Running a five-star nursing home

By Jeff Kelly Lowenstein

Top-rated homes had more nurses, less turnover

Excerpts from this story referencing "Center for Public Integrity":

"… nt staffing levels and a five-star rating, according to an analysis by the Center for Public Integrity. The Center’s analysis of more than 10,000 nursing homes found consisten …"

More scrutiny coming for Medicare Advantage, Obamacare

By Fred Schulte

New round of audits coming; Obamacare too.

Excerpts from this story referencing "Government":

"… hed up just $157,777 to settle the matter in December 2013, for instance. Government officials aren’t sure how much of the suspected overpayments to Medicare …"

Another whistleblower suit alleges Medicare Advantage fraud

By Fred Schulte

California litigation alleges 'house calls" yielded false claims

Excerpts from this story referencing "Medicare":

"… m of diagnosing “false and fraudulent” medical conditions that several Medicare Advantage plans allegedly used to overcharge the federal government by $1 …"

"… nta Ana, California-based firm sends medical professionals to the homes of Medicare Advantage members to assess their health. Silingo claims she was fired la …"

"… fornia, was unsealed by a judge late last month. The suit also names four Medicare Advantage insurance plans which, Silingo alleges, “turned a blind eye” …"

"… s lawsuit is likely to draw further attention to government oversight of Medicare Advantage plans. The health plans, an alternative to standard Medicare, ar …"

GAO takes on Medicare Advantage spending

By Fred Schulte

GAO will investigate program spending.

Excerpts from this story referencing "Health":

"… attorney with the Center for Medicare Advocacy in Washington. America’s Health Insurance Plans, the industry’s trade group, wouldn’t comment on the G …"

"… y lobbied to scale back planned pay cuts to the Health plans. America’s Health Insurance Plans, the industry trade group, spent nearly $5 million lobbyin …"

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 Advantage":

"… to provide incentives for health insurance companies to participate in the Medicare Advantage program and administer the Medicare drug program. The Affordable Care Act …"

"… ch themselves, in both lawful and unlawful ways, since the creation of the Medicare Advantage program in 1997.  Under this program, Medicare pays privately run he …"

"… CPI investigation uncovered as much as $70 billion of improper payments to Medicare Advantage plans from 2008 through last year. Will Congress act to save taxpayers bi …"

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 "Health":

"… Jepsen called for federal officials to “aggressively scrutinize” UnitedHealthcare’s decision to drop a large number of doctors from its Medicare Advan …"

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 "Medicare":

"… ut reporting to the state. Keep reading 6. About a third of all people on Medicare are covered by health plans that are susceptible to billing abuse Americ …"

"… ealth insurance plans are simply claiming they are. Our investigation into Medicare Advantage found that billions of tax dollars are wasted every year through …"

"… nd that billions of tax dollars are wasted every year through leakage of a Medicare payment tool called a “risk score.” The formula is supposed to pay hea …"

How Medicare Advantage plans code for cash

By Fred Schulte

Federal study criticizes Medicare Advantage and calls for changes.

Excerpts from this story referencing "Congress":

"… Further policy changes will likely be necessary,” the study concludes. Congress created Medicare Advantage in 2003 to encourage private insurance companie …"

"… stry and the fear of angering seniors also has largely quieted concerns in Congress that Medicare Advantage plans can be a poor value for taxpayers. Congress …"

"… Congress that Medicare Advantage plans can be a poor value for taxpayers. Congress recognized problems with Medicare Advantage coding as far back as 2005, wh …"

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 "Medicare":

"… lic. The case is pending. …"

"… ally, are seeking new power to recover excessive charges. The Centers for Medicare and Medicaid Services says its wants to set up “a formal process to reco …"

"… Center for Public Integrity investigation published last month found that Medicare paid the health plans nearly $70 billion in “improper” payments — mo …"

"… verstating the health risks of patients — from 2008 through 2013 alone. Medicare expects to pay more for sicker patients and less for those in good health …"

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 "Medicaid":

"… at more needs to be done to protect tax dollars. Centers for Medicare and Medicaid Services (CMS) officials unveiled a new data analysis system to identify o …"

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 "Barack Obama":

"… told you so” note to a few folks in Washington. …"

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 "Medicare":

"… te House, regardless of who is sitting in the Oval Office. The Center’s Medicare Advantage Money Grab investigation, led by veteran reporter Fred Schulte, …"

"… Federal officials made nearly $70 billion in “improper” payments to Medicare Advantage plans from 2008 to 2013, mostly overbillings, by manipulating or …"

"… lans from 2008 to 2013, mostly overbillings, by manipulating or misusing a Medicare payment tool called a “risk score.” From 2007 through 2011, Medicare …"

"… Medicare payment tool called a “risk score.” From 2007 through 2011, Medicare Advantage risk scores rose more than twice as fast as the average for peop …"

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.

Excerpts from this story referencing "Medicare":

"… y Gordon Witkin.      …"

"… ls that billions of tax dollars are wasted every year through leakage of a Medicare payment tool called a "risk score". Get involved   If you are a hea …"

"… are a health professional or medical coder and have a story to tell about Medicare Advantage billing issues or “risk scores”, please send Fred Schul …"

"… res”, please send Fred Schulte an email. If you are a patient in a Medicare Advantage plan and have been scheduled for a “home visit” let us know …"

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 "Medicare Advantage":

"… itizens who called Arizona insurance agent Denise Early wondered why their Medicare Advantage health plans were eager to send a doctor to visit them at home. A few wor …"

"… e cottage industry is flourishing as federal officials struggle to prevent Medicare Advantage plans from overcharging the government by billions of dollars every year, …"

"… has found. Medicare made nearly $70 billion in “improper” payments to Medicare Advantage plans from 2008 through 2013, mostly overbillings based on inflated risk s …"

"… ons posed in writing. Limiting the house calls could have cut payments to Medicare Advantage plans by nearly $3 billion a year, according to a report prepared for the …"

Medicare Advantage lobbying machine steamrolls Congress

By Fred Schulte

Under pressure, Medicare Advantage critics morph into defenders.

