Running a five-star nursing home

By Jeff Kelly Lowenstein

Top-rated homes had more nurses, less turnover

Excerpts from this story referencing "Health":

"… p; …"

"… omes, the studies said. Jack Wagoner, administrator of the Carlton Shores Health and Rehabilitation Center in Daytona Beach, Florida, said several of the n …"

"… nt, according to a 2012 report by nursing home industry group the American Health Care Association. Buckland estimated that half of the staff at Woodview ha …"

"… as about 55 percent for all of the homes analyzed. Bita Kash, professor of Health Policy and Management at Texas A & M University, said Medicaid’s com …"

More scrutiny coming for Medicare Advantage, Obamacare

By Fred Schulte

New round of audits coming; Obamacare too.

Excerpts from this story referencing "Medicare Advantage":

"… ending on managed health care in the new fiscal year, ranging from private Medicare Advantage groups that treat millions of elderly to health plans rapidly expanding un …"

"… aid waste, fraud and abuse, said it would conduct “various reviews” of Medicare Advantage billing practices with an eye toward curbing overcharges. Results are due …"

"… lent sign ups. The Inspector General’s office did not say if individual Medicare Advantage plans would be audited, but indicated it would focus on concerns that some …"

"… t companies that bill for services never rendered. The abuses suspected in Medicare Advantage are more subtle and complex. Unlike standard Medicare, in which doctors an …"

Another whistleblower suit alleges Medicare Advantage fraud

By Fred Schulte

California litigation alleges 'house calls" yielded false claims

Excerpts from this story referencing "Ohio":

"… ites problems with in-home health visits to Medicare Advantage patients in Ohio, New York, California, Texas, Oregon and Virginia.   The four health …"

GAO takes on Medicare Advantage spending

By Fred Schulte

GAO will investigate program spending.

Excerpts from this story referencing "Miami":

"… dicare Advantage insurers are stacking up in federal courts. In one case, Miami physician Olivia Graves alleged that a Humana-affiliated clinic had diagno …"

A call for more scrutiny of private Medicare Advantage plans

By Fred Schulte

Researchers say aggressive billing by private plans may require more scrutiny

Excerpts from this story referencing "Health":

"… “upcoding.” Researcher Richard Kronick, director of the Department of Health and Human Services’ Agency for Healthcare Research and Quality, said off …"

"… ick, director of the Department of Health and Human Services’ Agency for Healthcare Research and Quality, said officials should consider tightening audit …"

"… ed to kill or scale back planned pay cuts to the Health plans. America’s Health Insurance Plans, the industry’s primary trade group, spent nearly $5 mil …"

"… p overpayments. Clare Krusing, director of communications for America’s Health Insurance Plans, did not respond directly to a question about the payment …"

Docs, drug companies, insurers drive up Medicare costs

By Wendell Potter

Commentary: reform drove down hospital costs, creating Medicare savings, but insurers, doctors and drug companies escaped cuts.

Excerpts from this story referencing "Medicare":

"… ated 78 million baby boomers in this country, I was delighted to hear that Medicare’s Hospital Trust Fund won’t run out of money until 2030 — 13 ye …"

"… attributed to the health care law, some of the provisions aimed at slowing Medicare spending, such as requiring Medicare to reduce payments to hospitals with …"

"… me of the provisions aimed at slowing Medicare spending, such as requiring Medicare to reduce payments to hospitals with high readmission rates, are likely he …"

"… elping. But the Hospital Trust Fund accounts for only about half of total Medicare spending. Most of the rest goes to cover physician fees, prescription drug …"

Medicare Advantage patients find themselves in regulatory limbo

By Fred Schulte

States lack oversight but feds are struggling to keep with fast-growing health plans.

Excerpts from this story referencing "Medicaid":

"… formal complaint, and about two dozen others, to Centers for Medicare and Medicaid Services (CMS) administrator Marilyn B. Tavenner. Swanson asked the federa …"

Ten major findings from our investigations so far this year

By Jared Bennett and Sarah Whitmire

Investigations from the first half of 2014

Excerpts from this story referencing "Washington":

"… outh and the many misleading ways special interests push an agenda in Washington.  Until then, we wanted to review some of the top findings from our …"

How Medicare Advantage plans code for cash

By Fred Schulte

Federal study criticizes Medicare Advantage and calls for changes.

Excerpts from this story referencing "Medicaid":

"… last month on an online research site run by the Centers for Medicare and Medicaid Services, part of HHS. Kronick directs the HHS Agency for Healthcare Resea …"

Feds seek new authority to recoup Medicare Advantage overcharges

By Fred Schulte

Impact: Feds act to recoup overcharges following Center investigation.

