Episode Title: The Medicaid Data Dump: $1.7 Billion in Billing From Shell Companies and Why Nobody Stopped It

Guest: Samir Unni | Biomedical Engineer, former Palantir healthcare data lead, currently working on federal data modernization efforts

Chapters

00:00 Introduction and Technical Difficulties

02:47 Reflections on Jay Bhattacharya's Insights

06:04 Navigating Polarization in Science

08:50 Moderna's Flu Vaccine Controversy

11:56 Understanding the FDA's Refusal to File

14:58 The Medicaid Data Dump and Its Implications

17:50 Duplicate Payments in Medicaid

20:59 The Role of Transparency in Healthcare

24:01 Home Health Services and Fraud Risks

42:57 Understanding Fraud in Government Billing

46:51 Political Ramifications of Home Health Agencies

50:53 Analyzing Data for Fraud Detection

56:30 Incentives and Accountability in Healthcare

01:01:52 The Role of Technology in Fraud Prevention

01:12:32 Legislative Solutions to Healthcare Fraud

Resources Mentioned:

• Samir Unni's viral Medicaid data thread (@SamirUnni on X)
• CMS TMSIS Medicaid provider-level data release
• Anish Koka's deep dive on Fluarix clinical efficacy
• HHS Office of Inspector General excluded individuals/entities list
• Dr. Mandrola's posts on the Moderna/FDA controversy
• Alex Berenson's report on autism behavioral therapy billing trends

About Samir Unni:

Samir Unni is a biomedical engineer who has spent over a decade working at the intersection of healthcare and data analytics. He previously served as a lead at Palantir working with government and healthcare organizations, and is now focused on modernizing how the federal government leverages AI and data tools to identify waste and fraud in public health programs.

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Co-hosts: @anish_koka | @drdanchoi | @dutchrojas | @sdixitmd | @DrDiGiorgio

In this engaging conversation, Dr. Jay Bhattacharya discusses his unique perspective as a health economist and the impact of his training on his approach to public health, particularly during the COVID-19 pandemic. He reflects on the Great Barrington Declaration, the importance of dissent in science, and the need for reform within the NIH to foster innovation and address the replication crisis in research. Dr. Bhattacharya emphasizes the necessity of a culture shift in science, advocating for transparency and rigorous inquiry into public health issues, including vaccines and chronic diseases.

Takeaways

Dr. Bhattacharya's background in economics shapes his approach to health policy.

The COVID-19 pandemic highlighted the importance of considering trade-offs in public health decisions.

Dissent in science is crucial for progress and innovation.

The Great Barrington Declaration challenged the prevailing public health narrative during the pandemic.

The NIH must adapt to foster a culture of questioning and innovation.

Addressing the replication crisis is essential for restoring trust in scientific research.

Public health responses must be transparent and trustworthy to gain public confidence.

Raising the evidentiary bar for vaccines is necessary to ensure safety and efficacy.

The NIH's role in funding research should focus on improving health outcomes.

A second scientific revolution is needed to shift the power dynamics in research.

Titles

Navigating Public Health: Insights from Dr. Jay Bhattacharya

The Economics of Health Policy: A Conversation with Dr. Bhattacharya

Chapters

00:00 Introduction to Dr. Jay Bhattacharya

03:18 The Influence of Economics on Health Policy

06:23 Unique Perspectives During the COVID-19 Pandemic

10:12 The Role of Authority in Public Health Decisions

13:08 The Great Barrington Declaration and Its Impact

16:27 Challenges to Scientific Consensus

19:08 Leading the NIH: An Economic Perspective

22:33 Addressing the Replication Crisis in Science

36:56 Addressing Scientific Stagnation and Replication Crisis

43:42 Fostering a Culture of Dissent in Science

52:56 Setting Research Priorities for Public Health

59:58 Navigating Vaccine Safety and Public Trust

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Co-hosts: @anish_koka | @drdanchoi | @dutchrojas | @sdixitmd | @DrDiGiorgio

Benjamin Ryan was the only journalist in the courtroom for every day of the first detransition lawsuit to reach a jury verdict. In January 2025, a White Plains jury awarded $2 million to Fox Varian, who received a double mastectomy at age 16 after being diagnosed with gender dysphoria. Years later, she detransitioned and sued her psychologist and plastic surgeon.

What happened in that courtroom tells a bigger story about how American medicine got here, why Europe is walking it back, and what happens when "affirmation" becomes the only acceptable path. Ben breaks down the testimony, the expert witnesses, the coerced mother, and why one of WPATH's own leaders sank the defense.

