WCI #334: How You’re Being Ripped Off By Incompetent and Corrupt CMS Bureaucrats with Dr. Alex Shteynshlyuger

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This is White Coat Investor podcast number 334 how you're being ripped off by incompetent and corrupt CMS bureaucrats. Do you ever find yourself wishing there was somewhere to go to ask your finance, insurance or investing questions? The White Coat Investor community is a great place to turn. We have a thriving community across all of our social, Facebook, Twitter, Instagram, Reddit and our WCI forum. We have been discussing solutions to your money problems since 2011. Join the Conversation with thousands of other White Coat investors. Follow WCI on your favorite social media platform for financial resources, tips and strategies. Just head to your platform of choice and search for the White Coat Investor. You can do this and the White Coat Investor can help. All right, welcome back to the podcast. I'm flying solo here in Utah. Not only am I holding down the fort here at the White Coat Investor, while about a third of our staff is out of town, I'm holding down the fort at home as well. Katie. As I record this in mid September, Katie is high on Kilimanjaro. I think she's in Camp 4 today and we'll soon be headed to the summit. So I've got to send her a weather forecast via a satellite text device so that she'll know what to expect as she heads for the summit. But that means for two or three weeks here, I'm holding down the fort at home. So it's been a very interesting experience. This is the longest Katie's been away from our family for 24 years. You know, a three week trip, I've been away this long three times. Two deployments with the military and a trip to the Grand Canyon. But this is kind of an interesting experience for me to kind of be taking care of everything, you know, hold down a job because I still have shifts while she's gone. I got to make sure the kids are taken care of while I'm in working those shifts as well as making sure everybody's fed and happy and school's progressing and teams are coached and all those kinds of things. So if you've never had the opportunity to do this, it's a good one and it sure will make you appreciate your spouse a lot. All right, what else can I tell you? Before we get into our interview today? We should do our quote of the day. This one comes from A relatively fake famous politician, Barack Obama. He said a budget is more than just a series of numbers on a page. It is an embodiment of our values. I suspect he was talking about the federal budget when he made that statement, but it certainly applies to our personal budgets. All right, we've been registering people now for WC Icon 24 in sunny Orlando. Early bird registration goes for a couple more weeks here and unless the thing fills, then of course we're going to stop registering. But that saves you 300 bucks off. 300 bucks off until October 12th. That's when the price goes up. So highly recommend you register asap. Number one, to make sure you get to come to the conference. Number two, cause you can't book a room until you registered for the conference. And you definitely want to get in on our room block. Not only is it cheaper, but you get to stay on site, which is that much better at the conference. But you do have until October 12th if we don't sell out to get the early bird pricing. But this conference is going to be awesome and this is going to be our best one yet. There's a reason people rave about this conference. It truly is a wonderful life. Changing career, changing finance, changing burnout, changing four or five days and that includes the travel time. The conference itself is only 3, plus the opening reception the night before. So come join us in sunny Orlando. It's in February, February 5th through 8th. You can register@wcievents.com we'd love to see you there. I love to hear about your challenges. I'd love to hear about your successes. And it's even better when I get to do that in person at wcicon. All right, we have an interview today with somebody that has been out working on a problem that you probably didn't even know existed. Some things that have been annoying you maybe, you know, dealing with insurance companies. Statistics suggest that a huge percentage of our healthcare dollar is being wasted, wasted somewhere in between the providers of healthcare, hospitals, doctors, et cetera, and these third party paying organizations, insurance companies, these third parties that are sitting there between you and the patient. And they hire yet more companies to enter the bureaucracy to make it so money is wasted. So you're not paid, so patients are frustrated. At any rate, our guest today has been working on this problem and aspects of it that I wasn't even aware of. And I suspect that most of you are not either. So I want you to listen to this podcast so you're at least aware of the problems and so that we can start talking about solutions for it and banding together and getting these problems solved because they are not only affecting your pocketbook, which makes it very important for this podcast and its mission and this audience, but it's affecting patient care. It's making for worse patient care. And that's a real problem. We've all, not all of us, but many of us. You know, 75% of those listening to the podcast have dedicated their lives to healing the sick and injured. And today we're going to be talking about a problem that is preventing that. And the worst part about it is it's kind of a self imposed problem. Not by us, but self imposed by government bureaucrats and lobbyists and this organization out there that exists and shouldn't. So let's get our guests on the line and talk about it. My guest today on the White Coat Investor podcast is Dr. Alex Steinschluger, who is somebody you may not have ever heard of, but he has been doing incredible work on your behalf behind the scenes now for quite a long time. And the work he's been doing is the subject of our podcast today. Welcome to the podcast, Dr. Steinschlugger.

