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 …"

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 …"

GAO takes on Medicare Advantage spending

By Fred Schulte

GAO will investigate program spending.

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

"… hing we have focused on before.” The GAO audit comes in the wake of the Center for Public Integrity’s “Medicare Advantage Money Grab” series published in June, which sh …"

"… ed at nearly $650 million for 2007 alone — just for those six plans. The Center for Public Integrity investigation confirmed in June that federal officials, after years of hag …"

"… year, or the results. So it’s not clear if any have been completed. The Center for Public Integrity in May sued CMS under the Freedom of Information Act, in part to …"

Comparison shopping for a health plan

By Wendell Potter

California makes it easy to do your homework.

Excerpts from this story referencing "Cigna":

"… onprofits. The plans with the fewest stars were Aetna, Anthem Blue Cross, Cigna, Health Net and UnitedHealthcare of California, all for-profit companies. …"

"… bsp;were the for-profits and the ones with the lowest were the nonprofits. Cigna, where I used to work, had the highest ratio. It had more than three times …"

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 "Patrick Burns":

"… s. “Inflating Medicare Advantage risk scores is a perfect scam,” said Patrick Burns, co-director of Taxpayers Against Fraud in Washington. “You simply syste …"

California coverage plan for undocumented echoes earlier call by Schwarzenegger

By Wendell Potter

Commentary: former governor supported plan allowing coverage for undocumented residents.

Excerpts from this story referencing "Governor":

"… at with folks hanging off the sides of the ship." …"

"… nuary 2007 that was similar to the one enacted in Massachusetts under then-Governor Mitt Romney. Schwarzenegger’s plan had one notable difference: it would …"

How a coal miner's autopsy proved a top doctor wrong

By Chris Hamby

When a coal miner's lungs finally gave out, his autopsy proved a top doctor was wrong — giving hope to thousands of other miners.

Excerpts from this story referencing "National Institute for Occupational Safety and Health":

"… School of Medicine and, before that, ran the X-ray-reading program at the National Institute for Occupational Safety and Health (NIOSH), which licenses physicians such as Wheeler to examine films for bl …"

Obamacare helps millions, but falls short in many ways

By Wendell Potter

The Affordable Care Act has reduced the ranks of the uninsured, but cost of care must be addressed.

Excerpts from this story referencing "Barack Obama":

"… ot just those who have become newly insured over the past year. President Barack Obama cited some of the impressive statistics last Thursday, the day after the o …"

New types of health care delivery are improving the 'patient experience'

By Wendell Potter

Commentary: eliminating role of insurers could improve health care delivery.

Excerpts from this story referencing "Health":

"… s in It for Me? What Everyone Needs to Know About the Affordable Care Act. …"

"… fact, in some ways they have been part of the problem. Providence-Swedish Health Alliance, a not-for-profit, hospital-based accountable care organization ( …"

"… he Health insurance market are hiring companies like Chicago-based Valence Health, a fast-growing firm that offers services ranging from claims adjudication …"

"… in: An Insurance Company Insider Speaks Out on How Corporate PR is Killing Health Care and Deceiving Americans and Obamacare: What’s in It for M …"

Health insurers turning into who knows what?

By Wendell Potter

Commentary: health insurers are transforming themselves — but into what?

Excerpts from this story referencing "Mark Bertolini":

"… ely destroying the current business model to enable a new one,” said CEO Mark Bertolini at a health care technology conference earlier this year.  Cigna CEO …"

Black lung disease surges to highs not seen since the '70s, research shows

By Chris Hamby

The likely culprit: a failure by coal mining companies to use readily available tools to control the dust that lodges in miners' lungs.

Excerpts from this story referencing "Kentucky":

"… y hard in a triangular region encompassing southern West Virginia, eastern Kentucky, and southwestern Virginia. In these areas, thick deposits of coal largely …"

Taking insurance companies out of health care

By Wendell Potter

If Boeing experiment flies, health care system could be transformed.

Excerpts from this story referencing "health insurance":

"… onal insurer. I predict that the big for-profits will eventually cede the health insurance marketplace to nonprofit insurers and provider-led organizations like ACOs …"

Contractor, Hispanic worker deaths up in 2013, BLS says

By Talia Buford

The number of contractors and Hispanic workers who died on the job increased in 2013 even as the overall tally of worker deaths declined.

