States continue war over Obamacare

By Fred Schulte

State lawmakers at odds over hundreds of bills to either cripple or prop up Affordable Care Act.

Excerpts from this story referencing "Kaiser Family Foundation":

"… rise as more folks take advantage of its benefits. A tracking poll by the Kaiser Family Foundation showed a small drop in “unfavorable” views of the law over the past ye …"

"… spitals and insurers, which stand to profit from Medicaid expansions. The Kaiser Family Foundation, which studies health policy issues, keeps a running tally that shows 28 s …"

Health care findings you may have missed in 2014

By The Center for Public Integrity

$70 billion in "improper" Medicare Advantage payments and the problem shared by 80 percent of nursing homes.

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 "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 "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.

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 "director of communications":

"… ls have largely stumbled in trying to recoup overpayments. Clare Krusing, director of communications for America’s Health Insurance Plans, did not respond directly to a ques …"

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 "insurance":

"… er physician fees, prescription drugs and to provide incentives for health insurance companies to participate in the Medicare Advantage program and administer …"

"… roups also recommended that Congress allow Medicare to create its own drug insurance plan that could directly negotiate drug prices in the same way as another …"

"… e drug companies for campaign support,” he said. He could have included insurance companies and physicians and host of other special interests on that list. …"

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 "Minnesota":

"… ht Humana for insurance coverage it promised to provide,” she said. …"

"… ital was “out of network,” according to an affidavit he filed with the Minnesota Attorney General’s Office last year. “Considering that I was expectin …"

"… to state regulators. “It was a nightmare,” he said. In October 2013, Minnesota Attorney General Lori Swanson sent Morphew’s formal complaint, and about …"

"… as I’m aware, there has been no formal enforcement action taken,” said Minnesota attorney general’s office spokesman Benjamin Wogsland. “We have very s …"

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 "CEO":

"… iscuss, but the data is in black and white and speaks volumes,” Cassano, CEO of Accucode Consulting, wrote in an email. Medicare Advantage enjoys soli …"

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 "CMS":

"… d less for those in good health using a formula known as a risk score. But CMS largely trusts health plans to identify and return any money paid in error …"

"… th plans to identify and return any money paid in error. In its proposal, CMS acknowledges it lacks a process for routinely going after these overpaymen …"

"… stimate that Medicare loses billions annually as a result. How much money CMS expects to recover also remains unclear. CMS said the health plans could b …"

"… as a result. How much money CMS expects to recover also remains unclear. CMS said the health plans could be on the hook for overpayments dating back si …"

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 "Center for Public Integrity":

"… s paid improperly, including $11.8 billion to Medicare Advantage plans. A Center for Public Integrity investigation published earlier this month found as much as $70 billion of …"

"… government overpays the health plans— and that some plans overbill. The Center for Public Integrity last month sued HHS under the Freedom of Information Act to obtain a wide …"

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 "primary":

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

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 "Medicaid":

"… ry source was quoted as saying that, "If CMS (the Centers for Medicare and Medicaid Services) doesn't keep Medicare Advantage payment rates flat next year, it …"

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 "Fred Schulte":

"… t Medicare Advantage billing issues or “risk scores”, please send Fred Schulte an email. If you are a patient in a Medicare Advantage plan and have been …"

"… strict of Columbia in late May. The series is reported by Center reporter Fred Schulte, with data analysis by David Donald and Erin Durkin, and edited by Go …"

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 "Dallas":

"… according to McCallum, a co-founder of CenseoHealth, who retired from the Dallas-based home visit company last year. McCallum stressed that home visits sh …"

Medicare Advantage lobbying machine steamrolls Congress

By Fred Schulte

Under pressure, Medicare Advantage critics morph into defenders.

Excerpts from this story referencing "Insurance":

"… ng. The health Insurance industry’s main trade group, America’s Health Insurance Plans, or AHIP, funds its own “grassroots” lobbying group and its memb …"

Health insurers have their way with regulators

By Fred Schulte

Billions in Medicare Advantage overpayments likely gone for good.

Excerpts from this story referencing "media attention":

"… CMS. The inspector general’s audits are widely distributed and can draw media attention as well as demands for reform in Congress. Absent the inspector general …"

New audits may recover missing millions — or not

By Fred Schulte

Secretive audits target some Medicare Advantage plans.

Excerpts from this story referencing "Health":

"… ld stall any repayment orders for years. CMS is part of the Department of Health and Human Services (HHS). The HHS Office of Inspector General, which acts …"

"… rs that the plan was among the 30 selected for review this year. Samaritan Health Plan, based in central Oregon with 6,500 members, also was picked, accordi …"

"… on with 6,500 members, also was picked, according to a company newsletter. Health Net, Inc. disclosed in a Securities and Exchange Commission filing that it …"

"… V audits underway amid criticism from the industry over the details. Group Health, a non-profit plan that operates in Washington state and Idaho, argued in …"

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 "Fred Schulte":

"… ost. Our Multimedia Editor Eleanor Bell sat down with the project reporter Fred Schulte to talk about some of his findings. Eleanor Bell: The government is …"

"… sp; That's the key finding of a new Center report by journalist Fred Schulte. For more than a year, he’s been investigating Medicare Advantage, the …"

"… than a decade ago to stabilize health care costs, has it been effective? Fred Schulte: Well it’s been very effective for many patients. Witness the fact …"

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 "chief medical officer":

"… nfirmed that the investigation has been closed. Dr. Inés Hernández, MCS chief medical officer, said that the health plan has moved aggressively to treat patients in the …"

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 "real estate developer":

"… h-care businesses, also has worked with hedge funds and as a New York City real estate developer. Joyce said Straus would have no comment. The whistleblower suit is signi …"

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 …"

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 "Health":

"… r stories. …"

The Canadian health care system I disparaged

By Wendell Potter

Commentary: health care system up north is more efficient.

Excerpts from this story referencing "insurance":

"… know I always will be. Over the course of a two-decade career as a health insurance executive, I spent hours and hours implementing my industry’s ongoing pr …"

"… ial governments to create the country’s publicly funded universal health insurance system — known as Medicare — our lawmakers in Washington were establis …"

"… s poor. Ever since, most of the rest of us have had to deal with private insurance companies and pay whatever they felt like charging us for coverage. Canadi …"

"… ybody in every audience I stood before gasped when I told them that health insurance premiums in the U.S. increased 131 percent between 1999 and 2009 — the m …"

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 "Georgia":

"… dismayed that so many Republican governors, including Gov. Nathan Deal of Georgia, where Sullivan was born and still lives, have refused to expand the Medic …"

"… Tampa in 2012. Sullivan told the journalists Thursday that, in his view, Georgia can’t afford not to expand Medicaid. Not only would the expansion bring …"

"… pand Medicaid. Not only would the expansion bring hundreds of thousands of Georgians into coverage, the millions of dollars the federal government would send …"

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.

Excerpts from this story referencing "Medicaid":

"… April 3, 2014: Small Smiles will no longer be allowed to serve patients on Medicaid started Sept. 30, affecting hundreds of thousands of children, the inspect …"

"… t doesn't plan to appeal the decision, which will bar the company from the Medicaid program for five years. Small Smiles, which has been under federal scruti …"

"… orming unnecessary dental treatments on children, could be barred from the Medicaid program beginning next month. The inspector general of the Department of …"

"… new dentist willing to treat them. Small Smiles will be excluded from the Medicaid program in early April unless it appeals the decision. The owner of the co …"

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