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 "Health":

"… “upcoding.” Researcher Richard Kronick, director of the Department of Health and Human Services’ Agency for Healthcare Research and Quality, said off …"

"… ick, director of the Department of Health and Human Services’ Agency for Healthcare Research and Quality, said officials should consider tightening audit …"

"… ed to kill or scale back planned pay cuts to the Health plans. America’s Health Insurance Plans, the industry’s primary trade group, spent nearly $5 mil …"

"… p overpayments. Clare Krusing, director of communications for America’s Health Insurance Plans, did not respond directly to a question about the payment …"

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 …"

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 "deputy administrator":

"… n, which has argued that it violated the privacy of doctors. CMS principal deputy administrator Jonathan Blum, who left the agency in May, previously announced on his&nbs …"

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.

Excerpts from this story referencing "Medicare":

"… can answer it, we'll do so and add it here. …"

"… so and add it here. …"

"… and Medicare? They’re two sides of the same coin. By choosing standard Medicare, people can visit any doctor they want. But they may have to buy supplemen …"

"… ant. But they may have to buy supplemental insurance to cover gaps in what Medicare will pay for. This option is called “fee-for-service.” By contrast, M …"

Center sues in an effort to make Medicare Advantage files public

By Fred Schulte

Center sues to make records public.

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

"… ian billing records prompting media outlets to report similar stories. …"

"… to make them available,” the lawsuit states. It is the second time the Center for Public Integrity has sued the Medicare agency to compel disclosure of billing data and othe …"

Feds propose shakeup for emergency room billing

By Fred Schulte

Proposal seeks to counter alleged over-billing with standardized rate

Excerpts from this story referencing "Iowa":

"… indfall for some hospitals, but others could lose,” said Duane Abbey, an Iowa health care billing consultant who called the proposal a “major change. …"

Feds 'listen' for sounds of Medicare billing abuse

By Fred Schulte

Baltimore session looks at role of electronic health records in higher medical bills.

Excerpts from this story referencing "Medicare":

"… doctors and hospitals could be using electronic health records to overbill Medicare, top government officials swung into action. U.S. Health and Human Servic …"

"… an merited — a practice is known as “upcoding.” But the Centers for Medicare and Medicaid Services, which reports to Sebelius, is taking a much less co …"

"… of the plan, citing a range of concerns from patient privacy to stepped-up Medicare billing fraud. Their report noted that many medical experts believe the d …"

GOP senators call for overhaul of electronic health records program

By Fred Schulte

Report says $35 billion Obama administration stimulus program not working

Excerpts from this story referencing "Medicare":

"… ectronic medical records, citing concerns from patient privacy to possible Medicare billing fraud. The report issued Tuesday by the half-dozen Republicans co …"

"… igital systems may be increasing unnecessary medical tests and billings to Medicare. The government has not demanded that the various digital systems be able …"

"… al professionals have steadily billed higher rates for treating seniors on Medicare over the last decade — adding $11 billion or more to their fees. The Ce …"

"… overed a broad range of costly billing errors and abuses that have plagued Medicare for years—from confusion over how to pick proper payment codes to outrig …"

Electronic medical records probed for over-billing

By Fred Schulte

Are feds doing all they can to ferret out waste from move to electronic records?

Excerpts from this story referencing "Medicare":

"… be prompting some doctors and hospitals to improperly bill higher fees to Medicare. An investigation into those billing questions — which convened a hearin …"

"… al professionals have steadily billed higher rates for treating seniors on Medicare over the last decade — adding $11 billion or more to their fees. The inv …"

"… adding $11 billion or more to their fees. The investigation suggested that Medicare billing errors and abuses are worsening as doctors and hospitals switch to …"

"… re than $10 billion has been spent. Just over half the doctors now billing Medicare are using digital records. But critics of the initiative have claimed for …"

Center's 'Cracking the Codes' series wins Meyer journalism award

By The Center for Public Integrity

'Cracking the Codes' series about Medicare billing takes first place

Excerpts from this story referencing "Medicare":

"… ies documented how thousands of medical professionals have steadily billed Medicare for more complex and costly health care over the past decade – adding $1 …"

"… overed a broad range of costly billing errors and abuses that have plagued Medicare for years – from confusion over how to pick proper payment codes to appa …"

"… ditor Gordon Witkin and database editor David Donald, analyzed 133 million Medicare records over 20 months to demonstrate how upcoding of diagnoses and proced …"

"… monstrate how upcoding of diagnoses and procedures was steadily increasing Medicare payouts over the years.Less than a week after the final installment of Cra …"

Feds tighten scrutiny of health records

By Fred Schulte

Feds increase scrutiny of how electronic systems affect billing

Excerpts from this story referencing "Medicare fraud":

"… ruary 2009.  …"

Hospitals request government help in curbing possible billing abuses

By Fred Schulte

Federal help sought to create billing guidelines and oversee electronic medical records

Excerpts from this story referencing "Medicine":

"… tter to HHS Secretary Sebelius. She noted that a year ago the Institute of Medicine had urged HHS to develop a plan to minimize patient safety risks, but that …"

IMPACT: Administration official asks for Medicare billing review

By Fred Schulte

Administration official wants to know if electronic health records are causing Medicare over-billing

Excerpts from this story referencing "George W. Bush":

"… event billing fraud and assure patient safety and data integrity.President George W. Bush in 2004 set the goal of creating a digital medical record for every Americ …"

Top House Republicans demand suspension of electronic medical records program

By Fred Schulte

Top House Republicans want program suspended until government demands that systems communicate

