Health insurers have their way with regulators

By Fred Schulte

Billions in Medicare Advantage overpayments likely gone for good.

Excerpts from this story referencing "Health":

"… s having serious heart disease.  It took years for the Department of Health and Human Services (HHS) inspector general to publish those findings, and …"

"… ing errors tied to a complex payment formula known as a “risk score.” Health plans collect medical data that is used to compute the Health risks for ea …"

"… and secretive that it remains unfathomable to many Health professionals. Health plans that cheat can face civil or criminal penalties, but federal officia …"

"… Advantage contracts, records show.  CMS is but one part of the giant Health and Human Services Department. The HHS Office of Inspector General is supp …"

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 "National Institute for Occupational Safety and Health":

"… aps as many as 10,000 between 1995 and 2005, according to estimates of the National Institute for Occupational Safety and Health, a federal research agency.The high rate of disease detected in the bodies …"

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 "San Diego":

"… e was taking Zyprexa. "I just thought his appetite had increased," saidthe San Diego woman. She didn’t realize her son had developed severe hyperglycemia, ab …"

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 "Secretary of Health":

"… se enraged by 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 …"

Court case pushed by think tank could leave uninsured out in the cold

By Wendell Potter

Supreme Court case backed by think tank hinges on single sentence in Affordable Care Act.

Excerpts from this story referencing "Cato Institute":

"… mericans pay for their health insurance, it was time for high-fives at the Cato Institute in Washington. Cato’s director of health policy studies, Michael Cannon …"

"… s the crux of King v. Burwell, the case the justices agreed to hear. The Cato Institute, which began life 40 years ago as the Charles Koch Foundation, describes i …"

Nursing homes serving minorities offering less care than those housing whites

By Jeff Kelly Lowenstein

Nursing homes serving blacks, Latinos provide less daily registered nurse care than those housing whites.

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

"… or the period two weeks before annual nursing home quality surveys. But a Center for Public Integrity investigation has raised questions about the accuracy of the oft-used Nurs …"

Obama administration let opponents define the Affordable Care Act

By Wendell Potter

Commentary: Obama administration let foes define Affordable Care Act.

Excerpts from this story referencing "Jonathan Gruber":

"… Care Act. …"

Analysis shows widespread discrepancies in staffing levels reported by nursing homes

By Jeff Kelly Lowenstein

Analysis shows staffing levels lower than what's reported on public website.

Excerpts from this story referencing "federal government":

"… d data. The self-reported staffing levels are also a crucial metric in the federal government’s broader quality rating of nursing homes on the Compare website, from o …"

"… w York advocacy group the Long Term Care Community Coalition. “The federal government and the state are there so that people are supposed to be able to make cho …"

Methodology for our nursing homes investigation

By Jeff Kelly Lowenstein and Ben Wieder

Center compared self-reported staffing numbers with Medicare data

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

"… eived an earlier loan. …"

Running a five-star nursing home

By Jeff Kelly Lowenstein

Top-rated homes had more nurses, less turnover

Excerpts from this story referencing "federal government":

"… cy in staffing contributed to Woodview’s earning the top rating from the federal government for overall quality — a 5-star score on a 5-star scale from Nursing Home …"

"… just before annual inspections in order to earn a higher rating from the federal government. Nursing home administrators and a leading industry group deny those charg …"

Health insurers win midterm election!

By Wendell Potter

Commentary: midterm results create a friendlier Congress.

Excerpts from this story referencing "Health":

"… re prices of five of the six largest for-profit Health insurers — Cigna, Health Net, Humana, UnitedHealthcare and WellPoint/Anthem — reached their highe …"

"… ix largest for-profit Health insurers — Cigna, Health Net, Humana, UnitedHealthcare and WellPoint/Anthem — reached their highest points in a year last W …"

"… d — and in some cases even tripled. If you had invested $25,000 in UnitedHealthcare stock in 2010, you would have $78,750 today, a 315 percent return. Bu …"

"… 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 …"

More scrutiny coming for Medicare Advantage, Obamacare

By Fred Schulte

New round of audits coming; Obamacare too.