Thank you.

So before we get into the subject matter today, I think it would be interesting for our audience to hear a little bit about your upbringing, maybe what it taught you about money and the way you view it.

Oh, certainly my accent tells you about myself quite a bit. I guess the accent is Russian. I was born in the former Soviet Union when the former Soviet Union still existed under communist rule. I was raised in the Soviet Union. I came to the US as a teenager when I was 13 years old, and I went to high school in New York, in New York City. And I went to college in Massachusetts and came back to Brooklyn for medical school. And then I went to St. Louis Washington University for my fellowship.

Okay, so a little bit of Brooklyn accent, a little bit of Russian accent, but I think you're pretty understandable. So I don't think anybody's going to have any trouble understanding what you're saying.

And certainly, you know, when we talk about money, money are important. They are a way to exchange value and to allow the society to function, a modern society to function. Certainly, as you know, money is what we work for, but also it also allows us to pay our employees, which is very important. Right. The same business. If you're in private practice, a lot of hospitals are closing down the doors as well, because, you know, if the amount of money going out is greater than what you're bringing in, you can't really Stay open for too long. So money are important. And you know, one thing that I was taught about money is that you can't really leverage too much. You know, whatever comes in needs to be balanced by whatever comes out. Otherwise you're out of business pretty shortly. So as someone who is in private practice, my cash flow, so to speak, is very important. You know, at the end of the month, I need to pay my rent, I need to pay my employee salaries, and I need to take a take home paycheck as well. If I can't do that, I can stay in business.

So tell us a little bit about your practice. What do you do? What kind of patients do you see?

I'm a urologist. I'm in private practice. I finished a fellowship in a urological oncology. I have a pretty broad practice. Most of my patients are middle class, lower middle class. So not necessarily. Even though I practice in Manhattan, not all of my patients are billionaires. Okay. I practice general urology, ed, bph, urinary incontinence. I also see patients with prostate cancer, bladder cancer, for example. So it's a broad range of urology.

You know, that's very different from urologic practice. Out here in the desert, I feel like 80% of what the guys out here and the ladies out here are doing is all stones. They do stones all day long.

Well, you know, I don't cover the ER call as much now, so as a result, I don't see as many stones. But I do treat patients with kidney stones as well.

Yeah, so you're taking care of people that are middle class, that are lower middle class. You have employees, you have to make salary, you got to make payroll. Obviously you're not doing this out of the goodness of your heart. You also want to get paid as well. But you've noticed something in the, you know, relatively recent past that has affected your ability to do all that. And a recent article in ProPublica described you as being on a crusade against payment processor fees. Can you tell us what a payment processor fee is and why we should care?