This conversation covers the case details, the prefrontal lobotomy parallel, why the American Academy of Pediatrics can't back down, insurance incentives gone wrong, and what it's like to be the only journalist willing to cover the story everyone's afraid to touch.

Chapter List

• 1:00 - Introduction: Benjamin Ryan, The Only Reporter in the Room
• 4:00 - How Ben Got Into Trans Medicine Reporting
• 7:00 - The Case Overview: Fox Varian vs Her Medical Team
• 10:00 - Body Dysmorphia vs Gender Dysphoria: The Fatal Error
• 13:00 - Ken Einhorn and the Philosophy of Affirmation
• 17:00 - The Pride Center Records He Never Requested
• 19:00 - Dr. Loren Schechter: WPATH's President-Elect Testifies for Plaintiff
• 22:00 - Coercing the Mother: "You're Not in Reality, Mom"
• 25:00 - Why Was the Plastic Surgeon Liable?
• 29:00 - The Lobotomy Parallel: When Medicine Gets It Wrong
• 33:00 - The Ethics of Taking Functioning Organs
• 37:00 - Why the Plastic Surgeons Released a Statement
• 39:00 - Expert Witness Testimony: The Game-Changer
• 42:00 - Johanna Olson-Kennedy: "Live Son or Dead Daughter"
• 44:00 - The Nose Job Fallacy: Breasts Have Function
• 46:00 - How Did We Get Here? Internet, Social Media, Civil Rights
• 50:00 - Why Europe Walked It Back and America Didn't
• 54:00 - The Insurance Problem: Perverse Incentives
• 59:00 - Why Medical Societies Can't Say "We Don't Know"
• 1:02:00 - The Media Blackout: "No Institutional Bandwidth"
• 1:05:00 - Closing: Follow Ben's Substack for Case Files

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Co-hosts: @anish_koka | @drdanchoi | @dutchrojas | @sdixitmd | @DrDiGiorgio

Guest: Benjamin Ryan on Substack: Hazard Ratio (benryan.substack.com)

Ben's Free Press Article : A Legal First That Could Change Gender Medicine

Guest: Ed Gaines, JD, CPC Vice President of Regulatory Affairs, Zotec Partners Honorary Member, American College of Emergency Physicians

Episode Summary:

If you're a hospital-based physician and you don't understand the No Surprises Act, you're missing the biggest shift in payment leverage in decades. Insurance companies estimated there would be 17,000 disputes. The actual number? Over 2.5 million. And physicians are winning 85-90% of them.

Ed Gaines has been fighting for physician payment for 32 years—from the 1990s battle over 1099 independent contractors to today's war over Independent Dispute Resolution. He explains how California's "neutral" stance cost physicians dearly, why Trump's price transparency rule changed everything, and what Anthem's threat to cut hospital payments really means.

0:00 - Introduction & Opening

1:05 - Who is Ed Gaines?

2:25 - The Origin Story: From Healthcare Fascination to Capitol Hill

6:31 - The 1099 Battle: A Five-Year Fight (1997-2002)

14:19 - What is the No Surprises Act?

17:26 - State Laws vs. Federal Action

23:48 - California's Mistake: When the CMA Was "Neutral"

26:44 - The Consolidation Paradox

28:36 - The Legislative Battle: Ways and Means vs. Energy and Commerce

31:43 - Becerra's Sabotage: Four Lawsuits, Four Victories

37:39 - The Current Battle: Insurance Companies Strike Back

40:43 - The Trump Transparency Game-Changer

42:55 - Who's Really Using IDR?

43:50 - Anthem's New Tactic: Going After Hospitals

46:18 - The Antitrust Argument

47:40 - Closing Thoughts

In This Episode:

• The 1099 battle (1997-2002): How persistence won a 5-year legislative fight
• Why the California Medical Association regrets being "neutral" on AB 72
• The $50 billion that health plans tried to extract from physicians
• How HHS tried to sabotage the NSA—and lost in federal court four times
• Why CMS was off by 147X in predicting IDR case volume
• Trump's transparency rule: The data that's winning cases for physicians
• Anthem's new strategy: Threatening 10% payment cuts to hospitals
• The antitrust case against insurance company boycotts
• Why 70% of IDR users are independent physicians, not just PE groups

Key Quotes:

"CMS estimated 17,000 cases. The actual number was over 2.5 million. They missed by just a touch."

"The judge literally said the agency tried to put their thumb on the scales of justice in favor of health plans."

"The California Medical Association was neutral on benchmarking to 125% of Medicare. To their credit, they realized they'd made a mistake."

