DC EKG

Elizabeth Chamblee Birch, law professor and author of The Pain Brokers, exposes a coordinated healthcare fraud scheme targeting over 100,000 women. Stolen HIPAA-protected health records were weaponized by call centers in India and South Florida to convince women they needed emergency mesh removal surgery. Many women were left permanently incontinent after unnecessary procedures. The scheme involved call centers using stolen medical data, South Florida surgical operations, lawyers creating hidden liens, and litigation funders profiting from women's suffering. Birch introduces the villains: Vince Chabra (online pill mill founder), Blake Barber (travel concierge), and complicit doctors. She also highlights heroes: Barbara Bennis (defense attorney who uncovered the conspiracy) and J.R. Baxter (young plaintiffs lawyer who fought back). The episode reveals how electronic health record systems enabled massive data breaches, how private equity infiltrated the legal system, and what reforms are desperately needed to prevent future schemes.

Key Timestamps

0:53 Joe Grogan introduction
1:25 Joe asks Elizabeth about her background
1:37 Elizabeth's background: 21 years teaching mass torts
2:25 Elizabeth's MFA in narrative nonfiction at UGA
3:26 What is vaginal mesh used for?
5:21 Sharon gets intimate stolen medical data in phone call
6:00 Sharon didn't know she had mesh inserted
6:32 Call centers in India and South Florida
7:32 Alpha Law: Frankenstein firm through D.C. loophole
9:31 Outbound calls fueled by illegal stolen HIPAA data
10:12 Sharon's journey through the system
12:39 Sharon's financial devastation: $69-120K lien
13:24 Litigation funders threaten Sharon's house after settlement
15:00 Multi-district litigation vs class action
16:15 The perverse economics of the scheme
17:33 Economics: $15K vs $215K+ for removal
19:10 Women left permanently incontinent after unnecessary surgeries
21:15 Meet Vince Chabra and Blake Barber: the kingpins
26:11 Wolf of Wall Street moment: 14,000 claims for $40 million
27:45 Cold called over 100,000 women, signed 14,000 as clients
28:35 Barbara Bennis: defense attorney hero discovers conspiracy
30:37 Jerry Plummer and J.R. Baxter: young lawyer fighting back
34:36 Electronic health records enabled the data breach
36:07 Women receive $40K average settlement before fees
37:30 Data bias in medicine: gender gap in settlements
42:37 Solutions: anti-kickback statute reform
43:35 Private equity infiltrating law firms: the next frontier

Key Topics
Vaginal mesh litigation, healthcare fraud, HIPAA violations, stolen health records, call center fraud, litigation funding, private equity, women's health bias, legal reform, unnecessary surgery, settlement bias, data breach, electronic health records

Podcast: DC EKG with Joe Grogan | Episode: 139 | Host: Joe Grogan | Guest: Elizabeth Chamblee Birch, Law Professor, University of Georgia

Sponsor: Survivors for Solutions – https://survivorsforsolutions.org
Executive Producer: John "CZ" Czwartacki, DC EKG Podcast
Producer: Stay on Course Studios – https://www.stayoncourse.studio

Guest: John Bertrand, former Digital Diagnostics

Episode Description
Joe Grogan sits down with John Bertrand, a veteran healthcare technology executive who scaled Digital Diagnostics to 75 health systems and achieved the first FDA approval and CMS reimbursement for an autonomous AI diagnostic device without a physician in the diagnostic loop. Bertrand reveals the harsh realities of bringing AI innovation to market: FDA and CMS regulatory frameworks are built for traditional medical devices and physician-driven care, not autonomous AI diagnostics. The conversation covers the shocking CMS reimbursement draft that came in 40-60% below cost of goods sold, the massive first-mover disadvantage in regulated medical device AI, and why reimbursement is the true gating factor for adoption—not clinical superiority. Bertrand explains how workflow integration and financial incentives matter far more than being clinically better. The episode explores the massive gap between what entrepreneurs think should happen with new innovations and the regulatory reality. He concludes with a sobering assessment: if building diagnostic AI again, he would choose supply chain automation instead because the regulatory and reimbursement headwinds are so significant they punish innovators. Where AI is actually making an impact today is patient-facing triage agents, administrative automation, and revenue cycle management—areas with far less friction.