Right. So back in 1990, a federal law called HIPAA law was passed. It's called HIPAA Administrative Simplification Requirements. The law was designed to lower the administrative costs of health care and administrative burdens in health care. In fact, the law allowed only those practices that lower the cost of health care and lower administrative costs to be implemented. The law sought to transition health care to the electronic era. So it's mandated that all the paper transactions go away and be replaced by Electronic transactions. So instead of sending paper claims by usps, the claims are going out electronically. As a matter of fact, right now, 97% of claims for payment go out electronically in the United States, which is a great accomplishment, certainly saving a lot of trees and money. In the same vein, the explanation of benefits should be coming in electronically and they should have correct information on them. That's a federal law. Payments should not be coming through the USPS by mail. Instead they should be coming electronically through electronic funds transfer eft, which is less expensive, faster, saves a lot of money to insurance companies and physician practices and it's safer. There is no risk of checks being stolen or disappearing in the mail. So the law was adopted in the 1990s, the regulations were issued and they went into effect in 2004. So starting in 2004, every health plan should be compliant with these regulations, which mandated that insurance companies send payments upon request as long as the physician asks for it to be sent electronically. That the insurance companies send it at no cost to the physicians and other healthcare providers electronically directly to their bank account. That actually saves a lot of money to insurance companies and it certainly saves money to practices. In the end, that allows lower cost provision of healthcare. Because every dollar that I spend on administration has to be paid by someone, right? So in this situation, some health plans decided to hire a third party providers that would, instead of sending payments at no cost as the law requires, impose tremendous costs on payments. For example, zealous charges 2 to 3%, right? 2.5% most recently for sending electronic transaction EFT to providers. 2.5% is actually a tremendous amount of money if you think about it. You know, MedPAC reports that hospital operate on 8% profit margin. So if they have to pay 2.5%, that's 30% of the annual profit. Just paying to receive the payment for the care they provided. It costs at least $5 billion, but more likely $10 billion a year to medical practices. In the in these fees there are also virtual credit cards that health plans and these contractors, third party contractors send to medical practices which create tremendous burden in terms of administration, processing these payments, entering them into EMRs and medical record systems and the processing of credit cards can cost as much as 16% according to a Zealous representative. So this costs a lot of money. Now the interesting part is that when you run a credit card and you pay your merchant fee, that fee is actually split between the bank and Zealous. Then Zealous takes a certain amount of it as splits it with the insurance company. So insurance company and Zealous get a kickback from the banks for processing credit cards for which medical practices are paying through the nose.

So between the credit card fees and the payment processor fee, what percentage of a practice's revenue is going to these third party companies that are doing nothing more than facilitating the payment?

More than you think? More than you think. So the merchant processing fees cost at least 3% of revenue. I'm not even talking about profitability or profit. 3% of overall revenue. So if you buy a cancer medication for $10,000 and you get $60 from Medicare for it for administration and processing, you're paying 3% of the amount you paid for in these fees. It adds up probably overall to more than $10 billion a year. In terms of how much of the total amount of payments are processed, my best estimate is Zealous alone process about 3% of payments in the United States. So at least 3% are affected through Zealous alone. But Zealous is not the only company that does that. UnitedHealthcare VPay is another company that engages in exactly the same practices. It's probably even bigger than Zealous. Echo Health is another one that does exactly the same thing. It imposes fees on EFTs and sends virtual credit cards. And my belief, though now the numbers are difficult to come by, my belief is that they are actually bigger than Zealous as well. So you potentially 7 to 10% of healthcare payments are affected by these fees and costs.

Yeah, I mean, I had never heard of Zealous before I started reading of your work and I suspect that's the case for a lot of our audience. What is Zealous exactly? And why are they so powerful?

Zealous is a multibillion dollar private equity company that is operating on the edges of lawlessness in health care. What they do is that they provide a solution to health plans to comply with the federal law called HIPAA Administrative simplification requirements. They format the data into a compliant form, which is a good service to health plan. It's a legally mandated service. The problem is that they're doing something underhanded. Instead of charging health plans for the services they provide to health plans, they impose these costs on healthcare providers. Right. In addition, because we have no option, I cannot select another merchant to deliver the payments because the merchant is selected by the health plan. Basically, this is a vertical antitrust issue at hand where they basically bend you over and extort you for these fees. Otherwise you're not getting your payment electronically. So while Zealous Provides valuable service to health plans. It provides zero value to healthcare practices. It does nothing for us. There is no reason for us to pay for something where we derive no value. Health plans are legally obligated to deliver the payments to our bank accounts at no cost. That's what the law says. And we're actually being extorted by companies such as Zealous, UnitedHealthcare, VP and Echo Health for something that we are legally entitled to.

