Our Mission To Fast Reliable Effective Healthcare
Discere was born from the passion of avoiding big corporate emergency rooms. We found a more reliable cost effective way to treat emergency needs.
With 14 different locations in five states URGENT CARE is now the most trusted healthcare clinics in America. Fast, Reliable and Includeds all Specialist.
Disclaimer
Our clinics are staffed with licensed physicians, nurses and other clinicians. We utilize rotational residents in the treatment of care.
Public Exposure is the ONLY Reliable Disinfectant.
PCP - Specialist Referral SCAM
What is the problem?
PCP-Specialist Scams:
Primary care physicians (PCPs) are often compensated for their Medicare Part C patients based on a PMPM captivated payment from the Medicare Advantage Plan. This means PCPs make more money when their Part C patients are provided fewer service. The PCP is the gatekeeper for ALL services.
These PCP's take advantage of captivated payment structure by choosing the least costly treatment options regardless of patient need, and by referring their patients ONLY to specialists who AGREE to do the same. The resulting ' cost savings' routinely come at the expense of patient wellbeing.
Specialist comply with the scheme in exchange for continued referrals. These doctors fraudulently retain tens of millions of dollars to which they were not entitled. Worse they have failed to provide critical care paid to them from the Medicare Program.
Instances to watch for: Patients with intestinal blockages, diverticulosis, various cancers and certain heart conditions.
These plans are implemented to elevate profit over patient care and choice, its the exact harm the False Claims Act, AKS and Stark Law were created to deter. These scams are usually after surgery or upon diagnosis of a set of treatments that will cost the PCP money. These doctors should be reported and investigated along with ALL the physicians that are participating.
Sometimes- these PCP will have more than one Whistleblower Complaint- When more than one person is coming forward to the DOJ complaining about a practice- then the DOJ should start to pay attention to what is taking place with this provider, group, company- they aren't all wrong. The physician or Group is corrupt.
Example: Amgen kickback and Off-Label Promotion Settlement (Ongoing into 2024)
Pharmaceutical Giant Amgen settled for $762 Million in 2024 over allegations of paying kickbacks to induce Medicare covered prescriptions for off-label uses of drugs like Aranesp (for cancer related anemia). The case, rooted in whistleblower's qui-tam suit, resolved claims from 2009- 2018 and reflects persistent pharmaceutical enforcement under the Anti-Kickback Statute.
Example: Amgen kickback and Off-Label Promotion Settlement (Ongoing into 2024)
Pharmaceutical Giant Amgen settled for $762 Million in 2024 over allegations of paying kickbacks to induce Medicare covered prescriptions for off-label uses of drugs like Aranesp (for cancer related anemia). The case, rooted in whistleblower's qui-tam suit, resolved claims from 2009- 2018 and reflects persistent pharmaceutical enforcement under the Anti-Kickback Statute.
Public exposure is the only reliable disinfectant because it bypasses gatekeepers and forces accountability through market pressure, regulatory response, and legal action. When fraud is hidden behind NDA, shredded records, server alterations, fabricated documents, and "internal resolutions" the perpetrators continue operating until the cost of secrecy exceeds the profit.
A single viral expose-backed by documents, recordings, or data-can trigger OIG audits, DOJ subpoenas, insurer clawbacks, LICENSE REVOCATIONS in weeks not decades. Now they are also the subject of documentaries.
History proves this: the Tenet Healthcare $ 900 million Settlement followed by media leads of unnecessary cardiac procedures: Theranos dissolved after Wall Street Journal investigations exposed fake blood test results. Without the daylight, fraud metastasis- exposure is not optional, it is the last line of defense for patient who will never know their "routine surgery" was a billing scam until someone risks everything to tell him.
Hospice scams: The newest scam is for hospice and long term care companies to start their own I-SNP (Health Plan) Its now a way to hide kickbacks, pay themselves excessive fee's and sign off on physicians that are transferring patients to hospice that would otherwise not qualify.