KEY TIMESTAMPS
0:40 Joe introduces John Bertrand and his healthcare tech background
1:28 John clarifies he recently left Digital Diagnostics for supply chain work
2:40 John's career: 13 years at Epic Systems across multiple roles
6:10 What does Digital Diagnostics' AI device do? Automating retinal imaging
7:56 First FDA approval and first CMS reimbursement for autonomous AI diagnostic
9:02 Joe's threshold question: shouldn't better innovation be easily adopted?
9:50 Reality: workflow integration and reimbursement matter more than clinical quality
11:50 The adoption curve: all successful FDA-approved AI devices have CMS reimbursement
14:10 FDA experience: desire to help but frameworks built for old technology
15:40 FDA scrutiny on AI exceeds scrutiny on human clinicians
18:05 FDA guidance changes every 6-12 months, creating constant pivoting and delays
20:08 Shifting to CMS: the shocking draft reimbursement story
20:45 Draft came in at $10 per test, needed $30+ to be viable
22:42 Four months of negotiations with CMS to shift value argument
24:40 Process not codified: each company follows unique regulatory path
28:04 Six years at Digital Diagnostics: was it worth it?
28:44 John would not recommend diagnostic AI to new founders
33:02 Turning down multiple diagnostic AI opportunities post-Digital Diagnostics
34:19 AI hype vs reality: where are patients actually seeing life improvements?
34:19 Patient-facing triage agents are the second inning of real AI opportunity
36:25 Reimbursement for chat-based triage: who gets paid?
38:23 Autonomous vs assistive AI: the regulatory gap that exists
40:31 Could Digital Diagnostics have done physician-in-loop from the start?
41:33 Real opportunity: clinical practices deploying their own AI
42:20 State licensing nightmare: deploying AI across 50 states
44:55 The real concern: RCM automation becoming a zero-sum AI bot battle
45:20 Dead Internet Theory applied to healthcare revenue cycle
47:38 Closing: a tour de force on AI healthcare reality

Key Topics
AI in healthcare, FDA approval process, CMS reimbursement, autonomous AI diagnostics, Digital Diagnostics, diabetic retinopathy, regulatory frameworks, first-mover disadvantage, workflow integration, reimbursement strategy, patient-facing AI, healthcare innovation, regulatory friction, adoption barriers, state licensing, RCM automation, healthcare AI reality

About the Guest
John Bertrand is a veteran healthcare technology executive with over 20 years of experience. He spent 13 years at Epic Systems in analyst, product manage

This is a legacy episode recorded in January 2026. At the time of recording, Naomi Lopez was founder of Nexus Policy Consulting and a leading voice in healthcare policy, healthcare AI, and state health reform.

Joe Grogan sits down with Naomi Lopez from Nexus Policy Consulting to recap the first Healthcare AI Policy Summit held in December 2025 in Washington, DC. They discuss big themes shaping healthcare AI, HHS approaches to AI adoption, and what regulatory clarity could look like. The conversation covers new federal initiatives like ACCESS and TEMPO that may reshape chronic disease management for Medicare patients. They unpack HHS Deputy Secretary Jim O'Neill's vision for AI in government, including using large models to improve physician productivity, payment integrity, and care coordination. They dig into ACCESS Medicare payment model and FDA TEMPO initiative, explaining how these pilots test AI tools in real-world chronic disease management for hypertension, diabetes, musculoskeletal pain, and depression. The discussion widens to physician burnout, interoperability, rural care, states and federal preemption, and what tech companies becoming Medicare Part B providers could mean for healthcare innovation.

