GAO takes on Medicare Advantage spending

By Fred Schulte

GAO will investigate program spending.

Excerpts from this story referencing "Josh Valdez":

"… gnosed. Humana has denied the allegations. In a separate civil case, Josh Valdez, a former Bush administration health official, alleges that two Puerto Ric …"

Comparison shopping for a health plan

By Wendell Potter

California makes it easy to do your homework.

Excerpts from this story referencing "Health":

"… plans, you can go to Healthcare.gov, maintained by the U.S. Department of Health and Human Services, or a private online source like Healthinsurance.org, w …"

"… patient experience. They were followed by Blue Shield of California, Sharp Health Plan (in greater San Diego), and Western Health Advantage (in the Sacramen …"

"… hield of California, Sharp Health Plan (in greater San Diego), and Western Health Advantage (in the Sacramento area). All of those plans are also nonprofits …"

"… ts. The plans with the fewest stars were Aetna, Anthem Blue Cross, Cigna, Health Net and UnitedHealthcare of California, all for-profit companies. Convers …"

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 "Medicare":

"… s need to do a better job ferreting out billing errors and overpayments to Medicare Advantage plans — mistakes which are estimated to cost taxpayers billion …"

"… xpayers billions of dollars every year, a top government researcher says. Medicare pays the privately-run Advantage health insurance plans, which cover more …"

"… n criticized for allegedly overstating how sick some patients are to boost Medicare revenue, a practice known as “upcoding.” Researcher Richard Kronick, …"

"… that seem to diagnose much higher-than-expected rates of patient illness. Medicare Advantage plans that have been “significantly more aggressive than avera …"

California coverage plan for undocumented echoes earlier call by Schwarzenegger

By Wendell Potter

Commentary: former governor supported plan allowing coverage for undocumented residents.

Excerpts from this story referencing "Mitt Romney":

"… 7 that was similar to the one enacted in Massachusetts under then-Governor Mitt Romney. Schwarzenegger’s plan had one notable difference: it would have require …"

Obamacare helps millions, but falls short in many ways

By Wendell Potter

The Affordable Care Act has reduced the ranks of the uninsured, but cost of care must be addressed.

Excerpts from this story referencing "Washington":

"… born with. During the months that health care reform was being debated in Washington, I met many young people who told me they had not been able to buy an insu …"

"… were not willing to do in 2009 because of the political clout they have in Washington. Consequently, much more reform will have to be undertaken in years to com …"

New types of health care delivery are improving the 'patient experience'

By Wendell Potter

Commentary: eliminating role of insurers could improve health care delivery.

Excerpts from this story referencing "Medicare":

"… ederal government works with insurers in the same way to handle claims for Medicare beneficiaries. Gifford also told me he’s in discussions with a number o …"

"… ompanies, to some extent. And he noted that government entities, including Medicare and state governments, are following a similar path. It’s a path that l …"

"… ey Peninsula in California, which earlier this year began offering its own Medicare Advantage plan to serve area seniors through a subsidiary called Aspire. …"

Health insurers turning into who knows what?

By Wendell Potter

Commentary: health insurers are transforming themselves — but into what?

Excerpts from this story referencing "WellPoint":

"… other business lines that once defined them. As for UnitedHealthcare and WellPoint, few people had even heard of them 25 years ago. But thanks to cash genera …"

"… tates and a leader worldwide in helping people live healthier lives…” WellPoint says it is “working to transform health care with trusted and caring sol …"

Defeat of California initiative would protect insurers' profits

By Wendell Potter

Proposition 45 would allow California's insurance chief to block insurance rate hikes; insurers are spending millions to kill it.

Excerpts from this story referencing "Health":

"… millions of dollars to an organization called Californians Against Higher Health Care Costs. If you think the companies’ CEOs opened their personal check …"

"… that are paying for the propaganda campaign. Californians Against Higher Health Care Costs (CAHHCC) is not a grassroots, consumer-led organization as the …"

"… the state: Anthem/WellPoint; Blue Shield of California; Kaiser Foundation Health Plan; Health Net; and UnitedHealthcare. Of $37.9 million donated to CAHHC …"

"… nthem/WellPoint; Blue Shield of California; Kaiser Foundation Health Plan; Health Net; and UnitedHealthcare. Of $37.9 million donated to CAHHCC as of Augus …"

Docs, drug companies, insurers drive up Medicare costs

By Wendell Potter

Commentary: reform drove down hospital costs, creating Medicare savings, but insurers, doctors and drug companies escaped cuts.