Excerpts from this story referencing "Health":

"… new tranche of data came on the same day that the Occupational Safety and Health Administration released a final revised rule requiring employers to n …"

"… gel, executive director of the National Council on Occupational Safety and Health, a coalition of local and state worker safety groups. “That’s one reas …"

Defeat of California initiative would protect insurers' profits

By Wendell Potter

Proposition 45 would allow California's insurance chief to block insurance rate hikes; insurers are spending millions to kill it.

Excerpts from this story referencing "health insurance":

"… ine ads, which, ironically, they unknowingly will be paying for with their health insurance premiums. The ads are a part of a multi-pronged, multimillion dollar camp …"

"… which would give the state’s insurance regulators the ability to reject health insurance rate increases they deem excessive. But while a number of business and he …"

"… t it might interfere with the efforts of Covered California, the state’s health insurance exchange, to provide individuals and small businesses with affordable cove …"

"… d more than three years’ experience reviewing individual and small group health insurance rates under the federal reform law “including experience last year compl …"

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 "federal government":

"… ssage of the Medicare Modernization Act in 2003, which created Part D, the federal government benefited from discounts on prescription medicines for people covered by b …"

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 "George Jepsen":

"… by the limits on their authority. In October, Connecticut Attorney General George Jepsen called for federal officials to “aggressively scrutinize” UnitedHealth …"

Dire predictions of endless waits for a doctor have proven unfounded

By Wendell Potter

Commentary: Obamacare has not resulted in long waits for a doctor.

Excerpts from this story referencing "Health":

"… out. To find out if the critics’ were prescient or way off base, Kaiser Health News reporter Phil Galewitz went looking for problems. He didn’t find ma …"

How Medicare Advantage plans code for cash

By Fred Schulte

Federal study criticizes Medicare Advantage and calls for changes.

Excerpts from this story referencing "Analyzing government":

"… eating elderly patients — and have gotten away with doing it for years. Analyzing government data never before made public, Department of Health and Human Services res …"

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 "Health":

"… at least where they think they can make money. Leading the pack is UnitedHealth Group, the country’s biggest Health insurer. The company offered 2014 po …"

"… n only about a dozen states. During a call with investors last week, UnitedHealth CEO Stephen Hemsley said the company will compete for 2015 Obamacare busin …"

"… p to choose from. And based on preliminary rate filings, the Ohio co-op, InHealth Mutual, is besting its established competitors by almost 25 percent. Here …"

"… of 5.1 percent while two nonprofit carriers, Colorado Access and Colorado HealthOP, plan to reduce premiums by 22 and 9.63 percent, respectively. Mary …"

Attack ads may actually be benefiting Obamacare enrollment

By Wendell Potter

Publicity from attacks may actually help hike enrollment.

Excerpts from this story referencing "Senate":

"… re Kentucky, Arkansas, Louisiana and North Carolina, where hotly contested Senate races are underway. Senate Majority Leader Mitch McConnell, R-Ky., is hopi …"

"… siana and North Carolina, where hotly contested Senate races are underway. Senate Majority Leader Mitch McConnell, R-Ky., is hoping to hold on to his seat w …"

"… rolina are facing serious re-election threats. The balance of power in the Senate could be determined by the outcome of those contests. In at least two of t …"

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 "Martha Coakley":

"… assachusetts primary. State Treasurer Steven Grossman and Attorney General Martha Coakley were the other two qualifiers. Two days after securing a spot on the Sept …"

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 "New York":

"… a day of lobbying — coordinated by AHIP.   Even Charles Schumer of New York, who chaired the Democratic Senatorial Campaign Committee from 2005-2009 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.

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 "Virginia":

"… plans are paid fairly for taking on that responsibility. Scott Weiner, a Virginia Medicare billing expert, said health plans that don’t bill aggressively …"

"… , said Brian Wise, chief executive officer of Advance Health in Chantilly, Virginia. “I know there is a lot of good happening. People who are in danger are …"

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 …"

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 "WellPoint":

"… -S Management Corp., UnitedHealth Group, Universal American, Wellcare, and WellPoint) nine saw their stocks close near 52-week highs this past Friday. The big …"

"… e is up 31 percent, Cigna’s 32 percent. United’s is up 28 percent. And WellPoint’s is up 39 percent. But it is the CEO compensation that has been the mo …"