Excerpts from this story referencing "Health":

"… erly to Health plans rapidly expanding under the Affordable Care Act. The Health and Human Services Office of Inspector General, which investigates Medicar …"

"… ting illness, according to Richard Kronick, director of the HHS Agency for Healthcare Research and Quality. “I would not be surprised if there is some fr …"

Insurers spending cash, spreading fear in high-stakes California showdown

By Wendell Potter

Commentary: insurers have the cash to spread fear, confusion

Excerpts from this story referencing "Health Net":

"… surance marketplace: Anthem Blue Cross, Blue Shield of California, Kaiser, Health Net, and UnitedHealthcare.  What Proposition 45 would actually do is giv …"

Another whistleblower suit alleges Medicare Advantage fraud

By Fred Schulte

California litigation alleges 'house calls" yielded false claims

Excerpts from this story referencing "federal government":

"… ons that several Medicare Advantage plans allegedly used to overcharge the federal government by $1 billion or more. The suit was filed by Anita Silingo, a former comp …"

GAO takes on Medicare Advantage spending

By Fred Schulte

GAO will investigate program spending.

Excerpts from this story referencing "attorney":

"… airly while reducing wasteful overpayments,” said David A. Lipschutz, an attorney with the Center for Medicare Advocacy in Washington. America’s Health I …"

Comparison shopping for a health plan

By Wendell Potter

California makes it easy to do your homework.

Excerpts from this story referencing "Health Net":

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

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 "diabetes":

"… riations in levels of diseases in some health plans, from complications of diabetes to serious depression. The study concluded that “further policy changes …"

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 "Health":

"… s law does allow the undocumented to receive state-funded care through the Health Safety Net program for low-income persons). Schwarzenegger was feeling pre …"

"… ented immigrants is nearly a billion dollars a year,” Schwarzenegger’s Health and Human Services Secretary, Kim Belshe, told PBS NewsHour’s Gwen Ifill …"

"… . Among the many businesses and organizations supporting Lara’s bill is Health Access California, a statewide Health care consumer advocacy coalition. " …"

"… munities, and they need to be fully included in our Health system, too,” Health Access executive director Anthony Wright told me. “This (expanding cover …"

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 "Steve Day":

"… derground in the coal mines of southern West Virginia for almost 35 years, Steve Day thought it was obvious why he gasped for air, slept upright in a recliner, …"

"… ls — with devastating consequences. 'Superman' It was 1969 when Michael Steve Day arrived back home in Glen Fork, West Virginia, after a tour in Vietnam, wh …"

"… n more for his family. Steve and Nyoka had three children: a son, Michael Steve Day Jr., and two daughters, Stepheny and Patience. “My dad would come in fro …"

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 "Health":

"… 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 …"

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 "California":

"… ompanies. One example: the Community Hospital of the Monterey Peninsula in California, which earlier this year began offering its own Medicare Advantage plan to …"

Health insurers turning into who knows what?

By Wendell Potter

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

Excerpts from this story referencing "Insurance":

"… cessity.   Wendell Potter is the author of Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR is Killing Health Care and …"

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 "BuzzFeed":

"… had not yet had the opportunity to review the findings in detail, but told BuzzFeed News that “our industry continues its efforts to control coal dust to im …"

"… Chris Hamby, a former Center for Public Integrity reporter, now works for BuzzFeed. …"

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 "UnitedHealth Group":

"… h they expect to realize higher returns. The magazine cited as an example UnitedHealth Group’s Optum division, which works in technology and population health manage …"

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 "Labor":

"… ned, according to preliminary data released Thursday by the U.S. Bureau of Labor Statistics. In all, 4,405 workers died from injuries sustained on the job …"

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":

"… millions of dollars to an organization called Californians Against Higher Health Care Costs. If you think the companies’ CEOs opened their personal check …"

"… that are paying for the propaganda campaign. Californians Against Higher Health Care Costs (CAHHCC) is not a grassroots, consumer-led organization as the …"

"… the state: Anthem/WellPoint; Blue Shield of California; Kaiser Foundation Health Plan; Health Net; and UnitedHealthcare. Of $37.9 million donated to CAHHC …"

"… nthem/WellPoint; Blue Shield of California; Kaiser Foundation Health Plan; Health Net; and UnitedHealthcare. Of $37.9 million donated to CAHHCC as of Augus …"

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 "United States":

"… not only has created the severe shortage of primary care physicians in the United States, but it has also contributed to soaring health care costs, especially for …"

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 "official":

"… ervices (CMS) administrator Marilyn B. Tavenner. Swanson asked the federal official to “undertake an investigation of Humana’s practices and take appropri …"

"… gave CMS that power, thus preempting state laws and oversight. Minnesota officials don’t believe CMS should have a “monopoly” on oversight. “We thin …"

"… erminations by Medicare Advantage plans,” Wogsland said. “If they (CMS officials) don’t take action, there’s no other remedy.” Other state official …"

"… officials) don’t take action, there’s no other remedy.” Other state officials also have been frustrated by the limits on their authority. In October, C …"

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 "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 …"

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