Another whistleblower suit alleges Medicare Advantage fraud

By Fred Schulte

California litigation alleges 'house calls" yielded false claims

Excerpts from this story referencing "Health":

"… nd eye” to the practices. The Health plans named in the suit are: Molina Healthcare of California; WellPoint, Inc., which operates  Anthem Blue Cross …"

"… ; WellPoint, Inc., which operates  Anthem Blue Cross and Blue Shield; Health Net of California, Inc. and Alameda Alliance for Health.  None would …"

"… s and Blue Shield; Health Net of California, Inc. and Alameda Alliance for Health.  None would comment. MedXM chief executive officer Sy Zahedi called …"

GAO takes on Medicare Advantage spending

By Fred Schulte

GAO will investigate program spending.

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 "Washington":

"… ect scam,” said Patrick Burns, co-director of Taxpayers Against Fraud in Washington. “You simply systematically up-code conditions and that results in massi …"

"… g involved, the Medicare Advantage payment dispute is the sort of issue in Washington that barely registers outside of a small circle of policy wonks and indust …"

"… y lobbyists, who often rule the day in influencing government policy. In a Washington meeting last week, executives of the two biggest Medicare Advantage plans, …"

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.

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.

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 "Comcast":

"… ished. Keep reading 9. Only 12% of eligible households have signed up for Comcast's affordable Internet program Back in 2011, Comcast wanted to ease feder …"

"… s have signed up for Comcast's affordable Internet program Back in 2011, Comcast wanted to ease federal approval of its merger with NBC Universal, so it pr …"

"… es. The program, called "Internet Essentials," helped show regulators that Comcast's corporate deal was in the public interest (and it made for good public r …"

"… s in the public interest (and it made for good public relations, too). Now Comcast wants to buy Time Warner, and this new merger begs the question — what h …"

How Medicare Advantage plans code for cash

By Fred Schulte

Federal study criticizes Medicare Advantage and calls for changes.

Excerpts from this story referencing "Insurance":

"… boost payment rates. Clare Krusing, a spokeswoman for America’s Health Insurance Plans, the industry’s trade group, said the higher billing resulted from …"

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 "spokesman":

"… riority for CMS in order to protect beneficiaries and taxpayers," said CMS spokesman Raymond Thorn. "This new rule is just another tool that CMS would use to r …"

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 "Health":

"… a 2008 speech commemorating the 60th anniversary of the U.K.’s National Health Service (NHS). The headline of a story on the website of the conservative …"

"… out Berwick at the time: “CMS Nominee Favors Government-Run Rationing of Health Care.” The story went on to quote Berwick as having said in England, …"

"… several countries on dozens of performance measures, the U.K.’s National Health Service ranked No. 1 in the world. The U.S. didn’t come close to the top …"

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.

Medicare Advantage lobbying machine steamrolls Congress

By Fred Schulte

Under pressure, Medicare Advantage critics morph into defenders.

Health insurers have their way with regulators

By Fred Schulte

Billions in Medicare Advantage overpayments likely gone for good.

Excerpts from this story referencing "depression":

"… f extra dollars over the course of a year to treat a single patient. Take depression. Mild and temporary feelings of sadness and hopelessness don’t increase …"

"… f sadness and hopelessness don’t increase Medicare payments. But if that depression and other symptoms linger for at least two weeks it may be classified as …"

New audits may recover missing millions — or not

By Fred Schulte

Secretive audits target some Medicare Advantage plans.

Excerpts from this story referencing "Medicaid":

"… een completed, or what the results might be. The Centers for Medicare and Medicaid Services (CMS), the agency that runs Medicare, has quietly conducted some …"

150 billion reasons Medicare Advantage matters

By Eleanor Bell

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

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 "Washington":

"… ;Dr. Brian Biles, a professor in the Department of Health Policy at George Washington University, whose Freedom of Information Act lawsuits shook loose limited …"

"… ry intentionally tried to overpay them a little bit,” said Scully, now a Washington lobbyist with numerous health care industry clients. Health status was ad …"

"… rnment, including a criminal investigation by the Department of Justice in Washington and a criminal case involving the U.S. Attorney’s branch office in West …"

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 "Medicaid":

"… be “screwed” if it was audited by the federal Centers for Medicare and Medicaid Services, especially if the review reached back to 2007. She said overchar …"

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 Advantage":

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

"… e will pay for. This option is called “fee-for-service.” By contrast, Medicare Advantage plans accept a set fee from the government for covering a person’s healt …"

"… nd eyeglasses and cost patients less out of pocket than standard Medicare. Medicare Advantage is growing rapidly and now serves about 16 million people, about a third o …"

"… hat are risk scores? A risk score is a formula the government uses to pay Medicare Advantage plans. The system is supposed to pay higher rates for sicker patients that …"

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.

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 …"

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.

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 "Republicans":

"… of the Affordable Care Act are based on the reform proposals he and other Republicans crafted more than two decades ago. “Many of the features of the Afforda …"

"… to say that the plan he developed in 1991 with help and support from other Republicans — including those who are leading the charge against Obamacare today — …"

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.

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 "Oregon":

"… bsp; …"

"… t — which began in some states on January 1 — many who wrote about the Oregon study jumped to the conclusion that the millions of newly enrolled Medicai …"

"… I may be going out on a limb, but I for one don’t buy the idea that the Oregon study means emergency rooms are going to get even more crowded. And t …"

"… ropriately and inexpensively in a clinic or doctor’s office.   The Oregon study, which was published in the journal Science, would seem to disprove …"

As glitches fade, Obamacare approval will rise

By Wendell Potter

Commentary: as website improves, customers are finding insurance deals.

Feds propose shakeup for emergency room billing

By Fred Schulte

Proposal seeks to counter alleged over-billing with standardized rate

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