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 "Medicine":

"… . Graber, a physician and president of the Society to Improve Diagnosis in Medicine.  “Patients don’t have any idea how they are being coded.” Gra …"

How Medicare Advantage plans code for cash

By Fred Schulte

Federal study criticizes Medicare Advantage and calls for changes.

Excerpts from this story referencing "Washington":

"… esearchers Richard Kronick and W. Pete Welch has attracted scant notice in Washington. It was quietly posted late last month on an online research site run by t …"

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 "Obama administration":

"… y to cover millions of uninsured people. That’s consistent with an early Obama administration promise to reduce payments to the health insurers. But support for Medica …"

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

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 "Obama administration":

"… he work they do — which they often failed to do on by hand on paper. …"

"… tal medical record for every American within ten years. In early 2009, the Obama administration added billions of dollars in stimulus funds in the hopes that electronic h …"

"… data, positive or negative, that would be useful,” he said. In all, the Obama administration expects to spend more than $30 billion helping doctors and hospitals purch …"

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 "senior advisor":

"… about what is proper as medicine enters the digital era.Dr. David Kibbe, a senior advisor to the American Academy of Family Physicians on digital medicine, said the …"

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 "Obama administration":

"… es to “establish a set of national hospital…guidelines.”Although the Obama administration in early 2009 laid plans for spending as much as $30 billion helping docto …"

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 "Obama administration":

"… some doctors and hospitals to overbill Medicare.Dr. Farzad Mostashari, the Obama administration’s National Coordinator for Health Information Technology, said in an int …"

"… tal medical record for every American within ten years. In early 2009, the Obama administration added billions of dollars in stimulus funds in the hopes that electronic h …"

"… th enhance the quality of medical care and hold costs in check.In all, the Obama administration expects to spend more than $30 billion helping doctors and hospitals purch …"

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 "Obama administration":

"… medical record for every American within ten years. But in early 2009 the Obama administration championed using stimulus money to achieve the goal, hoping electronic hea …"

"… th enhance the quality of medical care and hold costs in check.In all, the Obama administration expects to spend more than $30 billion to help doctors and hospitals purch …"

"… health outcomes,” the House Ways and Means Committee said in a statement.Obama administration officials acknowledged the problem for the first time last month, assertin …"

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 "Texas":

"… tes of coding errrors, including one review in March of emergency rooms in Texas and Oklahoma that found $45 of every $100 was “paid in error.” Officia …"

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 fraud":

"… dgment by top federal officials that the digital era may spawn more costly Medicare fraud and billing abuse. In the past, federal officials have largely accepted th …"

OPINION: Center series demonstrates dangers of 'captured' regulators

By Wendell Potter

Center series demonstrates dangers of special interest influence

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 "Virginia":

"… ntractor called Trailblazer audited patient office visits in early 2010 in Virginia and found mistakes in half the records it reviewed. A similar audit in Col …"

"… i, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia and West Virginia. …"

"… th Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia and West Virginia. …"

Billing complexity spawns new industry

By Fred Schulte

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

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 "headache":

"… illing of the most expensive codes surged. Take the case of emergency room headaches. From 2001 to 2008, hospital billing of the top two evaluation and manage …"

"… 2008, hospital billing of the top two evaluation and management codes for headache patients more than doubled to 43 percent. The number of tests and procedur …"

"… led to 43 percent. The number of tests and procedures doctors performed on headache patients also rose. In 2001, hospital emergency rooms billed an average of …"

"… the hospital where costs occur, including imaging, labs, and supplies) for headache patients, according to Medicare billing data. In 2008, they billed an aver …"

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 "Texas":

"… records it reviewed. A similar audit in Colorado, New Mexico, Oklahoma and Texas reported a 91% error rate for billing for office visits. Billy Quarles, a …"

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

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

Excerpts from this story referencing "Texas":

"… ountry, but said they were most common in California, New York Florida and Texas.The audit comes amid growing controversy over how to compensate doctors, p …"

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 "physician":

"… dicare beneficiaries will be placed at risk.” …"

"… administrator on Tuesday, Murray and other convicted felons and unlicensed physicians are still listed as legitimate physicians on the health plan’s provider …"

"… convicted felons and unlicensed physicians are still listed as legitimate physicians on the health plan’s provider database, pointing to a serious vulnerabi …"

"… n isolated case. In the letter to Sebelius, the senators reference an Ohio physician who continues to have a valid Medicare provider number despite a convictio …"

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

Pages