Let's pause for a minute and I want to talk about one individual by the name of Matthew Albright. Can you explain who he is and what he has done to doctors?

So Matthew Albright is a bright guy. Apparently I've never met him in person, but he was the interim director of the division of National Standards at cms where according to his bio on Zealous website, he actually wrote the regulations that applied to every electronic transaction between physicians and health insurance companies, including electronic claim transaction, electronic payments via EFT and electronic remittance advice. He wrote the rules and the rules clearly state that the transaction should be delivered to healthcare provider at no cost. As a matter of fact, the regulations are written in such a way that that the entire onus on compliance is on health plans. The providers have a right, physicians have a right, but health plans have obligations. The reason this happened is that health insurance lobby clamored for these regulations. They wanted things to flow electronically because they are saving millions or billions of dollars by not sending paper statements, by not sending paper checks. So they really wanted physician practices and hospitals to adopt these transactions. And they made a deal that they will pay for implementation and for delivering these payments as long as physician practices and hospitals adopt them, agree to adopt them. And that's actually written in the federal regulations. It describes the process of what happened. It's very clear that there was a consensus between the health plans and the provider community that, you know, providers would agree to assume the cost of implementing this. This is also not free, right? We need to build our system to accept these formatted data files. And the insurance companies will pay for transmittal to the bank account payments to the bank account. Unfortunately, once the ink dried up, health plans turned around and started singing a different song. And with the help of Zealous, they started imposing billions of dollars in costs on healthcare providers. Worse, they actually profiting from this by splitting these fees with Zealous VPA and Echo Health. Now, Matthew Albright, after he worked at CMS and wrote the regulations that govern these transactions, a few years later, he went and started working for Zealous interacting with his past underlings as well as colleagues at cms, arguing that the regulations he wrote and enforced are actually not what they are and that they allow Zealous to charge these illegal fees.

So he was an administrator, a government employee, subsequently became a lobbyist for the company that he was in charge of regulating, essentially at his prior job.

Correct.

And it sounds like he's been a very effective lobbyist.

More than that. Tens of billions of dollars in value transferred from physicians to the likes of Zealous, UnitedHealthcare, VPA and Echo Health. Stolen money, essentially stolen from physicians. Burned, but stolen.

Now, there are some organizations, some people out there who aren't paying these processing fees. For example, the VA is refusing to pay these processing fees. Why can't we all do what the VA has done?

Well, what happened is that the va, which is the Veterans affairs, you know, it's a government run system of hospitals in the United States, say in the United States, they provide health care to veterans, but if a veteran comes there for treatment for diabetes, and it's not a covered benefit under the VA benefits and it's usually paid by the employer plan. Right. So Virginia gets paid by insurance companies, employer plans for the care they provide to veterans. So that's how they come into this play. They basically doing the same thing I'm doing in my urology practice now. The VA wanted to get payments electronically through EFT because it would save va, which is, I think, the largest hospital system in the United States, millions of dollars in costs. Instead of processing paper, getting electronic payments is much less costly and assumes less risk of fraud, stolen checks, et cetera, et cetera. So the VA actually filed a complaint with CMS against companies such as Zealous and their ilk. However, CMS did nothing to enforce the law and told the VA that it's completely on its own. So VA started sending hundreds of letters over the past, you know, eight, nine years to health plans asking them to comply with the federal law and send them payments electronically. However, as far as I can tell, based on the Freedom of Information act documents that I obtained from the Veterans affairs, they have not been very successful with that. So the only thing that VA resorted to doing is it stopped accepting virtual credit cards. It will not accept virtual credit cards that costed 3% of revenue and instead it calls the companies like Zealous, echo Health and UnitedHealthcare, VPA subsidiary, and ask them to send checks. So I think instead of incurring these fees, the VA is actually processing paper checks, which are more Costly and involves more administrative waste instead of actually getting what it's legally entitled to, electronic ERA and eft. So my understanding is that VVA is still not getting electronic transactions and instead of paying these fees, it simply incurs a different type of cost by processing paper checks instead of getting eft.

