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 "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.

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

"… records of who’s responsible and refuses to release them. Now the Center for Public Integrity is suing to make those files public. We’ll have more about that in a mo …"

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 "New York":

"… icker than normal — a claim many experts have challenged. In Rochester, New York, a Medicare plan was paid $41 million to treat people with serious disease …"

"… plans that date back as far as 2007. Excellus Health Plan, the Rochester, New York, health plan that federal auditors said may have overbilled by as much as …"

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 "Center for Public Integrity":

"… cally the same sort of accountability journalism we’ve been doing at the Center for Public Integrity for years. What’s coming next? We are committed to covering this progr …"

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 Services":

"… 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 for copi …"

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 "Medicaid":

"… vites overcharges. Now in a major turnabout, the Centers for Medicare and Medicaid Services are seeking tighter controls over the fees as part of a plan to r …"

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 "Health":

"… ds to overbill Medicare, top government officials swung into action. U.S. Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric H …"

"… order to inflate what providers get paid.” Sue Bowman, of the American Health Information Management Association, said her testimony in Baltimore would …"

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 "Health":

"… ud and abuse from errant billing, a process known as “upcoding.” U.S. Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric H …"

"… titled “REBOOT: Re-examining the Strategies Needed to Successfully Adopt Health IT” was released on Tuesday by Senators John Thune (R-S.D.), Lamar Alexa …"

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 "information technology":

"… ng the publication of our stories, the Obama administration’s top health information technology official launched an internal review to determine if electronic health rec …"

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 "Eric Holder":

"… Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder.“Hospitals share the administration’s goal of a health system that off …"

"… actice known as “upcoding.”HHS Secretary Sebelius and Attorney General Eric Holder on Sept. 24 warned five hospital and medical groups of their intention to …"

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 "Health":

"… . Farzad Mostashari, the Obama administration’s National Coordinator for Health Information Technology, said in an interview Monday afternoon that his pol …"

"… their bills “should be off limits.”In a Sept. 24 letter, Department of Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric H …"

"… icularly in hospital emergency rooms.Meanwhile, the 64,000 member American Health Information Management Association has announced it will hold an industry …"

"… hing to improve Health outcomes.”The industry’s trade association, the Healthcare Information and Management Systems Society,  opposed the suspensi …"

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 "disease":

"… le to mine data from millions of patients to discover better ways to treat disease and improve the nation’s overall health, which requires computers to lin …"

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 "Eric Holder":

"… Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder notified five groups representing hospitals and medical professionals that …"

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 "Medicare":

"… stepping up scrutiny  for doctors and hospitals that may be cheating Medicare by using electronic health records to improperly bill the health plan for …"

"… 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 Cent …"

"… 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 …"

"… proper payment codes to outright overcharges. The findings indicated that Medicare billing problems are worsening as doctors and hospitals switch to electron …"

OPINION: Center series demonstrates dangers of 'captured' regulators

By Wendell Potter

Center series demonstrates dangers of special interest influence

Excerpts from this story referencing "Health":

"… provided to patients. The Office of Inspector General of the Department of Health and Human Services recognizes that upcoding is a chronic and costly proble …"

"… to use EHRs. The government, mainly the Office of National Coordinator for Health Information Technology, never imposed any controls over the IT industry as …"

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 "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 "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 …"

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

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 "Medicare fraud":

"… Obama administration has made a significant commitment to cracking down on Medicare fraud and abuse, officials don’t appear to have an aggressive strategy for cut …"

About the 'Cracking the Codes' project

By The Center for Public Integrity

Behind the reporting

Excerpts from this story referencing "Gerald Loeb":

"… e George Polk Award, two Investigative Reporters and Editors awards, three Gerald Loeb awards for business writing and two Worth Bingham Prizes for investigative …"

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

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 "Health":

"… 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 t …"

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?

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

Excerpts from this story referencing "Internal Revenue Service":

"… ation and communication” between CMS, the Department of Justice, and the Internal Revenue Service. They also expressed concern that Medicare contractors “may be failing t …"

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

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