Excerpts from this story referencing "Medicaid":

"… king new power to recover excessive charges. The Centers for Medicare and Medicaid Services says its wants to set up “a formal process to recoup overpaymen …"

Medicare Advantage plans require more scrutiny

By Fred Schulte

Government inspector says private Medicare plans difficult to investigate due to lack of access to data.

Excerpts from this story referencing "Congress":

"… gin requiring Medicare Advantage plans to report fraud to the government. Congress created Medicare Advantage in 2003 to encourage private insurance companie …"

Praise for UK-style health system vindicates spurned nominee

By Wendell Potter

Former Medicare chief's support for UK's health care system may win votes in race for governor of Massachusetts.

Excerpts from this story referencing "Medicare":

"… dely respected physician and health policy expert, to lead the Centers for Medicare and Medicaid Services (CMS). Despite having broad support among other heal …"

Health insurance lobby keeps Medicare Advantage overpayments flowing

By Wendell Potter

Commentary: program bills are excessive, but don't expect reforms.

Excerpts from this story referencing "Humana":

"… not come as a shock to me. During my two decades in the industry, at both Humana and Cigna, I came to understand just how much of a cash cow the Medicare A …"

Get involved: Help Medicare Advantage investigation go further with donations and news tips

Join us in finding problems with Medicare Advantage billing, “risk scores”, or home visits.

Home is where the money is for Medicare Advantage plans

By Fred Schulte

Medicare Advantage home visits may not improve health, but boost risk scores and cost taxpayers billions.

Excerpts from this story referencing "Virginia":

"… plans are paid fairly for taking on that responsibility. Scott Weiner, a Virginia Medicare billing expert, said health plans that don’t bill aggressively …"

"… , said Brian Wise, chief executive officer of Advance Health in Chantilly, Virginia. “I know there is a lot of good happening. People who are in danger are …"

Medicare Advantage lobbying machine steamrolls Congress

By Fred Schulte

Under pressure, Medicare Advantage critics morph into defenders.

Excerpts from this story referencing "Humana Inc.":

"… of the nation’s mightiest insurance carriers — UnitedHealth Group and Humana Inc. are two of the biggest — dominate the market and are deeply invested in …"

Health insurers have their way with regulators

By Fred Schulte

Billions in Medicare Advantage overpayments likely gone for good.

Excerpts from this story referencing "inspector":

"… nbsp; It took years for the Department of Health and Human Services (HHS) inspector general to publish those findings, and government officials have yet to pr …"

"… d.   And despite the bundle of taxpayer dollars on the line, the HHS inspector general didn’t do any more audits, and decided in 2013 to scrap similar …"

"… btain those audits. The CMS policy means that those six audits by the HHS inspector general — which does publish its findings — stand as the only public a …"

"… etailing Medicare Advantage billing practices over the past decade. Those inspector general’s audits began late in 2008. Drafts weren’t presented to the h …"

New audits may recover missing millions — or not

By Fred Schulte

Secretive audits target some Medicare Advantage plans.

Excerpts from this story referencing "Medicare Advantage":

"… ieves. …"

"… o top $150 billion this year. The government audits are targeting chronic Medicare Advantage billing errors that federal officials blame for billions of dollars in “ …"

"… recoup as much as $370 million from overpayments allegedly made to the 30 Medicare Advantage plans during 2011, according to CMS. However, that figure is well below p …"

"… ral, which acts as a watchdog over CMS, has done some of its own audits of Medicare Advantage. It estimated much higher losses in six plan audits it conducted starting …"

150 billion reasons Medicare Advantage matters

By Eleanor Bell

Reporter Fred Schulte discusses his investigation into billions of dollars misspent on Medicare Advantage plans.

Excerpts from this story referencing "Medicare Advantage":

"… should be some accountability. …"

"… llion this year, but our latest investigation found that manipulation of a Medicare Advantage payment tool called a “risk score” is adding billions to the program's …"

"… journalist Fred Schulte. For more than a year, he’s been investigating Medicare Advantage, the government-backed alternative to Medicare for seniors run mostly by p …"

"… out that in a moment, but firstly Fred, let’s start from the beginning: Medicare Advantage was introduced by Congress more than a decade ago to stabilize health care …"

Whistleblower suit says health plan cheated government out of more than $1 billion

By Fred Schulte

Lawsuit: executives worried health plan would be ‘screwed’ if feds heard of overcharges.