Excerpts from this story referencing "pharmaceutical":

"… stament to the power and influence of the lobbyists who represent doctors, pharmaceutical companies and health insurers. Some lawmakers, including Rep. Henry Waxma …"

"… cy groups, elimination of that program “resulted in windfall profits for pharmaceutical manufacturers.” They cited an analysis showing that drug companies’ pr …"

Medicare Advantage patients find themselves in regulatory limbo

By Fred Schulte

States lack oversight but feds are struggling to keep with fast-growing health plans.

Excerpts from this story referencing "Health":

"… Jepsen called for federal officials to “aggressively scrutinize” UnitedHealthcare’s decision to drop a large number of doctors from its Medicare Advan …"

Dire predictions of endless waits for a doctor have proven unfounded

By Wendell Potter

Commentary: Obamacare has not resulted in long waits for a doctor.

Excerpts from this story referencing "Medicare":

"… says, if rather then repealing Obamacare, Congress would lift a freeze in Medicare’s support for physician-training positions that has been in effect since …"

Ten major findings from our investigations so far this year

By Jared Bennett and Sarah Whitmire

Investigations from the first half of 2014

Excerpts from this story referencing "Japan":

"… the financial industry’s proxy voices on Capitol Hill. Keep reading 3. Japan has no urgent plutonium needs, but a new plant will soon make more than 17 …"

"… on make more than 17,000 pounds of it each year Starting this October, a Japanese nuclear fuel plant 22 years in the making will begin churning out a nuc …"

"… e an energy source for the country. But the key word there is, eventually. Japan can't currently convert the explosive nuclear component. With that kind of …"

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 …"

Obamacare-driven competition lowering rates in some states

By Wendell Potter

Commentary: much-maligned Affordable Care Act attracting for-profit insurers, driving prices down in some states.

Excerpts from this story referencing "Health":

"… at least where they think they can make money. Leading the pack is UnitedHealth Group, the country’s biggest Health insurer. The company offered 2014 po …"

"… n only about a dozen states. During a call with investors last week, UnitedHealth CEO Stephen Hemsley said the company will compete for 2015 Obamacare busin …"

"… p to choose from. And based on preliminary rate filings, the Ohio co-op, InHealth Mutual, is besting its established competitors by almost 25 percent. Here …"

"… of 5.1 percent while two nonprofit carriers, Colorado Access and Colorado HealthOP, plan to reduce premiums by 22 and 9.63 percent, respectively. Mary …"

Attack ads may actually be benefiting Obamacare enrollment

By Wendell Potter

Publicity from attacks may actually help hike enrollment.

Excerpts from this story referencing "West Virginia":

"… entucky 8.35 points, Rhode Island 8.73 points and Oregon 10.54 points. Red West Virginia saw its rate drop the most: 10.74 points. . Yet another study, this …"

Feds seek new authority to recoup Medicare Advantage overcharges

By Fred Schulte

Impact: Feds act to recoup overcharges following Center investigation.

Excerpts from this story referencing "Health":

"… luating the proposal,” said Clare Krusing, a spokeswoman for America’s Health Insurance Plans, the industry’s trade group. Congress created Medicare A …"

"… s were presented at a conference of the American Society of Health Economists in Los Angeles on June 25. “Our study is the first that can …"

"… late May, the Center for Public Integrity sued the Department of Health and Human Services to make its audits and other records public. The case i …"

Medicare Advantage plans require more scrutiny

By Fred Schulte

Government inspector says private Medicare plans difficult to investigate due to lack of access to data.

Excerpts from this story referencing "Medicare":

"… ederal officials need to step up efforts to investigate fraud and abuse in Medicare Advantage health plans treating millions of elderly Americans, a top gover …"

"… Commerce. The hearing was called to assess fraud and abuse safeguards in Medicare, which last year covered about 51 million people at a cost to taxpayers of …"

"… $50 billion of that amount was paid improperly, including $11.8 billion to Medicare Advantage plans. A Center for Public Integrity investigation published ea …"

"… ed earlier this month found as much as $70 billion of improper payments to Medicare Advantage plans from 2008 through last year. The Center’s investigation …"

Praise for UK-style health system vindicates spurned nominee

By Wendell Potter

Former Medicare chief's support for UK's health care system may win votes in race for governor of Massachusetts.

Excerpts from this story referencing "New York":

"… ok to the Brits when it comes to health care. In a research report by the New York-based Commonwealth Fund that evaluated the health care systems of several …"

Health insurance lobby keeps Medicare Advantage overpayments flowing

By Wendell Potter

Commentary: program bills are excessive, but don't expect reforms.

Excerpts from this story referencing "Cigna":

"… s a shock to me. During my two decades in the industry, at both Humana and Cigna, I came to understand just how much of a cash cow the Medicare Advantage p …"

Home is where the money is for Medicare Advantage plans

By Fred Schulte

Medicare Advantage home visits may not improve health, but boost risk scores and cost taxpayers billions.

