology.
No public disclosures.
Just fixed numbers that never move.
💬 But here’s the part that makes people angry — and rightfully so:
These rates are controlled by ERISA-governed plans—union plans, employer plans, TPAs—who have LEGAL fiduciary duties:
✔ Act prudently
✔ Act in the best interest of members
✔ Operate transparently
✔ Manage plan funds responsibly
Yet freezing reimbursement for 15+ years while healthcare costs explode is the opposite of fiduciary responsibility.
If a provider did something even remotely questionable, the government would be at their door immediately.
But when huge plans do it?
🔇 Silence.
😴 Eyes closed.
⏳ Problems ignored.
🚨 This is not just unfair — it is unsustainable.
Small clinics cannot survive on reimbursement rates that are lower than some copays.
Many have already closed.
More will follow.
And patient access will collapse.
I shouldn’t have to say this, but I will:
❗ When providers go out of business, patients suffer.
❗ When plans hide behind outdated fee schedules, everyone loses.
❗ When the government looks away, the abuse continues.
💬 We need accountability. And we need it NOW.
I’m calling on State & Government agencies work directly with the U.S. Department of Labor to finally investigate these systemic reimbursement practices that violate the spirit — and possibly the letter — of ERISA.
Providers deserve fairness.
Patients deserve the benefits they’re paying for.
And these plans must finally be held accountable for what they’ve been doing behind the scenes.
Enough is enough.
This is not just my fight — this is a fight for every provider, every patient, and every small clinic trying to survive in a system stacked against them.
Please share. People need to hear this.s