Why would a doctor do this? Well Doctors are compromising patient health and wellbeing because doing so maximizes the revenues that he or his company retain from Medicare Advantage Program which pays a predetermined, captivated monthly payment for the patient. These providers agree with each other to minimize or deny medically necessary but costly care when they are referred-
When the patient condition are no longer profitable to the doctor, he simply recommends premature referral to hospice. They do so by falsely certifying these patients as terminally ill (having a life expectancy of six months or less), when in fact they could live well beyond that with the appropriate but costly treatment. In other words, these greedy physicians forgo 'curative or life extending treatment' to get these patients onto hospice which is a different type of payment scheme.
Now throw in the fact that many of these hospice companies own their own I-SNP (health plan). When the patient is transferred to hospice and they meet specific conditions that they physician usually certifies. They are placed on the I-SNP plan so the hospice can earn money.
If the I-SNP is using a TPA owned by the referring a physician- the I-SNP maybe paying the TPA a hefty PMPM guised as a kickback for the referrals.
In other words, everyone involved in this patients care are putting profit over treatment or a cure. They are allowing the patient to die, instead of rendering the treatment Medicare has already paid the PCP to provide.
It's a SCAM and it needs to be investigated.
A single viral expose-backed by documents, recordings, or data-can trigger OIG audits, DOJ subpoenas, insurer clawbacks, LICENSE REVOCATIONS in weeks not decades. Now they are also the subject of documentaries.
History proves this: the Tenet Healthcare $ 900 million Settlement followed by media leads of unnecessary cardiac procedures: Theranos dissolved after Wall Street Journal investigations exposed fake blood test results. Without the daylight, fraud metastasis- exposure is not optional, it is the last line of defense for patient who will never know their "routine surgery" was a billing scam until someone risks everything to tell him.
Hospice scams: The newest scam is for hospice and long term care companies to start their own I-SNP (Health Plan) Its now a way to hide kickbacks, pay themselves excessive fee's and sign off on physicians that are transferring patients to hospice that would otherwise not qualify.
Why would a doctor do this? Well Doctors are compromising patient health and wellbeing because doing so maximizes the revenues that he or his company retain from Medicare Advantage Program which pays a predetermined, captivated monthly payment for the patient. These providers agree with each other to minimize or deny medically necessary but costly care when they are referred-
When the patient condition are no longer profitable to the doctor, he simply recommends premature referral to hospice. They do so by falsely certifying these patients as terminally ill (having a life expectancy of six months or less), when in fact they could live well beyond that with the appropriate but costly treatment. In other words, these greedy physicians forgo 'curative or life extending treatment' to get these patients onto hospice which is a different type of payment scheme.
Now throw in the fact that many of these hospice companies own their own I-SNP (health plan). When the patient is transferred to hospice and they meet specific conditions that they physician usually certifies. They are placed on the I-SNP plan so the hospice can earn money.
If the I-SNP is using a TPA owned by the referring a physician- the I-SNP maybe paying the TPA a hefty PMPM guised as a kickback for the referrals.
In other words, everyone involved in this patients care are putting profit over treatment or a cure. They are allowing the patient to die, instead of rendering the treatment Medicare has already paid the PCP to provide.
It's a SCAM and it needs to be investigated.
Healthcare fraud occurs when providers, companies, or individuals deceive payers- Medicare, Medicaid, private insurers, or patients- to extract money they are not entitled to. Common schemes include: Billing for services never performed ( phantom billing), upcoming routing visits into complex procedures, unbundling bundled services to inflate reimbursements, prescribing unnecessary tests or drugs for kickbacks, and falsifying patient diagnoses to justify expensive treatments. But it can also be complicated: Physicians try to hide ownership of HMO's to avoid scrutiny of the contract the Physician practice may have, or begin TPA, that then require other providers to use to hide kickbacks guised as legitimate arms length relationships. They can also transfer patients to HOSPICE, if the patient would otherwise be expensive and they are captivated, by stating that the patient qualifies for hospice criteria when they do not.
For health plans, it can be a denial of clean claim to a provider for no W9. Allowing the health plan to keep all the money. Or manipulating risk scores that tells Medicare or Medicaid that the patient is more complex, but they really are not.