Are you doing this in your practice? Are you refusing to pay the fees and just taking paper checks?

Correct, that's exactly what I'm doing. And it may be actually more costly to me to do that because processing paper checks and electronic remittance advice paper explanation of benefits is not cheap as well, you know. It also exposes me to the risk of check theft or payment theft. But you know, more or less I'm doing it out of spite to companies such as United Healthcare, vpa, Echo Health and Zealous. Now I should note that after my complaints, Echo Health actually without my knowledge, it marked my account as no cost. So it sends me EFT at no cost. But I think I'm the only person in the United States who's getting that. They never told me that. The only reason I found out is because the reporter for the ProPublica article asked me some questions and I started digging. He asked me what am I paying to Echo Health? And I realized that most recently in the past year, I have not been getting, you know, virtual credit cards from them or paper checks. So we would be getting eft, but I never signed up or agreed to pay them. So it turns out they enrolled me in a paid product without asking me to pay for it, just to muzzle me so that I don't complain to cms.

I wonder if it's cheaper for them too. I mean, it can't be super cheap to send the paper checks either.

Oh no, it's not. It's more expensive than sending electronic transactions. But they use them as an extortion tool, like a good mafia tactic. Okay. That we will make it as difficult as possible for you even if it costs us money to extort you into paying us for EFT or getting virtual credit cards.

Yeah. So that's not really the solution to just take paper checks. What do you think the solution to this problem is?

Well, legally speaking, the federal law already forbids these practices. Right? The HIPAA law clearly states that anything that raises the cost of health care or raises administrative burden is illegal. The problem here is that CMS issued regulations with some vague language. Zealous latched onto this somewhat vague language. Now if you take zealous interpretation of regulations, that regulation, that interpretation is illegal per se. Because it raises the cost of health care. So the governing law would not allow that interpretation. But my impression is that CMS is afraid of being sued by zealous. But also, you have to understand that Matthew Albright is not the only person working and massaging CMS and hhs. This is a much broader effort. What I found out is that Visa and MasterCard spend a lot of money lobbying on this issue. You'd be surprised. What would Visa and MasterCard, what business do they have being at HHS and CMS? Lobbying. Right. Well, you'll be surprised. Turns out the lobbyists for MasterCard actually met with the attorneys at HHS and apparently gave them a nice presentation. I don't know if there was a lunch involved or MasterCard or pencils, I don't know. Erasers maybe as well. But they gave them a presentation apparently arguing that HHS should not be banning these virtual credit cards. I filed the Freedom of Information request to HHS about that meeting, but they have not released any information so far.

So it sounds like you feel like the solution is for CMS and HSS to just enforce the law as it is.

Yeah. The bottom line is that CMS needs to enforce the law. The problem is that there is a question whether or not the adoptive regulations have some vague language that prevents them from enforcing them the way they should be enforced. So at this point, I think the only solution is to sue CMS for violation of the federal law called the Administrative Procedure Act.

So how do you envision this lawsuit happening? Is this one doctor suing cms? Is this a class action suit? How do you anticipate this happening?

Well, I don't think you can sue CMS as a class action. You can't really get money from cms. The only thing you can get from CMS is from them to withdraw illegal regulations and issue something that complies with the governing law. Right. So I filed more than 100 complaints about CMS to CMS about these issues. CMS has not given straight answers. And it actually violated federal law called the Administrative Procedure act when it failed to resolve my complaints the way they should be resolved. So the only way to solve this problem is really to sue CMS to force it to comply with the Administrative Procedure Act. The problem is that the cost of a lawsuit like this is more than $500,000. Now you have to remember, at least $10 billion a year is stolen from a US by companies like VPay, UnitedHealthcare, Echo Health, and Zealous. So we're losing an order of Magnitude more money on this. Personally, I can't afford spending $500,000 to defeat Zealous and United Healthcare and the American Medical association will not do anything to help. Unfortunately, worse than that, the American Medical association actually states on its website that these virtual credit cards are not illegal. I have been fighting with the AMA for the past few years asking them to remove this unhelpful language. And the AMA apparently prefers to side with zealous UnitedHealthcare and Echo Health.

