GAO takes on Medicare Advantage spending

By Fred Schulte

GAO will investigate program spending

Excerpts from this story referencing "Washington":

"… d David A. Lipschutz, an attorney with the Center for Medicare Advocacy in Washington. America’s Health Insurance Plans, the industry’s trade group, wouldn …"

"… ntage groups. These private firms, known as Recovery Audit Contractors in Washington bureaucratese, have been pursuing fraud by doctors and hospitals for years …"

Comparison shopping for a health plan

By Wendell Potter

California makes it easy to do your homework.

Excerpts from this story referencing "Medicare":

"… om a private insurer unless we’re eligible for a government program like Medicare or Medicaid — you’d think it would be easy to discover which health pl …"

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 "Medicaid Services":

"… nter for Public Integrity. Kronick said that the Centers for Medicare and Medicaid Services, the arm of HHS that oversees Medicare Advantage, had proposed as far back …"

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 "White House":

"… he hospital companies, physician organizations and drug makers in ways the White House and members of both parties in Congress were not willing to do in 2009 bec …"

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 "Medicine":

"… nd care to many Boeing employees, along with UW (University of Washington) Medicine — without an insurance firm. Officials at Providence-Swedish told me Boe …"

"… Web. While Boeing is contracting directly with Providence-Swedish and UW Medicine, the ACOs will have their own deals with insurance companies to provide ba …"

Health insurers turning into who knows what?

By Wendell Potter

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

Excerpts from this story referencing "United States":

"… roup’s website, it is “the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives…” WellP …"

"… ida. We’re here to be the best health solutions company in the United States.” What all of those companies’ executives understand is that if profi …"

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 "American Medical Association":

"… reduce spending by billions of dollars if it wrested some control from the American Medical Association, which for more than two decades has largely determined how much doctors g …"

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 "Medicaid":

"… formal complaint, and about two dozen others, to Centers for Medicare and Medicaid Services (CMS) administrator Marilyn B. Tavenner. Swanson asked the federa …"

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 "judge":

"… having tobacco This is judge Tim Irwin of Tennessee. As a juvenile court judge, he is admired for kind gestures like handing out stuffed animals to small …"

"… ough New York’s luxury real estate. Keep reading 8. Sixteen high court judges ruled in 26 cases despite having a financial conflict More than half of …"

"… despite having a financial conflict More than half of federal appellate judges, arbiters of the second-highest court in the U.S., reported owning stock …"

"… -highest court in the U.S., reported owning stock in 2012. We wondered how judges were keeping track of their holdings when cases involved a company they'd …"

How Medicare Advantage plans code for cash

By Fred Schulte

Federal study criticizes Medicare Advantage and calls for changes.

Excerpts from this story referencing "Medicare":

"… on the proposal is due by November 1. …"

"… ns exaggerate how sick their patients are and how much they cost to treat. Medicare expects to pay the privately run plans — an alternative to traditional M …"

"… e expects to pay the privately run plans — an alternative to traditional Medicare — some $160 billion this year. The HHS study does not directly accuse a …"

"… to date that suspect billing practices have been common across much of the Medicare Advantage industry and are likely to get worse unless officials crack down …"

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 "health":

"… , crazy as it sounds, those ads may have contributed to the success of the health care legislation this year. The Obama administration had hoped that at le …"

"… even million Americans would sign up for coverage on the federal and state health insurance exchanges during the six-and-a half-month enrollment period that …"

"… ative ads people were exposed to, the more likely they were to enroll in a health plan. It seems that P.T. Barnum’s maxim — “I don’t care what they …"

"… uld change, of course. Obamacare likely will be back in the headlines when health insurers announce their rates for 2015 a few weeks before the November ele …"

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 "Medicare":

"… lic. The case is pending. …"

"… ally, are seeking new power to recover excessive charges. The Centers for Medicare and Medicaid Services says its wants to set up “a formal process to reco …"

"… Center for Public Integrity investigation published last month found that Medicare paid the health plans nearly $70 billion in “improper” payments — mo …"

"… verstating the health risks of patients — from 2008 through 2013 alone. Medicare expects to pay more for sicker patients and less for those in good health …"

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 "Medicare":

"… dely respected physician and health policy expert, to lead the Centers for Medicare and Medicaid Services (CMS). Despite having broad support among other heal …"

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 "Humana":

"… not come as 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 A …"

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.

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 "Department of Justice":

"… e billing, rarely spill out into public view. One case that did was a 2009 Department of Justice lawsuit against the owners of America’s Health Choice Medical Plans Inc. …"

Medicare Advantage lobbying machine steamrolls Congress

By Fred Schulte

Under pressure, Medicare Advantage critics morph into defenders.

Excerpts from this story referencing "Florida":

"… was a tough sell. It didn’t help that these “managed care” plans in Florida and other states were plagued by scandals, from failing to provide vital m …"

"… ublicans have stepped up their longstanding support of Medicare Advantage. Florida’s Marco Rubio, in a Senate speech in August of last year, said  …"

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":

"… even though by law we now have to buy coverage from those companies. …"

"… this year and soaring CEO compensation. Almost all of the publicly traded health insurers reported big increases in revenue and profits last year. The big …"

"… mpanies, led by Mark Bertolini, CEO of Aetna, the nation’s third largest health insurer. Bertolini’s total compensation of $30.7 million in 2013 was 131 …"

"… learning for the first time right now just how much the CEOs  of big health insurance companies make. Unless you subscribe to health Plan Week, 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 "Medicare":

"… ouch it you get nailed.” …"

"… indings signaled that billing errors could be deeply rooted within private Medicare Advantage plans — which contract with the federal government to care for …"

"… that these abuses could be wasting taxpayer dollars at a ferocious clip. Medicare expects to pay higher rates for legitimately sicker people who may require …"

"… rote.  In Arizona, a health plan collected thousands of dollars from Medicare to treat congestive heart failure in a patient seen for knee pain, accordi …"

New audits may recover missing millions — or not

By Fred Schulte

Secretive audits target some Medicare Advantage plans.

Excerpts from this story referencing "Medicare":

"… ieves. …"

"… s of millions of dollars for past overcharges and other billing mistakes. Medicare pays the health plans a set amount monthly for each person based on estima …"

"… o top $150 billion this year. The government audits are targeting chronic Medicare Advantage billing errors that federal officials blame for billions of doll …"

"… ts have yet been completed, or what the results might be. The Centers for Medicare and Medicaid Services (CMS), the agency that runs Medicare, has quietly co …"

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 "Department of Justice":

"… at it overbilled the government, including a criminal investigation by the Department of Justice in Washington and a criminal case involving the U.S. Attorney’s branch o …"

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.

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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