Health insurers have their way with regulators

By Fred Schulte

Billions in Medicare Advantage overpayments likely gone for good.

Excerpts from this story referencing "California":

"… icare Advantage contractor, hotly disputed audit findings for its plans in California and Texas.   Auditors had deemed the risk scores for 45 of 100 …"

"… and Texas.   Auditors had deemed the risk scores for 45 of 100 California patients “invalid” because medical records didn’t verify they had be …"

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 "Coal":

"… e than 40 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 t …"

"… uce the number of severe cases.George Ellis, president of the Pennsylvania Coal Association, said the current standard was “more than adequate.” Asked …"

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 "Obama administration":

"… up just $157,777 to settle the matter in December 2013, for instance. The Obama administration has taken years to get a new round of the RADV audits underway amid quibbl …"

Comparison shopping for a health plan

By Wendell Potter

California makes it easy to do your homework.

Excerpts from this story referencing "Medicare":

"… om a private insurer unless we’re eligible for a government program like Medicare or Medicaid — you’d think it would be easy to discover which health pl …"

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 "Congress":

"… an standard Medicare. The industry also enjoys wide bipartisan support in Congress and in recent years has successfully lobbied to kill or scale back planned …"

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 "Congress":

"… rmer California Governor Arnold Schwarzenegger, a Republican, Democrats in Congress decided as they worked on health care reform that providing coverage to th …"

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 "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 "Insurance":

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

Health insurers turning into who knows what?

By Wendell Potter

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

Excerpts from this story referencing "Cigna":

"… tend to think that insurers with well-known brands like Aetna, Blue Cross, Cigna and UnitedHealthcare have been around forever and likely will always be wi …"

"… spitals and became Humana the managed care company. I left Humana to join Cigna in 1993. Cigna, which started out as a fire and marine insurance company, …"

"… ame Humana the managed care company. I left Humana to join Cigna in 1993. Cigna, which started out as a fire and marine insurance company, had by then mor …"

"… ling health insurance by this time. But within a year or so after I joined Cigna, Wall Street decided that multi-line insurers were dinosaurs and insisted …"

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 "Texas":

"… ner of Blue Cross, was one developed by an executive of Baylor Hospital in Texas in the late 1920s. In the not too distant future, I believe we will be goi …"

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 "Anthem":

"… almost exclusively by five insurers with the most customers in the state: Anthem/WellPoint; Blue Shield of California; Kaiser Foundation Health Plan; Healt …"

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 "Center for Public Integrity":

"… ays privately run health plans a set monthly rate for each patient. As the Center for Public Integrity reported in a series of investigative reports this past June, about 16 mil …"

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 "Minnesota":

"… ht Humana for insurance coverage it promised to provide,” she said. …"

"… ital was “out of network,” according to an affidavit he filed with the Minnesota Attorney General’s Office last year. “Considering that I was expectin …"

"… to state regulators. “It was a nightmare,” he said. In October 2013, Minnesota Attorney General Lori Swanson sent Morphew’s formal complaint, and about …"

"… as I’m aware, there has been no formal enforcement action taken,” said Minnesota attorney general’s office spokesman Benjamin Wogsland. “We have very s …"

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 "Minnesota":

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

How Medicare Advantage plans code for cash

By Fred Schulte

Federal study criticizes Medicare Advantage and calls for changes.

Excerpts from this story referencing "spokeswoman":

"… ll. About 70 medical conditions can boost payment rates. Clare Krusing, a spokeswoman for America’s Health Insurance Plans, the industry’s trade group, said …"

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 "Colorado":

"… n published reports of preliminary filings and company announcements: Colorado: Anthem Blue Cross Blue Shield says it wants to lower rates by an average …"

"… to lower rates by an average of 5.1 percent while two nonprofit carriers, Colorado Access and Colorado HealthOP, plan to reduce premiums by 22 and 9.63 perce …"

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

Attack ads may actually be benefiting Obamacare enrollment

By Wendell Potter

Publicity from attacks may actually help hike enrollment.

Excerpts from this story referencing "Louisiana":

"… t per capita spending on anti-Obamacare ads so far are Kentucky, Arkansas, Louisiana and North Carolina, where hotly contested Senate races are underway. Senat …"

"… ld on to his seat while Democrats Mark Pryor of Arkansas, Mary Landrieu of Louisiana and Kay Hagan of North Carolina are facing serious re-election threats. Th …"

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 "Texas":

"… om line costs,” said Geruso, an assistant professor at the University of Texas at Austin.  Sen. Charles Grassley, R-Iowa, said that refining the pa …"

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 "Democratic Senatorial Campaign Committee":

"… dinated by AHIP.   Even Charles Schumer of New York, who chaired the Democratic Senatorial Campaign Committee from 2005-2009 and is the third ranking Democrat in the Senate, has become …"

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 "California":

"… that?’’ said Sy Zahedi, president and CEO of MedXm, in Santa Ana, California, which does home assessments. ‘Paucity of evidence’ The downside, fed …"

"… led with no admission of fault. In a third case — against SCAN, a major California health plan — a whistleblower alleged that the company hired reviewers t …"

"… ael Curran, chief operating officer of Health Data Vision Inc. in Burbank, California. Dollar signs Some experts believe that Medicare’s difficulties taming …"

Medicare Advantage lobbying machine steamrolls Congress

By Fred Schulte

Under pressure, Medicare Advantage critics morph into defenders.

Excerpts from this story referencing "Mitt Romney":

"… te floor in praise of the Affordable Care Act. Franken rebuked Republican Mitt Romney for his 2012 presidential campaign promise to “restore those billions 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 "Cigna":

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

"… t most of the other big companies. Aetna’s share price is up 31 percent, Cigna’s 32 percent. United’s is up 28 percent. And WellPoint’s is up 39 pe …"

"… mmission earlier this spring. When I handled financial communications for Cigna, the day I dreaded most every year was the day we filed the company’s pr …"

Pages