Excerpts from this story referencing "Healthcare":

"… er government health official claims, he discovered that the plans — MMM Healthcare and PMC Medicare Choice — had been cheating Medicare out of hundreds of …"

"… ts 2012 annual financial report to insurance officials in Puerto Rico, MMM Healthcare stated that it had not been subject to a CMS payment audit. However, in l …"

Explaining Medicare Advantage, and why it matters to you

By Fred Schulte and Sarah Whitmire

Explaining risk scores, Medicare Advantage and what alleged overbilling could mean for the Affordable Care Act.

Excerpts from this story referencing "Congress":

"… ervices and less for healthy people. Why were risk scores adopted?  Congress wanted to make sure health plans wouldn’t shy away from taking sicker pa …"

Methodology for 'Medicare Advantage Money Grab'

By David Donald and Erin Durkin

A behind-the-scenes look at the data analysis for the 'Medicare Advantage Money Grab' investigation.

Excerpts from this story referencing "Medicaid":

"… ed Medicare Advantage (MA) data obtained from the Centers for Medicare and Medicaid Services (CMS). The data contained enrollment and payment information for …"

Medicare Advantage made simple: a glossary

By Fred Schulte

Definitions for lesser-known terms relating to Medicare.

Excerpts from this story referencing "Medicaid":

"… hly premiums average about $35. Other terms The Centers for Medicare and Medicaid Services: Referred to as CMS, this federal agency oversees Medicare and Me …"

"… id Services: Referred to as CMS, this federal agency oversees Medicare and Medicaid, the government health plan for low income people. CMS is part of the Depa …"

"… les: The term refers to people who are eligible both for Medicare and Medicaid because they have low incomes. These patients are generally considered the …"

Why Medicare Advantage costs taxpayers billions more than it should

By Fred Schulte, David Donald and Erin Durkin

Critics warned of billing abuse in Medicare Advantage health plans, but oversight is lagging.

Excerpts from this story referencing "Medicare":

"… ee-part series. In South Florida, one of the nation’s top privately-run Medicare insurance plans faces a federal investigation into allegations that it ove …"

"… ivate health care plans for seniors ran up more than $100 million in added Medicare charges after asserting patients they signed up also were much sicker than …"

"… ormal — a claim many experts have challenged. In Rochester, New York, a Medicare plan was paid $41 million to treat people with serious diseases — even t …"

"… had those diseases. These health plans and hundreds of others are part of Medicare Advantage, a program created by Congress in 2003 to help stabilize health …"

Center sues in an effort to make Medicare Advantage files public

By Fred Schulte

Center sues to make records public.

Excerpts from this story referencing "Medicaid":

"… r reporter Fred Schulte requested records from the Centers of Medicare and Medicaid Services (CMS), an arm of HHS, in a May 21, 2013, letter. The letter asked …"

The Canadian health care system I disparaged

By Wendell Potter

Commentary: health care system up north is more efficient.

Excerpts from this story referencing "Congress":

"… program, but only for folks 65 and older and some younger disabled people. Congress also created the federal and state-administered Medicaid program for the n …"

"… ate to state, and (2) the prescription drug benefit (Medicare Part D) that Congress added a few years ago. The Canadian Medicare program is akin to our Medica …"

GOP opposition to Obamacare baffles Dr. Sullivan

By Wendell Potter

Commentary: former HHS Secretary Sullivan says Obamacare resembles plan crafted by Republicans.

Excerpts from this story referencing "Louis W. Sullivan":

"… y’s most admired figures, former Health and Human Services Secretary Dr. Louis W. Sullivan. Speaking at the opening session of the Association of Health Care Journa …"

Dental chain may be booted from Medicaid program

By David Heath

Small Smiles, under federal scrutiny for performing unnecessary dental treatments on children, could be barred from the Medicaid program.

Pay no attention to those insurance lobbyists behind the Medicare curtain!

By Wendell Potter

Commentary: 'grass-roots' campaign actually comes from health insurers.

Excerpts from this story referencing "Insurance":

"… al tenant of 601 Pennsylvania Avenue., N.W., Suite 500: America’s Health Insurance Plans, which is one of the best-funded and influential lobbying and PR out …"

Obamacare and emergency rooms: a bit of perspective needed

By Wendell Potter

Commentary: Oregon study cited by critics requires perspective.

Excerpts from this story referencing "insurance":

"… t even more crowded. And that’s because more Americans will finally have insurance.  Reform advocates have long suggested that getting folks out of the …"

"… costly care from hospitals’ emergency rooms. ‘Those of us with health insurance are also paying a hidden and growing tax for those without it — about $1 …"

"… a bit of twisted logic in that paragraph. It is true that those of us with insurance pay considerably more for it because those who don’t have it often can …"

"… e” to its insured customers. Researchers have estimated that people with insurance pay $1,000 more a year for it than they would if this cost shifting didn …"

Pages