Excerpts from this story referencing "Coordinator":

"… rgy health subcommittee chair Wally Herger, R-Calif.The Office of National Coordinator for Health Information Technology, which runs the incentive program, did n …"

Suit alleges retaliation for exposure of upcoding

By Fred Schulte

Nevada woman claims she was fired after questioning hospital's bills

Excerpts from this story referencing "Mitt Romney":

"… h to electronic health records.In campaign speeches, both Barack Obama and Mitt Romney have promised to tame Medicare’s spending growth while protecting senior …"

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 "Eric Holder":

"… Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder notified five medical groups of their intention to ramp up investigative o …"

OPINION: Center series demonstrates dangers of 'captured' regulators

By Wendell Potter

Center series demonstrates dangers of special interest influence

Excerpts from this story referencing "Medicaid Services":

"… affecting them. In many regards,  the Centers for  Medicare and Medicaid Services (CMS) has become a “captured agency” as a result of decisions made dec …"

Grassley says providers who overbill Medicare are draining its finances

By Fred Schulte

Grassley says providers charging too much threaten program's shaky finances

Excerpts from this story referencing "Charles Grassley":

"… to drain the elderly health-care program’s already shaky finances, Sen. Charles Grassley said Thursday.The Iowa Republican’s comments came in reaction to The Cen …"

Billing complexity spawns new industry

By Fred Schulte

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

Excerpts from this story referencing "Charles Grassley":

"… y “revenue maximization” consultants.At the ensuing hearing, U.S. Sen. Charles Grassley, R-Iowa, lamented that officials had no way to know how many doctors were …"

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 "Medicine":

"… professor of Medicine at the University of Pennsylvania Perelman School of Medicine, a member of the panel, said there are a number of possible causes for the …"

"… rgency physician and associate professor in the Emory University School of Medicine, examined data from the Centers for Disease Control and Prevention’s Nat …"

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 "lobbyist":

"… also a former director of the federal Medicare agency and now a Washington lobbyist with a range of health care clients. “I’m not sure it’s malicious. I …"

About the 'Cracking the Codes' project

By The Center for Public Integrity

Behind the reporting

Excerpts from this story referencing "Medicaid":

"… esult of a settlement from litigation against the Centers for Medicare and Medicaid Services.   Delving deeply into this data has now helped us expo …"

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 "Florida":

"… he assumption that what they do is more complex,” said Lester Perling, a Florida lawyer who has represented doctors in payment disputes. “That couldn’t …"

Manipulating Medicare in the election season

By Gordon Witkin

With the Paul Ryan pick, Medicare has returned as a top election topic

Excerpts from this story referencing "Medicare":

"… s selection of Rep. Paul Ryan as his vice-presidential nominee has vaulted Medicare to the top tier of election issues, thanks to Ryan's proposal that the ent …"

"… on the private market. Judging by the fiery rhetoric from both campaigns, Medicare seems certain to remain a high-profile topic for the remainder of the cont …"

"… to remain a high-profile topic for the remainder of the contest. But Medicare is a complex topic, and the charges and counter-charges seem likely to yie …"

"… on the finger-pointing, but there's been little of substance illuminating Medicare's increasingly precarious finances and its often-confusing spending choice …"

HHS IG report highlights docs' questionable billing of Medicare

By Fred Schulte

HHS IG report says thousand of doctors billing feds at rates beyond the norm

Excerpts from this story referencing "U.S. Department of Health and Human Services Office":

"… rges, according to a new government report.The audit released today by the U.S. Department of Health and Human Services Office of Inspector General stopped short of accusing the high-billing doctors of …"

Medicare fraud: What you need to know

By Sarah Whitmire

Last week's biggest-ever Medicare fraud bust nabbed 107 care providers, but how does this effort stack up?

Excerpts from this story referencing "Health":

"… agencies within the Department of Justice teamed up with the Department of Health and Human Services to create a Medicare Fraud Strike Force. It is a collab …"

"… It is a collaboration that became part of a larger initiative known as the Health Care Fraud Prevention and Enforcement Action Team (H.E.A.T.) in 2009. Now …"

Michael Jackson's doctor, other convicted felons, still listed as Medicare providers

By Joe Eaton

Senators' criticize Medicare's inability to weed out troubled physicians

Excerpts from this story referencing "Medicaid":

"… Secretary Kathleen Sebelius. A spokesman for the Centers for Medicare and Medicaid Services had no immediate comment.Murray’s case is a high profile exampl …"

Senators want more aggressive action to curb rampant Medicare fraud

By Joe Eaton

Hatch, Coburn, says federal health program for the elderly isn't weeding out scamsters, bad doctors

Excerpts from this story referencing "Medicaid Services":

"… he letter to Donald Berwick, administrator of the Centers for Medicare and Medicaid Services (CMS), Sen. Orrin Hatch, R-Utah, and Sen. Tom Coburn, R-Oklahoma, wrote th …"

After banned from Medicare, podiatrist bills $1M for fake care, including double-amputee's feet

By Ben Wieder

Maryland podiatrist banned from Medicare in 2007 admits to more fraud under Medicare Advantage

Excerpts from this story referencing "Health and Human Services Department":

"… om participating in Medicare and Medicaid.  His name was added to the Health and Human Services Department’s list of nearly 50,000 names of physicians, nurses and other providers …"

"… list of nearly 50,000 names of physicians, nurses and other providers the Health and Human Services Department has banned from the public-funded healthcare programs.But that didn't stop …"

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