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 "Washington":

"… ect scam,” said Patrick Burns, co-director of Taxpayers Against Fraud in Washington. “You simply systematically up-code conditions and that results in massi …"

"… g involved, the Medicare Advantage payment dispute is the sort of issue in Washington that barely registers outside of a small circle of policy wonks and indust …"

"… y lobbyists, who often rule the day in influencing government policy. In a Washington meeting last week, executives of the two biggest Medicare Advantage plans, …"

How Medicare Advantage plans code for cash

By Fred Schulte

Federal study criticizes Medicare Advantage and calls for changes.

Excerpts from this story referencing "Insurance":

"… boost payment rates. Clare Krusing, a spokeswoman for America’s Health Insurance Plans, the industry’s trade group, said the higher billing resulted from …"

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 "Washington":

"… ;Dr. Brian Biles, a professor in the Department of Health Policy at George Washington University, whose Freedom of Information Act lawsuits shook loose limited …"

"… ry intentionally tried to overpay them a little bit,” said Scully, now a Washington lobbyist with numerous health care industry clients. Health status was ad …"

"… rnment, including a criminal investigation by the Department of Justice in Washington and a criminal case involving the U.S. Attorney’s branch office in West …"

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 Advantage":

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

"… e will pay for. This option is called “fee-for-service.” By contrast, Medicare Advantage plans accept a set fee from the government for covering a person’s healt …"

"… nd eyeglasses and cost patients less out of pocket than standard Medicare. Medicare Advantage is growing rapidly and now serves about 16 million people, about a third o …"

"… hat are risk scores? A risk score is a formula the government uses to pay Medicare Advantage plans. The system is supposed to pay higher rates for sicker patients that …"

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 "Medicaid":

"… r reporter Fred Schulte requested records from the Centers of Medicare and Medicaid Services (CMS), an arm of HHS, in a May 21, 2013, letter. The letter asked …"

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 "Salt Lake City":

"… s. Dr. Brent Wallace, chief medical officer of Intermountain Healthcare in Salt Lake City, wrote to CMS on Aug. 6. He argued that the $875 bundled payment would mak …"

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 "Baltimore":

"… nfrontational stance as it opens a “listening session” this morning in Baltimore on the digital billing controversy. The agency has lined up nearly a doze …"

"… American Health Information Management Association, said her testimony in Baltimore would recommend research to figure out the precise role — if any — ele …"

"… e efficient, but it can also be misused,” she said in an interview. The Baltimore session takes place amid rumblings in Congress — at least among Republic …"

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 "Baltimore":

"… Centers for Medicare and Medicare Services on May 3 is holding a summit in Baltimore to discuss electronic records systems,   “the increase in code …"

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?

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 "Center for Public Integrity":

"… social science methods in the pursuit of better journalism.   …"

Feds tighten scrutiny of health records

By Fred Schulte

Feds increase scrutiny of how electronic systems affect billing

Hospitals request government help in curbing possible billing abuses

By Fred Schulte

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

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

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

Suit alleges retaliation for exposure of upcoding

By Fred Schulte

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

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

OPINION: Center series demonstrates dangers of 'captured' regulators

By Wendell Potter

Center series demonstrates dangers of special interest influence

Excerpts from this story referencing "insurance":

"… ame special interests. I have seen this play out in the same way regarding insurance company regulation. Many state insurance commissioners come straight from …"

"… lay out in the same way regarding insurance company regulation. Many state insurance commissioners come straight from the insurance companies they are charged …"

"… pany regulation. Many state insurance commissioners come straight from the insurance companies they are charged with regulating.  This week’s series, …"

Grassley says providers who overbill Medicare are draining its finances

By Fred Schulte

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

Billing complexity spawns new industry

By Fred Schulte

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

Excerpts from this story referencing "media attention":

"… enate Finance Committee hearing.Despite much legislative hand-wringing and media attention — CBS Evening News told her story prominently — little changed in the …"

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 "Centers for Disease Control and Prevention":

"… ofessor in the Emory University School of Medicine, examined data from the Centers for Disease Control and Prevention’s National Hospital Ambulatory Medical Care Survey, a well-established n …"

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 "Princeton University":

"… e AMA controls their publication and aggressively enforces its copyright. Princeton University Professor Uwe E. Reinhardt, a prominent health care economist, said govern …"

About the 'Cracking the Codes' project

By The Center for Public Integrity

Behind the reporting

Excerpts from this story referencing "Data Editor":

"… ff writer at the Washington City Paper and a reporter at The Roanoke Times.Data Editor: David DonaldData Analysis: Elizabeth Lucas, Elizabeth Caudill, Dan Tse, L …"

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 "Prosecutor":

"… ir bills don’t wind up in prison, according to a review of court filings.Prosecutors argue that proving criminal fraud is difficult given the complexity and s …"

"… han 57,000 claims to Medicaid alone between September 2006 and April 2010. Prosecutors allege that most patients never saw the doctor.One Medicare patient who s …"

Manipulating Medicare in the election season

By Gordon Witkin

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

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

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 "Department of Justice":

"… the overall problem.Brief history:Back in March 2007, agencies within the Department of Justice teamed up with the Department of Health and Human Services to create a Med …"

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

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

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 "Medicare Advantage":

"… am in 2007 for fraud, then submitted more than $1 million in fake bills to Medicare Advantage insurers.Dr. Larry Bernhard, a podiatrist from Gambrills Md., last week pl …"

"… m Gambrills Md., last week pled guilty to submitting hundreds of claims to Medicare Advantage on behalf of nursing home patients he did not treat. In one case involving …"

"… he signed a settlement with the government, he began sending fake bills to Medicare Advantage, a federally-funded program that is administered by private insurance comp …"

"… s to ensure that providers submitting bills are eligible to participate in Medicare Advantage. CMS does not see the names of providers that bill Medicare Advantage for …"