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 "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 …"

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 "Health":

"… the researchers from the National Institute for Occupational Safety and Health, part of the Centers for Disease Control and Prevention, wrote in a letter …"

"… to improve miners’ Health.” Back in 1969, the Federal Coal Mine Health and Safety Act limited the amount of dust allowed in mines with the e …"

"… 1, parts of a long-awaited rule from the federal Mine Safety and Health Administration took effect, and regulators say it should close these looph …"

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":

"… lth system,” Dr. Elliott Fisher, director of the Dartmouth Institute for Health Policy and Clinical Practice, was quoted as telling The Seattle Times. “ …"

"… Health insurers are quickly diversifying. Just two weeks ago, Modern Healthcare noted that because Health insurers are now required to spend at l …"

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

"… th in operating earnings. Meanwhile, in its core insurance business, UnitedHealth saw its 2013 operating margin decline to 6.4 percent, down from 7.6 percen …"

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":

"… 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.

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 …"

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 …"

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.

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 "Health":

"… mplications of diabetes to a history of heart trouble that’s flared up. Health plans can profit because Medicare pays them higher rates for sicker patien …"

"… ng to a report prepared for the insurance industry’s trade association. Health plans argue that home visits help them meet a patient’s total Health car …"

"… n Ignagni, president of the industry’s powerful trade group, America’s Health Insurance Plans, in a March 7, 2014 letter to CMS argued that the agency h …"

"… nment limits public access to billing data. But risk scores at one plan, XLHealth Corp., based in Maryland, jumped by at least 20 percent between 2007 and t …"

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 …"

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