"They're losing 85-90% of cases at 6, 7, 8X of Medicare. They didn't see this coming."

"For years they got to unilaterally decide what out-of-network payment would be, then just blame doctors for balance billing."

About Ed Gaines: Ed has worked in physician revenue cycle management for 32 years, supporting over 22,000 physicians across all 50 states. He specializes in emergency medicine, radiology, anesthesia, and orthopedics advocacy. The American College of Emergency Physicians made him an honorary member in 2010—rare recognition for a non-physician.

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What happens when a spine surgeon who's been in private practice since the Obamacare era sits down with doctors across the political spectrum? You get one of the most honest conversations about healthcare reform we've had.

Brian Gantwerker doesn't fit neatly into anyone's box. He's a private practice capitalist who thinks breaking up insurance companies is essential. He believes in "just pricing" for craniotomies (hint: it's more than $2,000). He thinks Medicare was actually a great payer—until Medicare Advantage ruined it. And he has strong opinions about why physicians spend so much time fighting each other on Twitter instead of finding common ground.

This conversation covers the Medicare Advantage meltdown (UnitedHealthcare shares tanking), vertical integration nightmares, why the FTC needs to break up both insurers AND hospitals, and what it's like when your congressman literally saves your practice. Plus: the real reason healthcare policy debates get so toxic on social media, and why quote-tweeting might be making everything worse.

0:00 - Introduction: Doctors in the Lounge 0:33 - Who is Brian Gantwerker? 2:08 - Starting Private Practice in the Obamacare Era 5:34 - UnitedHealthcare: The Pontine Glioma of Healthcare 7:43 - Medicare Advantage vs Traditional Medicare 10:26 - The Medicare Advantage Denial Story 14:35 - Who Gets the Value in Value-Based Care? 16:07 - The Free Market That Doesn't Exist Yet 19:16 - What Should a Craniotomy Cost? 21:47 - Breaking Up the Monopolies: Insurers AND Hospitals 27:09 - The Labor Theory of Value Debate 30:21 - CPT Codes and Central Planning 32:20 - The "Just Price" vs Free Market 35:42 - HSAs for Medicaid Recipients 38:47 - Price Transparency: Why Can't Healthcare Be Like Amazon? 40:03 - The Workout Period Problem 43:52 - FTC and Vertical Integration 46:04 - Lobbying, Congress, and Changing Minds 48:07 - Why Twitter Makes Physicians Fight Each Other 51:24 - Political Rancor and Taking Sides 55:14 - The Dr. Asghar Tweet Controversy 59:24 - Quote-Tweeting: The Death of Dialogue 1:03:03 - X as Thunderdome vs Real Conversation 1:04:35 - The Ted Lieu Saves: When Congress Actually Helps 1:07:32 - Closing: Shah Rukh Khan Hair and Finding Common Ground

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Follow the Show: X: @TheDoctorsLo

Co-hosts: @anish_koka | @drdanchoi | @dutchrojas | @drdigiorgio | @sdixitmd

Guest: @cscla

Guest: Josh Umbehr, MD | Co-founder & CEO, Atlas MD | DPC Pioneer

Summary: In 2010, Josh Umbehr launched Atlas MD charging $50/month for unlimited primary care with no insurance billing. Other doctors said it wasn't sustainable. Fourteen years later, he runs a platform serving 1,800+ practices and built his own insurance company. This conversation covers the full journey: wholesale medication costs ($0.01/pill metformin), the $2M it takes to start insurance, why Singapore's model works, and why 80% of healthcare spending is eliminable.

Key Topics:

• DPC Economics: How $50/month works ($2 CBC tests, cutting 5-6 staff)
• Building Insurance: $2M startup, actuarial challenges, association model
• Singapore Healthcare: What economists miss about primary care
• Fractional Specialists: 1,800 practices sharing one cardiologist
• CMS Meeting: "We can't participate and innovate"
• GLP-1 Pricing: Why insurance coverage raises costs
• Vaccine Nuance: Risk/benefit in context
• The 80% Solution: Eliminating waste, not rationing

Top Quotes:

• "80% of $4-5 trillion could be cut out. That's reasonable math, not wishful thinking."
• "We can't participate and innovate" [to CMS Administrator]
• "Best way to make GLP-1s affordable: stop covering with insurance"
• "Biggest DPC problem isn't the model—it's getting people to understand high quality + affordable price"

Keywords

Alex Berenson, COVID vaccine, Medicaid fraud, autism services, healthcare, investigative journalism, MCOs, AI in healthcare, public health, healthcare policy

Summary

In this conversation, Anish Koka and Alex Berenson delve into critical issues surrounding the COVID vaccine, Medicaid fraud, and the financial incentives within autism services. They discuss the implications of investigative journalism in public health, the role of Managed Care Organizations (MCOs), and the potential future of healthcare with the integration of AI. Berenson emphasizes the need for accountability and transparency in healthcare spending, particularly in Medicaid, which has ballooned to a trillion-dollar program with significant fraud and abuse. The discussion highlights the importance of asking tough questions and the consequences of ignoring systemic issues in healthcare policy.

