Health insurers have their way with regulators

By Fred Schulte

Billions in Medicare Advantage overpayments likely gone for good.

Excerpts from this story referencing "Maryland":

"… MS decision certainly spelled relief for Coventry Health Care in Bethesda, Maryland, which operates in more than a dozen states and is owned by insurance gian …"

Persistent black lung, old scourge of coal, found in autopsies of most Massey miners

By Chris Hamby

Persistent black lung, scourge of coal, found in autopsies of Massey miners

Excerpts from this story referencing "Health":

"… cording to estimates of the National Institute for Occupational Safety and Health, a federal research agency.The high rate of disease detected in the bodies …"

"… e rise, affecting younger miners in many cases.The federal Mine Safety and Health Administration recently proposed a rule intended to protect miners from du …"

"… years ago, Congress sought to end black lung as part of the 1969 Coal Mine Health and Safety Act. It set standards for the amount of coal dust to which mine …"

During Mitch Daniels’ decade at Eli Lilly, the drug giant paid billions in fines and settled thousands of lawsuits

By Joanne Kenen and Rochelle Sharpe

Eli Lilly paid billions in fines, settled thousands of lawsuits while Daniels was an executive at the drug giant

Excerpts from this story referencing "Health":

"… s the work of person A, B, or C,” said Dr. Sidney Wolfe, director of the Health Research Group at Public Citizen. “It’s industry-wide corporate cultur …"

"… laims in some of its direct-to-consumer advertising about the drug in Health and Prevention magazines.Once a drug is approved by the FDA for a certain …"

Congressman takes swipe at program to reduce Medicare fraud

By Naseem Miller and Joe Eaton

As health reform bills consume Congress, a battle over a program designed to help cut soaring rates of Medicare overpayment and fraud is pla

Excerpts from this story referencing "Health":

"… roduced five weeks ago.The squabble is occurring just as the Department of Health and Human Services is reporting — according to the Associated Press — …"

"… ,” said Gerry Roy, the assistant inspector general for investigations at Health and Human Services’ Office of Inspector General. Roy said organized crim …"

"… pokesman for the Centers for Medicare & Medicaid Services, a branch of Health and Human Services, said he is not aware of any counties that were left wi …"

"… the bidding delay back then was President George W. Bush’s Secretary of Health and Human Services at the time, Michael Leavitt. “If Congress fails to u …"

Obamacare-driven competition lowering rates in some states

By Wendell Potter

Commentary: much-maligned Affordable Care Act attracting for-profit insurers, driving prices down in some states.

Excerpts from this story referencing "Maryland":

"… althOP, plan to reduce premiums by 22 and 9.63 percent, respectively. Maryland: While CareFirst is seeking a whopping 28 percent average increase to its …"

Attack ads may actually be benefiting Obamacare enrollment

By Wendell Potter

Publicity from attacks may actually help hike enrollment.

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 "Health":

"… luating the proposal,” said Clare Krusing, a spokeswoman for America’s Health Insurance Plans, the industry’s trade group. Congress created Medicare A …"

"… s were presented at a conference of the American Society of Health Economists in Los Angeles on June 25. “Our study is the first that can …"

"… late May, the Center for Public Integrity sued the Department of Health and Human Services to make its audits and other records public. The case i …"

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 "Health":

"… or says. Gary Cantrell, a deputy Inspector General with the Department of Health and Human Services said reviews are “hampered by a lack of accurate, tim …"

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 "Health":

"… ns. Having served on the strategic communications committee of America’s Health Insurance Plans, I can imagine how sophisticated and multi-pronged the ind …"

"… terparts in the Medicare fee-for-service program.” The effort paid off. Health plan executives and financial analysts were happy that the relatively mino …"

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 "Maryland":

"… ess to billing data. But risk scores at one plan, XLHealth Corp., based in Maryland, jumped by at least 20 percent between 2007 and the end of 2011, a time wh …"

Medicare Advantage lobbying machine steamrolls Congress

By Fred Schulte

Under pressure, Medicare Advantage critics morph into defenders.

Excerpts from this story referencing "Health":

"… 50 billion. Some of the nation’s mightiest insurance carriers — UnitedHealth Group and Humana Inc. are two of the biggest — dominate the market and a …"

"… thriving. The Health insurance industry’s main trade group, America’s Health Insurance Plans, or AHIP, funds its own “grassroots” lobbying group an …"

Skyrocketing salaries for health insurance CEOs

By Wendell Potter

Commentary: soaring compensation, rising stock prices don't justify higher premiums.

Excerpts from this story referencing "Health":

"… they can hike premiums high enough to satisfy shareholders. According to Health Plan Week, a trade publication, the CEOs of the 11 largest for-profit comp …"

"… y were this time last year. Of those 11 companies (Aetna, Centene, Cigna, Health Net, Humana, Molina, Triple-S Management Corp., UnitedHealth Group, Univer …"

"… ntene, Cigna, Health Net, Humana, Molina, Triple-S Management Corp., UnitedHealth Group, Universal American, Wellcare, and WellPoint) nine saw their stocks …"

"…  of big Health insurance companies make. Unless you subscribe to Health Plan Week, it’s not likely you will stumble across their salaries. Nor i …"

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.

