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 "Senate":

"… ng Medicare Advantage, from January through June of 2014, according to the Senate records. But critics argue that some health plans exaggerate how sick the …"

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.

Excerpts from this story referencing "Medicare":

"… should be some accountability. …"

"… llion this year, but our latest investigation found that manipulation of a Medicare Advantage payment tool called a “risk score” is adding billions to the …"

"… journalist Fred Schulte. For more than a year, he’s been investigating Medicare Advantage, the government-backed alternative to Medicare for seniors run m …"

"… een investigating Medicare Advantage, the government-backed alternative to Medicare for seniors run mostly by private companies. At the heart of the story ar …"

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 "Medicaid":

"… vantage has faced much less scrutiny. The federal Centers for Medicare and Medicaid Services didn’t try to recoup overpayments until 2012, eight years after …"

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 "Medicaid":

"… y of the $70 billion in "improper" payments? The Centers for Medicare and Medicaid Services, which runs the program, has broad authority to recoup overpaymen …"

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

Feds 'listen' for sounds of Medicare billing abuse

By Fred Schulte

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

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 "Lamar Alexander":

"… dopt Health IT” was released on Tuesday by Senators John Thune (R-S.D.), Lamar Alexander (R-Tenn.), Pat Roberts (R-Kan.), Richard Burr (R-N.C.), Tom Coburn (R-Okla …"

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 "University of Pennsylvania":

"… and objective view on this.” Ross Koppel, a sociology professor at the University of Pennsylvania, said that officials face a difficult balance in making sure that the soft …"

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

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

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

Excerpts from this story referencing "Mitt Romney":

"… have emerged as a presidential campaign issue, with both Barack Obama and Mitt Romney promising to tame its spending growth while protecting seniors. But there …"

OPINION: Center series demonstrates dangers of 'captured' regulators

By Wendell Potter

Center series demonstrates dangers of special interest influence

Excerpts from this story referencing "Technology":

"… vernment, mainly the Office of National Coordinator for Health Information Technology, never imposed any controls over the IT industry as Technology companies s …"

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 "Arkansas":

"… rk regularly.The 15 states covered by the proposed RAC audit are: Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Car …"

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 "president":

"… ncy to discuss audits involving specific hospitals. But Baylor Irving’s president, Cindy Schamp, said CMS never questioned the hospital’s 2008 evaluation …"

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 "president":

"… S inspector general’s office. “They don’t see it as a crime.” AMA president Jeremy A. Lazarus agreed that doctors have shifted toward billing higher p …"

"… s. I can’t tell whether a charge is legitimate or not,” she said. AMA president Lazarus in his statement noted that while the AMA provides “guidance for …"

"… t doesn’t back off. In December of 2011, California Medical Association president Dr. James T. Hay fired off a letter to federal officials in Washington not …"

About the 'Cracking the Codes' project

By The Center for Public Integrity

Behind the reporting

Excerpts from this story referencing "Medicare":

"… e but the latest in a series of Center pieces that illuminate questionable Medicare practices and policies by marrying traditional shoe-leather reporting with …"

"… ndation of these pieces is the Center’s access to about two terabytes of Medicare claims data — data that was obtained by the Center in 2010 as the result …"

"… 2010 as the result of a settlement from litigation against the Centers for Medicare and Medicaid Services.   Delving deeply into this data has now h …"

"… ne of medicine’s dirty little secrets: medical providers garnering extra Medicare fees by “upcoding,” or billing for more extensive care than had actual …"

Judgment calls on billing make 'upcoding' prosecutions rare

By Fred Schulte

Authorities typically settle, and doctors often continue treating Medicare patients

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 "Medicare fraud":

"… that directs Medicare spending in often-inefficient ways.The big story in Medicare fraud last week was an unprecedented bust of 107 doctors, nurses and social work …"

"… , as reported by the Associated Press. Though the crackdown was huge, Medicare fraud is believed to cost up to $90 billion annually, the scams associated with …"

"… 011 alone) in medical services that never happened.Places to learn more:“Medicare fraud rampant in South Florida”, by The Miami Herald, August 3, 2008“11 …"

"… th Florida”, by The Miami Herald, August 3, 2008“111 charged with Medicare fraud in 9 cities” by The Washington Times, February 17, 2011“Feds Figh …"

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 "Office of Inspector General":

"… stice, the Internal Revenue Service, state agencies, and even with its own Office of Inspector General.“In a time of increased technological capability,” they wrote, “it a …"

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 "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 …"