Takeaways

Alex Berenson is a notable investigative journalist who challenges mainstream narratives.

The COVID vaccine's efficacy was overestimated, leading to misguided public health policies.

Medicaid fraud is rampant, with significant financial implications for taxpayers.

The autism services sector has seen explosive growth in spending without adequate oversight.

Managed Care Organizations (MCOs) often lack the incentive to control costs in Medicaid.

There is a need for more physician oversight in Medicaid-funded services.

The financial incentives in healthcare can lead to waste and abuse of funds.

AI's role in healthcare could complicate oversight and accountability.

Public support for Medicaid could diminish if fraud and waste are not addressed.

The conversation underscores the importance of transparency in healthcare spending.

Chapters

00:00 Introduction to Alex Berenson

06:11 Investigating COVID Vaccine Efficacy

12:22 Exploring Medicaid Fraud and Abuse

20:00 Autism Services and Financial Incentives

30:08 The Role of MCOs in Medicaid

36:50 The Future of Healthcare and AI

Links:

Berenson Substack on Medicaid and Autism:

(100) Medicaid fraud and abuse are hitting unthinkable levels

@X handles:

@alexberenson @anish_koka @DrDiGiorgio @drdanchoi @sdixitmd

Send us a text

Summary

In this episode of the Doctor's Lounge, hosts Anish Koka, Anthony DiGiorgio, and Sanat Dixit delve into the complexities of healthcare policy, particularly focusing on recent statements made by former President Trump regarding healthcare reform. They discuss the implications of Trump's proposed 'Great Healthcare Plan,' which aims to lower drug prices and insurance premiums while increasing price transparency. The conversation highlights the need for deeper reforms, such as relaxing insurance regulations and addressing hospital consolidation, to truly lower healthcare costs. The hosts express a mix of cautious optimism and skepticism about the effectiveness of these proposals, emphasizing the importance of patient empowerment in the healthcare marketplace.

The discussion then shifts to the role of AI in healthcare, particularly in clinical decision-making. The hosts explore the regulatory landscape surrounding AI tools and the potential for these technologies to enhance patient care while also raising concerns about accountability and the need for oversight. They conclude with a critical examination of the 340B drug discount program, discussing its unintended consequences and the need for reform to ensure that it serves its intended purpose of aiding low-income patients rather than enriching large health systems. Overall, the episode provides a nuanced look at the intersection of policy, technology, and patient care in the evolving healthcare landscape.


Keywords

healthcare reform, Trump healthcare plan, AI in healthcare, 340B program, healthcare policy, patient empowerment, drug pricing, insurance premiums, healthcare costs, medical malpractice

Chapters

00:00 Introduction to Healthcare Complexity
01:12 Trump's Healthcare Plan Overview
04:38 The Role of AI in Healthcare
09:31 FDA Regulations on AI Tools
17:34 Ethics and Accountability in AI
31:53 Case Study: Whole Body MRI and Malpractice
34:30 The Prenuvo Case and Medical Liability
38:59 Defensive Medicine and Its Implications
43:09 The 340B Drug Discount Program Explained
50:54 Critique of the 340B Program and Its Impact
01:00:02 Reimagining Healthcare Funding and Patient Care

🔗 Connect with the Hosts:

• Dutch Rojas on X

• Dr. Anthony DiGiorgio on X

• Dr. Anish Koka on X

• Dr. Dan Choi on X

• Dr. Sanat Dixit on X

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Keywords

healthcare, ACA subsidies, vaccine schedule, AI in healthcare, concierge medicine, food pyramid, healthcare policy, public health, physician autonomy, healthcare costs


Summary

In this episode, the hosts delve into the complexities of healthcare, discussing the ongoing saga of ACA subsidies, recent changes to vaccine schedules, and the implications of AI in healthcare. They explore the pros and cons of concierge medicine and the recent shift in dietary guidelines, emphasizing the need for a more patient-centered approach in healthcare policy. The conversation highlights the philosophical debates surrounding healthcare access, autonomy, and the role of government in managing health systems.


