GAO takes on Medicare Advantage spending

By Fred Schulte

GAO will investigate program spending.

Excerpts from this story referencing "Government Accountability Office":

"… mistakes estimated to cost taxpayers billions of dollars every year. The Government Accountability Office, the watchdog arm of Congress, is conducting the probe at the request of t …"

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.

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

"… ays privately run health plans a set monthly rate for each patient. As the Center for Public Integrity reported in a series of investigative reports this past June, about 16 mil …"

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 "Charles Lewis":

"… y year before. This year also marks the 25th Anniversary since our founder Charles Lewis started the Center from his guest bedroom.  But we still have a lot …"

How Medicare Advantage plans code for cash

By Fred Schulte

Federal study criticizes Medicare Advantage and calls for changes.

Excerpts from this story referencing "Health":

"… years. Analyzing government data never before made public, Department of Health and Human Services researchers found that many plans exaggerate how sick t …"

"… are and Medicaid Services, part of HHS. Kronick directs the HHS Agency for Healthcare Research and Quality, whose mission is to improve Health care delivery …"

"… said Dr. David Wennberg, a researcher at the Dartmouth Institute for Health Policy and Clinical Practice who has studied Medicare billing trends. Hea …"

"… lth Policy and Clinical Practice who has studied Medicare billing trends. Health care fraud expert Malcolm Sparrow, a professor at Harvard’s Kennedy Scho …"

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 "Medicare":

"… ederal officials need to step up efforts to investigate fraud and abuse in Medicare Advantage health plans treating millions of elderly Americans, a top gover …"

"… Commerce. The hearing was called to assess fraud and abuse safeguards in Medicare, which last year covered about 51 million people at a cost to taxpayers of …"

"… $50 billion of that amount was paid improperly, including $11.8 billion to Medicare Advantage plans. A Center for Public Integrity investigation published ea …"

"… ed earlier this month found as much as $70 billion of improper payments to Medicare Advantage plans from 2008 through last year. The Center’s investigation …"

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 "Massachusetts":

"… . a central part of his campaign for another high-profile job: governor of Massachusetts. Last week, Berwick got closer to that goal during the state’s Democrat …"

"… nvention when he became one of three candidates to qualify for the Sept. 9 Massachusetts primary. State Treasurer Steven Grossman and Attorney General Martha Coakl …"

"… d try to get a copy of the Commonwealth Fund report in the hands of every Massachusetts voter. And he might be tempted to send an “I told you so” note to a fe …"

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 "Center for Public Integrity":

"… o earnings,” to use Wall Street jargon. …"

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 "George W. Bush":

"… declined to be interviewed. Thomas A. Scully, who led CMS under President George W. Bush, serves on Matrix’s board and is a general partner in the investment fir …"

Medicare Advantage lobbying machine steamrolls Congress

By Fred Schulte

Under pressure, Medicare Advantage critics morph into defenders.

Excerpts from this story referencing "Center for Responsive Politics":

"… s industry over the past three election cycles, according to data from the Center for Responsive Politics. Franken alone has received at least $90,000 from the health services indu …"

New audits may recover missing millions — or not

By Fred Schulte

Secretive audits target some Medicare Advantage plans.

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

"… he end of last year, according to government sampling data reviewed by the Center for Public Integrity. Mary Inman, a San Francisco lawyer who represents whistleblowers, said o …"

"… ficial. The letter was signed by four other senior Democrats as well. The Center for Public Integrity’s independent analysis of government data confirmed that in 2011 more th …"

Health insurers have their way with regulators

By Fred Schulte

Billions in Medicare Advantage overpayments likely gone for good.

Excerpts from this story referencing "disease":

"… ia, a person treated for blurry vision was charted as having serious heart disease.  It took years for the Department of Health and Human Services (HHS …"

"… 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 ro …"

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

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

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.

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.

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.

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 Services":

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

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 "The Wall Street Journal":

"… ng data and other records. In a 2009 case, the Center, in partnership with The Wall Street Journal, sued to obtain Medicare billing records for thousands of doctors and hosp …"

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.

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 "Government Accountability Office":

"… boatload of money by participating in the Medicare Advantage program. The Government Accountability Office noted in a recent report that the federal government spent about $135 bill …"

Obamacare and emergency rooms: a bit of perspective needed

By Wendell Potter

Commentary: Oregon study cited by critics requires perspective.

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

Obamacare facts separated from spin by Wendell Potter, FactCheck.org

By Bill Buzenberg

Navigating the politicized issue of the Affordable Care Act is made easier by Wendell Potter and FactCheck.org.

Pages