The Office of Inspector General (OIG) estimates that fraud drains $60-$100 billion annually from Medicare and Medicaid alone, with the FBI labeling healthcare fraud as the TOP financial crime priority after violent crime.
These acts are not clerical errors- they are calculated thefts that raise premiums, divert resources from legitimate care, and directly endanger patients when substandard or unnecessary treatments are pushed for profit.
Internal reporting systems, mandated by most hospitals and clinics under compliance programs, are designed to look proactive but function primarily as FRAUD CONTAINMENT MECHANISMS. When a nurse, billing coder, or physician flag suspicious activity through the "official channel" the report typically lands with the same compliance officer or legal team paid by the institution. They are typically unwilling to do any self-reporting. They often conclude with "no findings"or minor policy tweaks. Sometimes they are the mechanism for the retaliation. Data from the National Whisteblower Center shows that over 70% of internal reporters experience retaliation, and fewer than 5% of internal reports ever reach the Department of Justice.
Example: In high-profile cases like the $1.7 billion Columbia/HCA fraud settlement, internal audits existed for years but produced zero meaningful disclosures-only after insiders bypassed the system and filed qui tam lawsuits under the False Claims Act id the scheme collapse.
For health plans, it can be a denial of clean claim to a provider for no W9. Allowing the health plan to keep all the money. Or manipulating risk scores that tells Medicare or Medicaid that the patient is more complex, but they really are not.
The Office of Inspector General (OIG) estimates that fraud drains $60-$100 billion annually from Medicare and Medicaid alone, with the FBI labeling healthcare fraud as the TOP financial crime priority after violent crime.
These acts are not clerical errors- they are calculated thefts that raise premiums, divert resources from legitimate care, and directly endanger patients when substandard or unnecessary treatments are pushed for profit.
Internal reporting systems, mandated by most hospitals and clinics under compliance programs, are designed to look proactive but function primarily as FRAUD CONTAINMENT MECHANISMS. When a nurse, billing coder, or physician flag suspicious activity through the "official channel" the report typically lands with the same compliance officer or legal team paid by the institution. They are typically unwilling to do any self-reporting. They often conclude with "no findings"or minor policy tweaks. Sometimes they are the mechanism for the retaliation. Data from the National Whisteblower Center shows that over 70% of internal reporters experience retaliation, and fewer than 5% of internal reports ever reach the Department of Justice.
Example: In high-profile cases like the $1.7 billion Columbia/HCA fraud settlement, internal audits existed for years but produced zero meaningful disclosures-only after insiders bypassed the system and filed qui tam lawsuits under the False Claims Act id the scheme collapse.
Transforming the Story
Some of these stories are very compelling and we believe exposure necessary to transform healthcare. Some of the stories of these practices are going to developed into screen plays and scripts to be sold to streaming services. The Healthcare Mafia, The Spring Hill Gang, and several in development. Without the power of visual media- these bad actors will continue to operate while causing untold amount of harm. They should be exposed for the good of the community.
Join Us Today!
Become part of a community dedicated to healthcare advancement.
HIPAA Mismanagement
Health Plan Fraud
HIPAA mismanagement is another area that needs further scrutiny. How many hospitals, health plans, TPA and physicians have had HIPAA violations and breaches and have failed to notify the OCR. Compliance issues arise when covered entities or their business associates (TPA or Billing firms) fail to safeguard PHI, leading to unauthorized access, disclosure or breaches. Common failures include:
Inadequate Risk Analysis and Management: HIPAA's Security Rule 164:308(a)(1) requires an enterprise-wide risk assessment to identify vulnerabilities. Many entities neglect thorough, ongoing analyses, leaving systems exposed to threats like phishing or ransomware.
Insufficient Security Safeguards: This encompasses weak access controls 164.312(a)(1)), lack of encryption 164.312(e)(2)), failure to monitor activity (164.312(b)), and inadequate incident response 164.308(a)(6)). Multi-factor authentication (MFA) lapses and unpatched systems are frequent culprits.