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 "Health":

"… their services. Clare Krusing, director of communications for America’s Health Insurance Plans, said that the industry trade group is “working together …"

"… cted overpayments to Health plans that date back as far as 2007. Excellus Health Plan, the Rochester, New York, Health plan that federal auditors said may …"

"… e data out,” said Dr. Brian Biles, a professor in the Department of Health Policy at George Washington University, whose Freedom of Information Act l …"

"… ugh it. There are always vested interests in protecting the status quo.” Health care politics The Affordable Care Act, or Obamacare, orders deep rate cut …"

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 "Health":

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

"… ultant who headed the California regional office of the U.S. Department of Health and Human Services from 2001 through 2003 under President George W. Bush. …"

"… Aveta’s Puerto Rico Health plans and MSO are now operated by InnovaCare Health Solutions, according to the firm’s website. InnovoCare has the same Fort …"

"… 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, …"

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 "Health":

"… e-For-Service Data. Brian Biles, an MD and professor in the Department of Health Policy at George Washington University, and Giselle Casillas, an MPP and s …"

"… llment remains relatively stable that month. Because of regulations in the Health Insurance Portability and Accountability Act (HIPAA), small Medicare Advan …"

Medicare Advantage made simple: a glossary

By Fred Schulte

Definitions for lesser-known terms relating to Medicare.

Excerpts from this story referencing "Health":

"… rnment Health plan for low income people. CMS is part of the Department of Health and Human Services. Dual Eligibles: The term refers to people who ar …"

"… These patients are generally considered the most costly to treat. In-Home Health Assessments: Medicare Advantage plans tout these free “house calls …"

"… $9,900 per person in 2011. Risk Adjustment Data Validation (RADV) audits: Health plans collect medical data used to calculate patient risk scores. But mist …"

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. …"

A different way of thinking about health care

By Wendell Potter

Commentary: Canadians take pride in their health care system.

Excerpts from this story referencing "Health":

"… ther so-called MPs last Wednesday in Ottawa at the request of the Canadian Health Coalition, a group that wants to maintain and expand the country’s publi …"

"… ars. Meanwhile, back in the states, Karen Ignagni, the CEO of America’s Health Insurance Plans, claimed during a recent C-SPAN interview that people long …"

Feds investigating allegations that Humana Inc. overcharged Medicare Advantage program

By Fred Schulte

Whistleblower suit at center of Medicare Advantage overbilling allegations.

Insurers following 'the playbook' in opposing California ballot initiative

By Wendell Potter

Commentary: multi-faceted effort to defeat California ballot initiative.

Excerpts from this story referencing "Health":

"… along with lawmakers and regulators, as among those subject to influence. Health care reform advocates in California, led by Consumer Watchdog, are support …"

"… 2.8 million itself, and has been joined by other insurers, including UnitedHealthcare, Kaiser Permanente, Blue Shield and Health Net. Published reports sho …"

"… r insurers, including UnitedHealthcare, Kaiser Permanente, Blue Shield and Health Net. Published reports show that they have been spending that money almos …"

"… hat no one has to know you have any association with the front group.” Health insurers named their front group to fight the ballot initiative “Califor …"

The Canadian health care system I disparaged

By Wendell Potter

Commentary: health care system up north is more efficient.

Excerpts from this story referencing "Health":

"… of our Medicare system and our other single-payer program — the Veterans Health Administration — both of which consistently out-perform private insurers …"

"… o push for the adoption of a nationwide drug benefit. As for the Veterans Health Administration, which owns and operates its own hospitals, it not only get …"

Be the 'squeaky wheel' if health claim denied

By Wendell Potter

Commentary: Obamacare may squeeze insurance industry profits, subscribers should know their rights when it comes to claim denials.

Excerpts from this story referencing "Maryland":

"… service in question — winning as many as 54 percent of such decisions in Maryland, for example,” CPR reported. Bottom line here: With profit margins unde …"

American-style health care system pushed in Canada

By Wendell Potter

Canada's conservative Prime Minister Stephen Harper wants to remake nation's health care system.

Excerpts from this story referencing "Health":

"… he scare campaign behind the scenes was the trade association, America’s Health Insurance Plans. With help from a right-wing Canadian outfit called the Fr …"

"… f the uninsured. What I’m doing on this tour, organized by the Canadian Health Coalition, is disabusing folks of the notion that more private involvement …"

"… and operated. One of the key provisions of that compact — known as the Health Accord — was a commitment that the federal government would increase its …"

"… increase its financial support to the provinces by 6 percent per year. The Health Accord also stipulates that the federal dollars be allocated based on both …"

What's the point, WellPoint?

By Wendell Potter

Commentary: insurer's talk of rate increases may boomerang.

Excerpts from this story referencing "Health":

"… apparently are. When I read WellPoint CEO Joe Swedish comments in Modern Healthcare that, there will “undoubtedly be remarkable price increases” for h …"

"… justify the company’s actions. In her own letter to Braly, Secretary of Health and Human Services Kathleen Sebelius wrote that the WellPoint proposal "re …"

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