Health insurers have their way with regulators

By Fred Schulte

Billions in Medicare Advantage overpayments likely gone for good.

Excerpts from this story referencing "federal government":

"… es. Four years ago, Medicare auditors came to an alarming conclusion: the federal government shouldn’t have paid a half-dozen insurance plans hundreds of millions of …"

"… rooted within private Medicare Advantage plans — which contract with the federal government to care for nearly 16 million elderly Americans — and that these abuses …"

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 Mining Association":

"… any more than the current one, said Carol Raulston, a spokesperson for the National Mining Association. The industry has argued that the requirement could have serious economic …"

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 "head of corporate strategy and policy":

"… anapolis.“He was an idea man, a thinker, and that’s why he ended up as head of corporate strategy and policy,” said Woodley, who describes himself as both an acquaintance and an adm …"

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 …"

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 "Health":

"… attorney with the Center for Medicare Advocacy in Washington. America’s Health Insurance Plans, the industry’s trade group, wouldn’t comment on the G …"

"… y lobbied to scale back planned pay cuts to the Health plans. America’s Health Insurance Plans, the industry trade group, spent nearly $5 million lobbyin …"

Comparison shopping for a health plan

By Wendell Potter

California makes it easy to do your homework.

Excerpts from this story referencing "California":

"… we get it through an employer or buy it on our own. But unless you live in California, chances are you won’t find much information about how satisfied people …"

"… cal performance information and complaint ratios is a lot more difficult. California is the only state I know of where you can find data on both, but it’s no …"

"… le of seeking it out. Back in 2000 when Democrat Gray Davis was governor, California began operating an agency called the Office of The Patient Advocate (OPA). …"

"… The most recent report card was released last Wednesday. If you’re a Californian and care as much about good customer service as you do about how much you …"

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 "trade":

"… health plans. America’s Health Insurance Plans, the industry’s primary trade group, spent nearly $5 million lobbying on a variety of issues, including …"

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 "Phil Angelides":

"… been re-elected in a landslide, winning 56 percent of the vote to Democrat Phil Angelides’ 38.9 percent. Schwarzenegger’s reasoning was that undocumented immig …"

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 "miner":

"… ad lost his case to receive benefits guaranteed by federal law to any coal miner disabled by black lung. The coal company that employed the miner usually p …"

"… any coal miner disabled by black lung. The coal company that employed the miner usually pays for these benefits, and, as almost always happens, Steve’s …"

"… from relatives or neighbors to make it through the month. Like many other miners, he had lost primarily because of the opinions of a unit of doctors at th …"

"… found severe black lung. In late September, a Labor Department claims examiner issued an award of benefits. But this is only a first step in what is usua …"

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 "University of Washington":

"… providing both coverage and care to many Boeing employees, along with UW (University of Washington) Medicine — without an insurance firm. Officials at Providence-Swedish t …"

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 "West Virginia":

"… sease has hit especially hard in a triangular region encompassing southern West Virginia, eastern Kentucky, and southwestern Virginia. In these areas, thick deposi …"

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 "America":

"… What Everyone Needs to Know About the Affordable Care Act. …"

"… at Cigna once said that what kept him up at night was the possibility that Americans — business leaders in particular — would ultimately conclude that in …"

"… s that are employer-driven. You can be certain that big employers all over America will be paying close attention. If the Boeing ACO experiment demonstrates …"

"… nsider Speaks Out on How Corporate PR is Killing Health Care and Deceiving Americans and Obamacare: What’s in It for Me? What Everyone Needs to K …"

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 "Occupational Safety and Health Administration":

"… slightly from 2012. The new tranche of data came on the same day that the Occupational Safety and Health Administration released a final revised rule requiring employers to notify OSHA with …"

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 "Insurance":

"… sinesses with affordable coverage options in a timely fashion. California Insurance Commissioner Dave Jones, who is up for re-election this year, rejects that …"

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 "Medicare Advantage":

"… to provide incentives for health insurance companies to participate in the Medicare Advantage program and administer the Medicare drug program. The Affordable Care Act …"

"… ch themselves, in both lawful and unlawful ways, since the creation of the Medicare Advantage program in 1997.  Under this program, Medicare pays privately run he …"

"… CPI investigation uncovered as much as $70 billion of improper payments to Medicare Advantage plans from 2008 through last year. Will Congress act to save taxpayers bi …"

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 "Maine":

"… els in your dentist’s office too. Three states — Alaska, Minnesota and Maine — are the first to license dental health care therapists, who can and wi …"

How Medicare Advantage plans code for cash

By Fred Schulte

Federal study criticizes Medicare Advantage and calls for changes.

Excerpts from this story referencing "diabetes":

"… billing for an inordinately high number of patients with complications of diabetes. Despite its broad implications for Medicare spending, the study by HHS r …"

"… . Even more striking, according to the study, is how much higher reported diabetes rates have been in certain health plans than others. The study tracked rap …"

"… began, up to last year, and made them public for the first time. Overall, diabetes with serious complications, which pays higher rates, was reported as much …"

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 "Kentucky":

"… ates with the highest per capita spending on anti-Obamacare ads so far are Kentucky, Arkansas, Louisiana and North Carolina, where hotly contested Senate race …"

"… utcome of those contests. In at least two of those states — Arkansas and Kentucky — enrollment in Obamacare plans exceeded expectations. Although Yaraghi …"

"… re were impressive gains in several red states in addition to Arkansas and Kentucky. His findings were consistent with another state-by-state analysis&n …"

"… of red and blue states. Arkansas’s uninsured rate decreased 7.10 points, Kentucky 8.35 points, Rhode Island 8.73 points and Oregon 10.54 points. Red West Vi …"

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 "Medicaid Services":

"… at more needs to be done to protect tax dollars. Centers for Medicare and Medicaid Services (CMS) officials unveiled a new data analysis system to identify overpaymen …"

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 "Medicare Advantage":

"… itizens who called Arizona insurance agent Denise Early wondered why their Medicare Advantage health plans were eager to send a doctor to visit them at home. A few wor …"

"… e cottage industry is flourishing as federal officials struggle to prevent Medicare Advantage plans from overcharging the government by billions of dollars every year, …"

"… has found. Medicare made nearly $70 billion in “improper” payments to Medicare Advantage plans from 2008 through 2013, mostly overbillings based on inflated risk s …"

"… ons posed in writing. Limiting the house calls could have cut payments to Medicare Advantage plans by nearly $3 billion a year, according to a report prepared for the …"

Medicare Advantage lobbying machine steamrolls Congress

By Fred Schulte

Under pressure, Medicare Advantage critics morph into defenders.

Excerpts from this story referencing "Medicare Advantage":

"… ng their policies.” …"

"… thanked by industry surrogates for their help in killing some of the same Medicare Advantage cuts he’d previously supported so forcefully. By most accounts it was a …"

"… rs of Congress and the Obama administration, and a forceful flexing of the Medicare Advantage industry’s growing political might in Washington. John Gorman, a top Me …"

"… ge industry’s growing political might in Washington. John Gorman, a top Medicare Advantage consultant, hailed the lobbying victory in early 2013 as a “direct refle …"

Pages