So what can doctors do to help?

Well, I think that doctors needs to raise hell with the ama. AMA is the only organization that can afford to sponsor a lawsuit like this and overturn this unhelpful regulations. The physicians should also complain and ask their state medical associations as well as their medical societies such as American Urological Society for me, for example, to help with a lawsuit like that. If we have 20 associations pinching you $25,000, we can do that. Now the big issue is that this issue does not affect simply these electronic transactions and payments. The law is much greater than that. There are many, many issues, including prior authorization electronic attachments that are involved with this. So if we don't force CMS to fix the regulations and enforce them, we are going to suffer much greater on this, including with prior authorizations and electronic attachments. Right now, United Healthcare changed division called Change Healthcare is trying to charge for transmitting electronic attachments. Right. So it's coming up soon. CMS is writing regulations about electronic attachments and United Healthcare is already trying to charge us fees for that. If we don't fix it, it's not going to be a $10 billion a year, it would be 20 or $30 billion a year problem. Now this is the same law, the Administrative Procedure law, Act law is the same law that of course in Texas recently found that cms, HHS violated this law at least three times in a row when it implemented the no Surprises Act. So as you might have heard, the federal court in Texas declared that CMS violated the Administrative Procedure act three times in the past year and forced CMS to reissue no Surprises act regulations. So a lawsuit like this can work. And there is a proof, so to speak, that it does work. It can work fast. Within a year, CMS was forced to rewrite the regulations three times. And that I think is the only way to solve the problem at hand.

All right, well, I sure appreciate you coming on letting us know about this problem. I think step one is just letting people know about it. I mean, I didn't know about this and I'm guessing 99, 99% of doctors didn't know about it. And so it's not just the doctors, it's the practice managers and the billing managers and everybody else like you mentioned. So I think step one is just getting the word out. So I hope today we've helped a lot with that getting the word out about this problem. And then it sounds like step two is raising some money to pay some lawyers to go do lawyer work. So maybe there's even some lawyers listening to this podcast that are interested in helping with this problem because it certainly is a huge problem. Our healthcare system has enough problems as it is. It doesn't need, you know, self imposed ones. So I sure appreciate you coming on to let us know about this. What else do you think doctors need to know that we haven't yet talked about?

Well, I think it's important to know what's happening with prior authorization. It's the greatest problem in healthcare today, affecting patients, our staff and ourselves. The reality is prior authorization is not going away anytime soon. As a matter of fact, the policymakers in Washington D.C. the people at CMS, they see prior authorization as the ultimate mecca in terms of controlling the healthcare expenditures and delivering what they call cost effective evidence based care. The problem is that gold carding is not really a viable solution. Gold carding is easy to overcome. Today they will gold card you, tomorrow they will deny it. You need to do the same service many, many times to get cold carded. The reality is that, you know, every practice does a lot of one thing, but 80% of prior authorizations involve one off medications or procedures. So even if you get gold covered for some procedures or tests or medications, you will not get gold covered for others. The real problem with prior authorization is not that it exists, but it's that we don't get compensated for doing it. So every time we do a prior authorization, it actually we're just pulling money out of pocket. There is a great disincentive for physician practices and hospitals to do prior authorization or to appeal prioritization denials. As a result, patients are suffering. Patients are not getting the care they need because physicians don't have the right incentive to appeal wrongfully denied prior authorizations. The only viable solution to prior authorization reform is a fear compensation for doing prioritization and a fair compensation for appealing improper denials of prior authorization that has been proposed to the ama. However, nothing has been done. The AMA needs to issue CPT codes for prior authorization and for prioritization denial Appeals. And Washington D.C. the Congress and CMS need to mandate that if a health plan wants to require a physician to do prior authorization, it has to compensate adequately and fairly for prior authorization. That is the only way the problem can be fixed properly, fairly, and long term. Any other solution will not be viable. You know, even if you get denial. You know, the real problem is that patients are harmed by prior authorization deniers that are wrongfully denied and not appealed. Physicians cannot afford to appeal every wrongfully denied prior authorization unless they're compensated for that. That's the basic economics behind it. And health plans are writing this as much as they can. They know that we cannot appeal wrongfully denial priorizations, and that's why they denying right and left and taking money to the bank. That's very appropriate for your podcast, as a matter of fact. The economics, that works.