Takeaways

Healthcare plans are more complicated than they seem.
The ACA subsidies have been extended amidst political maneuvering.
Changes in vaccine schedules reflect a shift towards shared decision-making.
AI is becoming increasingly integrated into healthcare practices.
Concierge medicine offers personalized care but raises equity concerns.
The food pyramid has been updated to reflect healthier eating guidelines.
Patients deserve autonomy in their healthcare decisions.
Government involvement in healthcare often leads to inefficiencies.
The healthcare system needs to prioritize patient relationships.
Philosophical debates about healthcare access continue to evolve.

Chapters

00:00 The Complexity of Healthcare Plans
01:11 The ACA Subsidies Debate
04:58 Vaccination Schedules and Public Health
12:46 AI in Healthcare: Innovations and Concerns
37:53 Ezekiel Emanuel and the Affordable Care Act
40:09 Critique of Healthcare Policies and Ideologies
43:48 The Flaws of Central Planning in Healthcare
46:55 Concerns Over Incremental Changes in Healthcare
49:37 Cultural Shifts and the Future of American Healthcare
54:50 Concierge Medicine: Access and Quality of Care
01:00:07 Dietary Changes and Public Health Messaging

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• Dutch Rojas on X

• Dr. Anthony DiGiorgio on X

• Dr. Anish Koka on X

• Dr. Dan Choi on X

• Dr. Sanat Dixit on X

Send us a text

Keywords

healthcare policy, Medicaid, ACA, fraud, social media, bureaucracy, primary care, immigration, healthcare reform, insurance


Takeaways

The One Big Beautiful Bill aimed to reform Medicaid and tighten eligibility checks.
Fraud in Medicaid has been highlighted by recent cases, particularly in Minnesota.
Work requirements for Medicaid recipients are seen as a reasonable eligibility check.
The expiration of ACA subsidies has led to increased healthcare costs for many.
Social media has become a platform for impactful healthcare discussions.
Bureaucracy in healthcare is under scrutiny, with calls for more accountability.
First principles thinking is essential for developing effective healthcare solutions.
Physicians must consider how their income and practices are perceived in society.
Immigration policies impact the supply of physicians in the US healthcare system.
Access to primary care is crucial for reducing ER congestion and improving health outcomes.


Summary

In this New Year's episode, Anthony DiGiorgio and Anish Koka reflect on the significant healthcare policy changes of 2025, focusing on the One Big Beautiful Bill and its impact on Medicaid. They discuss the recent fraud cases in Minnesota, the expiration of ACA subsidies, and the role of social media in shaping healthcare conversations. The conversation also touches on the importance of primary care access, the perception of physicians, and the need for first principles thinking in healthcare reform. As they look ahead to 2026, they express hope for more accountability and innovative solutions in the healthcare system.



Sound bites

"Bureaucracy in healthcare is under scrutiny."
"Physicians must consider their income perception."
"Immigration policies impact physician supply."

Chapters

00:00 New Year Reflections on Healthcare Policy
10:44 The Impact of ACA Subsidy Expiration
14:53 Social Media Influence in Healthcare Discussions
19:53 Examining Bureaucracy and Professional Organizations
25:12 First Principles in Healthcare Solutions
33:58 The Fairness of Medical Training and Immigration
34:27 The Role of Third-Payer Systems in Healthcare
35:25 Collectivism vs. Individualism in Healthcare
36:16 The Future of Healthcare: Leftist Movements and Universal Care
37:34 Populism and Promises in Politics
38:33 Uncovering Medicaid Fraud and Healthcare Spending
40:29 The Impact of High Salaries in Healthcare
41:45 The Dangers of Single-Payer Systems
42:13 The Canadian Healthcare System: A Case Study
44:21 Primary Care and Emergency Room Dynamics
46:19 Price Signals in Healthcare
49:22 The Debate on Hospital Capacity and Access
51:45 The Misconceptions of Universal Healthcare
53:31 The Role of Private Insurance in Universal Systems
55:42 Healthcare Innovation and Market Dynamics
57:24 The Economics of Healthcare Employment
59:11 The High-Speed Rail Controversy and Government Spending
01:01:35 Looking Ahead: Hopes for 2026

🔗 Connect with the Hosts:

• Dutch Rojas on X

• Dr. Anthony DiGiorgio on X

• Dr. Anish Koka on X

• Dr. Dan Choi on X

• Dr. Sanat Dixit on X