Key Timestamps

0:00 Intro and why the Healthcare AI Policy Summit matters
2:00 Summit recap: big themes and regulatory pressure points
6:00 Jim O'Neill at HHS: regulatory clarity and adoption inside government
12:00 ACCESS explained: Medicare chronic disease management payment model
18:00 TEMPO explained: FDA's risk-based approach for chronic care tools
24:00 Wearables, remote patient monitoring, and virtual ICU models
30:00 Privacy, de-identification, and re-identification risk
35:00 AI inside HHS and FDA: productivity, payment integrity, care coordination
41:00 Reducing admin burden and physician burnout
47:00 Rural healthcare: scaling diagnostics and access with AI
52:00 Interoperability and data sharing: APIs, friction, and incentives
58:00 State AI laws versus federal preemption
1:04:00 2026 outlook: tech companies as Medicare Part B providers
1:09:00 Wrap-up and what to watch next

Key Topics
Healthcare AI, ACCESS payment model, TEMPO initiative, FDA regulation, Medicare reimbursement, chronic disease management, AI in government, physician productivity, care coordination, wearables, remote patient monitoring, privacy and de-identification, rural healthcare, interoperability, state AI regulation, federal preemption, healthcare innovation, payment integrity

About the Guest (at time of recording, January 2026)
Naomi Lopez is the founder of Nexus Policy Consulting and a leading voice in healthcare policy, healthcare AI, and state health reform. She co-founded a healthcare AI working group and co-hosted the inaugural Healthcare AI Policy Summit in December 2025 in Washington, DC. Her work focuses on how regulation, Medicare and Medicaid policy, and state law shape healthcare innovation, access, and affordability.

Podcast: DC EKG with Joe Grogan
Host: Joe Grogan
Guest: Naomi Lopez

Sponsor: Survivors for Solutions
Executive Producer: John CZ Czwartacki, DC EKG Podcast

In this "REFILL" episode, Joe Grogan sits down with Jackson Hammond from Paragon Health Institute to unpack what the latest CMS National Health Expenditure data says about where U.S. healthcare is headed. They break down spending trends from $5.2 trillion to projections of $8.6 trillion, explaining what changed, what didn't, and what it means for affordability, Medicare, Medicaid, and long-run fiscal pressure. The conversation connects spending outlook to Jackson's work on CMS Innovation Center reform and debates whether CMMI is bending the cost curve or adding bureaucracy without accountability. Jackson argues we should aim for healthcare so affordable you barely need insurance, exploring how choice and competition could reshape the system.

Key Timestamps

0:55 Jackson's background and how he got into health policy
3:39 Focus areas: Medicare, hospitals, drug pricing, PBMs, and 340B
5:14 What the NHE report is showing
6:14 Healthcare spending trajectory: $5.2T to $8.6T and why it matters
8:00 Why health spending is not really optional
10:11 Where the money goes: payer mix and per-enrollee costs
12:23 Medicaid costs, provider taxes, and state financing tactics
15:58 Medicare spending pressure and fiscal risk
21:06 Misconception: coverage equals care
26:18 Why provider payments keep rising after COVID demand and consolidation
33:01 Rural care, consolidation, and rural emergency hospital models
40:08 Drug pricing: retrospective versus prospective MFN approaches
49:20 2026 outlook and closing thoughts

Key Topics
National Health Expenditure, healthcare spending, CMS reform, CMS Innovation Center, Medicare spending, Medicaid costs, hospital consolidation, rural healthcare, drug pricing, PBMs, 340B program, provider payments, patient-centered care, healthcare affordability, choice and competition, fiscal policy

About the Guest (at time of recording, January 2026)
Jackson Hammond is a Senior Policy Analyst at the Paragon Health Institute focused on health spending, CMS policy, and reforms centered on choice, competition, and patient-centered care. He authors Paragon's Paragon Prognosis analyses and has written extensively on CMS Innovation Center reform and strategies for making healthcare more affordable through competitive market approaches.

Podcast: DC EKG with Joe Grogan
Host: Joe Grogan
Guest: Jackson Hammond

Sponsor: Survivors for Solutions
Executive Producer: John CZ Czwartacki, DC EKG Podcast