Excerpts from this story referencing "Medicare Advantage":

"… ng their policies.” …"

"… thanked by industry surrogates for their help in killing some of the same Medicare Advantage cuts he’d previously supported so forcefully. By most accounts it was a …"

"… rs of Congress and the Obama administration, and a forceful flexing of the Medicare Advantage industry’s growing political might in Washington. John Gorman, a top Me …"

"… ge industry’s growing political might in Washington. John Gorman, a top Medicare Advantage consultant, hailed the lobbying victory in early 2013 as a “direct refle …"

Health insurers have their way with regulators

By Fred Schulte

Billions in Medicare Advantage overpayments likely gone for good.

Excerpts from this story referencing "diseases":

"… ngress wanted to systematically pay more for people with chronic or costly diseases, such as cancer and diabetes with complications, and less for those in rob …"

"… heir patients were­ — or failing to document that patients actually had diseases the plans were paid to treat, according to CMS. Overall, Medicare paid the …"

"… e paid fairly. Medicare tried to predict the costs of treating a range of diseases, including those likely to require expensive treatment and adjusted paymen …"

New audits may recover missing millions — or not

By Fred Schulte

Secretive audits target some Medicare Advantage plans.

Excerpts from this story referencing "Medicare":

"… ieves. …"

"… s of millions of dollars for past overcharges and other billing mistakes. Medicare pays the health plans a set amount monthly for each person based on estima …"

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

"… ts have yet been completed, or what the results might be. The Centers for Medicare and Medicaid Services (CMS), the agency that runs Medicare, has quietly co …"

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":

"… 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 …"

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

"… een investigating Medicare Advantage, the government-backed alternative to Medicare for seniors run mostly by private companies. At the heart of the story ar …"

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 "Florida":

"… being provided,” Cosgrove said. …"

"… al health officials to improve reporting of risk score data. In the South Florida case, government lawyers have been investigating Humana, Inc. for several …"

"… hysician Olivia Graves against Humana. Graves, who has practiced in South Florida for more than three decades, alleges that a Humana-owned clinic …"

"… hing to stop it.. The U.S. Attorney’s Office declined to join the South Florida case even though a federal judge granted it 11 requests for more time to i …"

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 "New Jersey":

"… two Puerto Rican Medicare Advantage health plans owned by a subsidiary of New Jersey company: Aveta Inc. But a few months after coming on board, the former go …"

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 "Medicare":

"… can answer it, we'll do so and add it here. …"

"… so and add it here. …"

"… and Medicare? They’re two sides of the same coin. By choosing standard Medicare, people can visit any doctor they want. But they may have to buy supplemen …"

"… ant. But they may have to buy supplemental insurance to cover gaps in what Medicare will pay for. This option is called “fee-for-service.” By contrast, M …"

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 "Government":

"… rcent growth overall between just two of the years in the data. Finally, a Government Accountability Office Report suggests it could be higher. A 3 percent aver …"

Medicare Advantage made simple: a glossary

By Fred Schulte

Definitions for lesser-known terms relating to Medicare.

Excerpts from this story referencing "Medicare":

"… ronic diseases such as diabetes and take other steps to manage their care. …"

"… any doctor they want and buy insurance policies to cover any gaps in what Medicare will pay for. Doctors bill Medicare for each service they provide. Medica …"

"… nce policies to cover any gaps in what Medicare will pay for. Doctors bill Medicare for each service they provide. Medicare Advantage: Nearly 16 million seni …"

"… dicare will pay for. Doctors bill Medicare for each service they provide. Medicare Advantage: Nearly 16 million seniors have joined about 700 insurance plans …"

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 "Medicare":

"… nd Human Services, seeking a wide range of records concerning oversight of Medicare Advantage health insurance plans for senior citizens. The suit, filed tod …"

"… equires a response within 20 working days.  “The information about Medicare Advantage that we are asking for should be readily available to the taxpay …"

"… g our request,” said Bill Buzenberg, the Center’s Executive Director. Medicare Advantage, a privately-run alternative to standard Medicare, has enrolled …"

"… ive Director. Medicare Advantage, a privately-run alternative to standard Medicare, has enrolled nearly 16 million elderly and disabled persons at an annual …"

The Canadian health care system I disparaged

By Wendell Potter

Commentary: health care system up north is more efficient.

Excerpts from this story referencing "Medicine":

"… RAND Corporation found in a 2004 study published in the Annals of Internal Medicine that the VHA outperformed all other sectors of the U.S. health care system …"

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 "Tampa":

"… overnment is in,” Deal said during the Republican National Convention in Tampa in 2012. Sullivan told the journalists Thursday that, in his view, Georgi …"

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 "America":

"… f the ads is the real tenant of 601 Pennsylvania Avenue., N.W., Suite 500: America’s Health Insurance Plans, which is one of the best-funded and influentia …"

Obamacare and emergency rooms: a bit of perspective needed

By Wendell Potter

Commentary: Oregon study cited by critics requires perspective.

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