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How doctors and hospitals have collected billions in questionable Medicare fees

By Fred Schulte and David Donald

Center investigation suggests cost from upcoding and other abuses likely tops $11 billion.

Excerpts from this story referencing "Health":

"… problem,” said Dr. Mark McClellan, who directs the Engelberg Center for Health Care Reform at the Brookings Institution in Washington. McClellan, a forme …"

"… alicious. It’s a fact a life,” he said.However, the U.S. Department of Health and Human Services inspector general in a May report stated that payments …"

About the 'Cracking the Codes' project

By The Center for Public Integrity

Behind the reporting

Judgment calls on billing make 'upcoding' prosecutions rare

By Fred Schulte

Authorities typically settle, and doctors often continue treating Medicare patients

Excerpts from this story referencing "Health":

"… idence.Jennifer Trussell, who directs investigations for the Department of Health and Human Services Office of Inspector General, discussed such a case at a …"

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OPINION: ObamaCare's crucial benefits

By Wendell Potter

Health care law will cap out-of-pocket spending

Excerpts from this story referencing "Health":

"… he lowest rate of increase in years, according to Kaiser’s 2012 Employer Health Benefits Survey, which was released last week. Double-digit premium increa …"

"… the overall rise in premiums.    A study published last year in Health Affairs found that the gains in wages U.S. workers made over the past deca …"

Growth of electronic medical records eases path to inflated bills

By Fred Schulte

Billing software helps medical professionals document higher fees.

Excerpts from this story referencing "Health":

"… er Trussell, who directs the investigations unit of the U.S. Department of Health and Human Services Office of Inspector General.“We are all excited about …"

"… one more diligently would justify higher codes and fees.The HHS Agency for Healthcare Research and Quality, an advocate for pressing ahead with electronic h …"

"… the administration of President George W. Bush.In July 2005, the American Health Information Management Association identified an “unintended incentive f …"

"… hich was commissioned by HHS officials.Two months later, a second American Health Information Management Association panel stated that “without a delibera …"

Billing complexity spawns new industry

By Fred Schulte

Thousands now employed as professional coders, but oversight is lacking.

Excerpts from this story referencing "Health":

"… nies nationwide handle billing for doctors and hospitals, according to the Healthcare Billing and Management AssociationBy all accounts, demand is rising. C …"

"… al Coders, founded in 1988, boasts more than 117,000 members. The American Health Information Management Association, which has advocated for accurate medic …"

"… can create an incentive to overcharge, they remain in wide use. But the Healthcare Billing and Management Association contends these deals are “appropr …"

"… oding guidelines assure “there’s going to be a wide range of errors.”Health lawyer and coding expert Miscoe agreed. “Fundamentally, we need to chang …"

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Hospitals grab at least $1 billion in extra fees for emergency room visits

By Joe Eaton and David Donald

Center probe suggests facilities have taken advantage of government’s failure to set billing standards.

Excerpts from this story referencing "Health":

"… aid Barbara Vandegrift, a Health care consultant at Tennessee-based Quorum Health Resources. “It’s ‘wait until we get caught and we’ll fight it at t …"

"… ,” said Judith Kelly, director of Health information management at Unity Health System in Rochester, N.Y. To address the issue, Kelly said CMS should issu …"

"… the cut.In 2002, the American Hospital Association (AHA) and the American Health Information Management Association, an association representing Health inf …"

OPINION: Center series demonstrates dangers of 'captured' regulators

By Wendell Potter

Center series demonstrates dangers of special interest influence

Excerpts from this story referencing "American Medical Association":

"… d state levels in which special interests — in this case groups like the American Medical Association — dominate regulatory bodies that set the rules and make important decis …"

IMPACT: Cabinet officials signal crackdown on Medicare billing abuse

By Fred Schulte and Joe Eaton

Sebelius, Holder signal new scrutiny in wake of Center series

Excerpts from this story referencing "Health":

"… he Health plan for more complex and costly services than they deliver.U.S. Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric H …"

"… bill for services never provided. The Department of Justice, Department of Health and Human Services, the FBI and other law enforcement agencies are monitor …"

"… letter are: the American Hospital Association, the Association of Academic Health Centers, the National Association of Public Hospitals and Health Systems, …"

"… Academic Health Centers, the National Association of Public Hospitals and Health Systems, the Federation of American Hospitals.The association of public ho …"

OPINION: Documentary captures what's wrong with U.S. health care

By Wendell Potter

Documentary 'Escape Fire' captures what's wrong with U.S. health care.

Excerpts from this story referencing "Health":

"… n of Obamacare, you will find “Escape Fire: The Fight to Rescue American Health Care,” a compelling and convincing indictment of a Health care system co …"

"… conversation about Health care."Escape Fire: The Fight to Rescue American Healthcare" opens on Friday, Oct. 5 in select theaters nationwide, on iTunes and …"

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