Privacy Rule Violation: Impermissible disclosures 164.502, failure to provide timely access to records (164.524), and inadequate patient rights notification (164.520)
Breach Notification Failures: Entities must notify affected individuals, HHS, and sometimes media within 60 days 164.404-164.408, but delays or underreporting occur often. In some cases, we have provided information to lawyers who file the Class Action when we know of the breach and the covered entity fails to report.
Business Associate Oversight: Covered Entities must ensure associates comply via contracts ( 164.314), their lack of oversight and due diligence lead to cascading failures and ultimately the covered entity is responsible for the penalty.
Inadequate Risk Analysis and Management: HIPAA's Security Rule 164:308(a)(1) requires an enterprise-wide risk assessment to identify vulnerabilities. Many entities neglect thorough, ongoing analyses, leaving systems exposed to threats like phishing or ransomware.
Insufficient Security Safeguards: This encompasses weak access controls 164.312(a)(1)), lack of encryption 164.312(e)(2)), failure to monitor activity (164.312(b)), and inadequate incident response 164.308(a)(6)). Multi-factor authentication (MFA) lapses and unpatched systems are frequent culprits.
Privacy Rule Violation: Impermissible disclosures 164.502, failure to provide timely access to records (164.524), and inadequate patient rights notification (164.520)
Breach Notification Failures: Entities must notify affected individuals, HHS, and sometimes media within 60 days 164.404-164.408, but delays or underreporting occur often. In some cases, we have provided information to lawyers who file the Class Action when we know of the breach and the covered entity fails to report.
Business Associate Oversight: Covered Entities must ensure associates comply via contracts ( 164.314), their lack of oversight and due diligence lead to cascading failures and ultimately the covered entity is responsible for the penalty.
Health plans are equally as bad in covering up their practices. They have relationships with physicians and ACO, and IPA's, they have funny accounting practices that strip medicare of funds, providers of legitimate services.
TPA Fraud: Some of the biggest abusers of rule violations and fraud are TPA's. Because the Health plan has a huge lack of oversight or because in some cases the TPA ownerships are referral sources- the TPA is a risk. They are outsourcing to off shore entities and they aren't doing a better cheaper job, most advertise falsely, or claim proprietary code or software that doesn't exist. Eventually, nearly all TPA are not what they claim which is better, cheaper, faster and more accurate. They are more manual and laxed policies.
TPA Fraud: Some of the biggest abusers of rule violations and fraud are TPA's. Because the Health plan has a huge lack of oversight or because in some cases the TPA ownerships are referral sources- the TPA is a risk. They are outsourcing to off shore entities and they aren't doing a better cheaper job, most advertise falsely, or claim proprietary code or software that doesn't exist. Eventually, nearly all TPA are not what they claim which is better, cheaper, faster and more accurate. They are more manual and laxed policies.
TPA-s and Compliance
TPA's on the surface with have compliance plans, polices, and have all the right documents to waive around. However, behind the veneer they are undisciplined, low paying and low performance. The few that actually understand their business are typically self funded groups.
Health plans beware of the TPA hired. At least, do a google name search and speak to references. Look to see if the parent companies have had lawsuits and what the hiring practices are. Get solid 'roll out' data - if they are using off shore workers find out about their training. American's shouldn't be out of work for the so-called H1B visa holder and off shore worker in healthcare. The level of fraud in some cultures should be concerning to American healthcare workers.
I have yet to see a TPA that offers compliance and HIPAA training - most do not.
Health plans beware of the TPA hired. At least, do a google name search and speak to references. Look to see if the parent companies have had lawsuits and what the hiring practices are. Get solid 'roll out' data - if they are using off shore workers find out about their training. American's shouldn't be out of work for the so-called H1B visa holder and off shore worker in healthcare. The level of fraud in some cultures should be concerning to American healthcare workers.
I have yet to see a TPA that offers compliance and HIPAA training - most do not.
Partnering for Success
There are good doctors, hospitals, health plans out there, but the consumer needs to ask questions, and law enforcement needs to do their job. It's time to hold these guys accountable. Put the bad actors out of work - expose them because once the consumer and the media is aware of the bad actor then practices will change.