Excerpts from this story referencing "CMS":

"… s to treat any disease they diagnose. In late February of this year, CMS officials said in a draft regulation that they had seen “little evi …"

"… de group, America’s Health Insurance Plans, in a March 7, 2014 letter to CMS argued that the agency had shown no evidence that diagnoses made at home v …"

"… believe the proposal is misguided and should be withdrawn,” she wrote. CMS changed its mind with a final order issued in early April that said simply …"

"… “analyze data” and “may reconsider” their decision in the future. CMS officials have been trying to arrest the rise in risk scores for years. A …"

Medicare Advantage lobbying machine steamrolls Congress

By Fred Schulte

Under pressure, Medicare Advantage critics morph into defenders.

Excerpts from this story referencing "Medicaid":

"… ss who signed a February 2014 letter to Centers for Medicare and Medicaid Services Administrator Marilyn Tavenner supporting Medicare Advantage. The …"

Get involved: Help Medicare Advantage investigation go further with donations and news tips

Join us in finding problems with Medicare Advantage billing, “risk scores”, or home visits.

Excerpts from this story referencing "Medicare":

"… y Gordon Witkin.      …"

"… ls that billions of tax dollars are wasted every year through leakage of a Medicare payment tool called a "risk score". Get involved   If you are a hea …"

"… are a health professional or medical coder and have a story to tell about Medicare Advantage billing issues or “risk scores”, please send Fred Schul …"

"… res”, please send Fred Schulte an email. If you are a patient in a Medicare Advantage plan and have been scheduled for a “home visit” let us know …"

Skyrocketing salaries for health insurance CEOs

By Wendell Potter

Commentary: soaring compensation, rising stock prices don't justify higher premiums.

Excerpts from this story referencing "Health":

"… they can hike premiums high enough to satisfy shareholders. According to Health Plan Week, a trade publication, the CEOs of the 11 largest for-profit comp …"

"… y were this time last year. Of those 11 companies (Aetna, Centene, Cigna, Health Net, Humana, Molina, Triple-S Management Corp., UnitedHealth Group, Univer …"

"… ntene, Cigna, Health Net, Humana, Molina, Triple-S Management Corp., UnitedHealth Group, Universal American, Wellcare, and WellPoint) nine saw their stocks …"

"…  of big Health insurance companies make. Unless you subscribe to Health Plan Week, it’s not likely you will stumble across their salaries. Nor i …"

Health insurers have their way with regulators

By Fred Schulte

Billions in Medicare Advantage overpayments likely gone for good.

Excerpts from this story referencing "Obama administration":

"… he number of audits the agency said it would do in 2009. At that time, the Obama administration had promised to ramp up efforts to recoup overpayments to help fund the Af …"

New audits may recover missing millions — or not

By Fred Schulte

Secretive audits target some Medicare Advantage plans.

Excerpts from this story referencing "lawyer":

"… reviewed by the Center for Public Integrity. Mary Inman, a San Francisco lawyer who represents whistleblowers, said officials have been concerned for year …"

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 "cuts":

"… lth care politics The Affordable Care Act, or Obamacare, orders deep rate cuts in Medicare Advantage, partly to cover millions of uninsured people. That …"

"… , the insurance industry mounted a fierce media campaign to block the rate cuts, enlisting support from more than 200 members of Congress and forcing the …"

"… rgue their patients are poorer and sicker than average. They also say that cuts required under the Affordable Care Act have hit them hard, prompting cuts …"

"… cuts required under the Affordable Care Act have hit them hard, prompting cuts in benefits and higher premiums for patients who can ill afford to pay mor …"

Whistleblower suit says health plan cheated government out of more than $1 billion

By Fred Schulte

Lawsuit: executives worried health plan would be ‘screwed’ if feds heard of overcharges.

Excerpts from this story referencing "Medicaid":

"… be “screwed” if it was audited by the federal Centers for Medicare and Medicaid Services, especially if the review reached back to 2007. She said overchar …"

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 …"

Methodology for 'Medicare Advantage Money Grab'

By David Donald and Erin Durkin

A behind-the-scenes look at the data analysis for the 'Medicare Advantage Money Grab' investigation.

Excerpts from this story referencing "Medicare":

"… n purposes only. …"

"… egrity analyzed Medicare Advantage (MA) data obtained from the Centers for Medicare and Medicaid Services (CMS). The data contained enrollment and payment inf …"

"… information for MA contract-plans and Fee-For-Service (FFS or traditional Medicare) payment data by county, downloaded from three CMS web pages: CMS Plan Pay …"

"… in the Health Insurance Portability and Accountability Act (HIPAA), small Medicare Advantage plans with 10 or less people are omitted from the data so that p …"

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