Absolutely. You know, I talk a lot on this podcast about people maximizing their income, you know, and this is a great way to do it. I mean, we're talking about a boost of your income that is not insignificant here to solve these problems. So imagine a day in which you're doing a quarter as many prior authorizations. Once they start paying for them, they're not gonna make you do them nearly as often, number one. And number two, actually getting paid for your time when you do that. It's ridiculous how much donated time docs are doing out there.

Absolutely. It's not even a question of making a profit. It's actually a question of recovering the costs. Okay. When the costs are not recovered, the patients are harmed because prior authorizations are not happening. Improper denials are not appealed. It's well documented in literature and published literature. So I'm not making it up. It's all documented. Patients are harmed by improper denials, especially patients who are least able to afford. Patients on Medicaid are particularly denied, affected, especially those who have significant medical problems.

Yeah. It's not just a financial issue. It's also a patient care issue. Thank you for pointing that out.

Absolutely.

All right, well, Dr. Alex Steinschlueger, thank you so much for coming on the White Coat Investor podcast to make us aware of these problems as well as the potential solutions for them. We appreciate your time. We appreciate all the work you've been putting in over the years.

Jim, I really appreciate your podcast and giving me an opportunity to inform the community about these issues.

It's our pleasure.

Thank you. Have a good day.

Okay. I hope you enjoyed that podcast. You know, he throws out this number, half a million dollars for a lawsuit like it's some insurmountable Sum, I mean, we're talking about 50 cents a doctor. I guess we got a million doctors in the country and we need $500,000. I mean, yeah, it's 50 cents. 50 cents a doctor. That's what we need is 50 cents a doctor to sue these guys and make them actually invent the law the way it is. That is not a lot of money. This should have already been done. What is taking so long? All right, so those of you involved in organized medicine, those of you who aren't, write your medical societies, write the ama, Send in these complaints to cms. Let's get this problem solved. This shouldn't exist. It's affecting patient care. It's affecting your pocketbook. It's affecting physician burnout. Right? This is a problem. Let's solve this problem. We can do this. All right, what else can I tell you? As we wrap up this podcast, don't forget about WCICON. Okay? You sign up@wcievents.com there'll be links in the show notes. There's a link on the main white code investor.com webpage. This is not hard to register. We want you to come register and come to this conference. It's $300 off until October 12th, so please register, come to the conference. It's going to be great. Bring your family. It's in Orlando. Did I mention that right? So come with your family a few days early, Go to Disney World, go to Universal Studios, go to SeaWorld, or stay a few days late, spend the weekend afterward. You know, this is a wonderful time of year to be in Florida and tons of fun stuff to do and it's a life changing conference. So please come. Do you ever find yourself wishing there was somewhere to go to ask your finance, insurance or investing questions? The White Coat investor community is a great place to turn. We have a thriving community across all of our social, Facebook, Twitter, Instagram, Reddit and Facebook. In our WCI forum, we've been discussing solutions to your money problems since 2011. Join the Conversation with thousands of other White Coat investors. Follow WCI on your favorite social media platform for financial resources, tips and strategies. Just head to your platform of choice and search for the White Coat Investor. You can do this and the White Coat Investor can help. Thanks. For those of you who've been leaving five star reviews on this podcast and telling your friends about it, this really does help us to spread the word. One of our reviews that came in very recently is from John Lund who said not just for docs. This is a down to earth, easy to Understand Podcast. The blog and the podcast both give extremely useful investment and life advice. Thank you for working so hard to bring this invaluable advice for free. 5 stars. Thanks John. Appreciate that kind review. For the rest of you, keep your head up, your shoulders back. You've got this and we can help. We'll see you next time on the White Coat Investor Podcast.

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