OPINION: making the tough health care calls

By Wendell Potter

Independent Payment Advisory Board may be best hope for trimming costs, eliminating unnecessary procedures.

Excerpts from this story referencing "Medicaid":

"… o Medicare. Even though the program is run by the Centers for Medicare and Medicaid Services, members of Congress frequently exert their influence over that a …"

"… dical procedures and devices paid for by taxpayers to cover state workers, Medicaid recipients and the people receiving benefits through the state’s workers …"

Clinton supporter suspected of illegal donations

By Alan Suderman and Ben Wieder

Clinton's 2008 campaign received $50,000 from "assembly line of illegal campaign contributions."

Excerpts from this story referencing "John McCain":

"… ($20,000 in the 2004 cycle), former Republican presidential candidate Sen. John McCain ($13,800 in the 2008 cycle) and Senate Majority Leader Harry Reid ($9,600 …"

High court upholds key part of Obama health law

By The Associated Press

ObamaCare's individual mandate survives Supreme Court as a tax.

Excerpts from this story referencing "Medicaid":

"… irness," Roberts said.The court found problems with the law's expansion of Medicaid, but even there said the expansion could proceed as long as the federal go …"

"… ong as the federal government does not threaten to withhold states' entire Medicaid allotment if they don't take part in the law's extension.The court's four …"

"… the purchase of health insurance and in denying non-consenting states all Medicaid funding."In all, the justices spelled out their views in six opinions tota …"

"… l budget woes will force them to confront painful options for Medicare and Medicaid, the giant federal programs that cover seniors, the disabled, and low-inco …"

Is Michael Jackson's doctor disqualified from Medicare? Or are two senators mistaken?

By Joe Eaton

Obama admin. disputes senators' contention that Michael Jackson's physician still eligible to bill Medicare

Excerpts from this story referencing "Medicare":

"… rs that Michael Jackson’s physician mistakenly remained eligible to bill Medicare long after being convicted for his role in the singer’s 2009 death. But …"

"… rin Hatch, R-Utah, and Tom Coburn, R-Oklahoma, on Tuesday sent a letter to Medicare’s administrator alleging that Jackson’s doctor, Conrad Murray,  a …"

"… ld have caused him to be immediately kicked out of the program.Centers for Medicare and Medicaid spokesman Brian Cook said the senators are mistaken. Conrad …"

"… rollments have been revoked and deactivated, and the latest that he billed Medicare was in 2010,” Cook said. The spokesman declined to comment further about …"

Analysis — Are seniors paying attention to Paul Ryan's plan for Medicare?

By Wendell Potter

ANALYSIS: Republicans sold seniors a bill of goods on health care reform and Medicare

Excerpts from this story referencing "Plus Association":

"… uld “cut Medicare.” Also joining in on the campaign of lies was the 60 Plus Association, a group that, according to the Washington Post, AARP and other sources, h …"

"… years from the pharmaceutical industry and other special interests.The 60 Plus Association ran TV ads in numerous congressional districts last fall against Democrats …"

Analysis — Insurers’ ‘friends’ will influence public option debate in Conn.

By Wendell Potter

Health insurers in Connecticut will call on some of their longtime allies to help turn the public and state lawmakers against the idea of cr

Excerpts from this story referencing "Connecticut":

"… alth Care and Deceiving Americans. …"

"… rk in the Senate and hit paydirt when they convinced Sen. Joe Lieberman of Connecticut to come out against it. Lieberman had previously expressed support for t …"

"… option for affordable coverage. Meanwhile, though, state legislators in Connecticut passed a bill to create the framework for SustiNet. In an effort to quash …"

"… s, is potentially more helpful. In fact, the NFIB is already on the job in Connecticut. The Hartford Courant last week quoted an NFIB official as saying that & …"

States continue war over Obamacare

By Fred Schulte

State lawmakers at odds over hundreds of bills to either cripple or prop up Affordable Care Act.

Excerpts from this story referencing "Los Angeles":

"… in, who said he runs the 10th Amendment Center from the living room of his Los Angeles apartment. Though he concedes detractors label his group as “crazies, …"

"… 4, federal health officials announced $60 million in navigator grants. The Los Angeles Times reported in January 2014 that California’s exchange had …"

Selling out for big business: business as usual on Capitol Hill

By Wendell Potter

Commentary: upcoming Obamacare bills benefit corporations, not regular folks.

Excerpts from this story referencing "Elizabeth Warren":

"… gress—which even includes liberals like Sen. Al Franken of Minnesota and Elizabeth Warren of Massachusetts (there are a lot of medical device makers in both of thei …"

Health care findings you may have missed in 2014

By The Center for Public Integrity

$70 billion in "improper" Medicare Advantage payments and the problem shared by 80 percent of nursing homes.

Excerpts from this story referencing "Medicare":

"… ons. Keep reading …"

"… ar. If you weren't aware, you might have missed $70 billion in "improper" Medicare Advantage payments and the problem shared by 80 percent of all nursing hom …"

"…   1. $70 billion in 'improper' payments A Center investigation into Medicare Advantage uncovered how $70 billion in "improper" payments have been made …"

"… vantage uncovered how $70 billion in "improper" payments have been made to Medicare Advantage plans from 2008 to 2013. Most of these improper payments can be …"

Nursing homes serving minorities offering less care than those housing whites

By Jeff Kelly Lowenstein

Nursing homes serving blacks, Latinos provide less daily registered nurse care than those housing whites.

Excerpts from this story referencing "Nursing":

"… of more than 15,000 skilled Nursing facilities nationwide. That website, Nursing Home Compare, is promoted by the government and widely used by the public …"

"… rity investigation has raised questions about the accuracy of the oft-used Nursing Home Compare information. Critics say it may reflect staffing levels that …"

"… affing levels, especially among registered nurses, than those reflected in Nursing Home Compare. In 2005 the federal Centers for Medicare and Medicaid Servic …"

"… c. Hundreds of majority-black homes throughout the country were listed in Nursing Home Compare as providing a little more than a half-hour of registered nur …"

Running a five-star nursing home

By Jeff Kelly Lowenstein

Top-rated homes had more nurses, less turnover

Excerpts from this story referencing "Texas":

"… he homes analyzed. Bita Kash, professor of Health Policy and Management at Texas A & M University, said Medicaid’s comparatively low reimbursements h …"

Analysis shows widespread discrepancies in staffing levels reported by nursing homes

By Jeff Kelly Lowenstein

Analysis shows staffing levels lower than what's reported on public website.

Excerpts from this story referencing "Charles Grassley":

"… 2016 after bipartisan legislation authorized $11 million in funding. Sen. Charles Grassley, R-Iowa, and Schakowsky, two of the leading figures in pushing for the tra …"

More scrutiny coming for Medicare Advantage, Obamacare

By Fred Schulte

New round of audits coming; Obamacare too.

Excerpts from this story referencing "Medicare":

"… ending on managed health care in the new fiscal year, ranging from private Medicare Advantage groups that treat millions of elderly to health plans rapidly ex …"

"… Health and Human Services Office of Inspector General, which investigates Medicare and Medicaid waste, fraud and abuse, said it would conduct “various revi …"

"… aid waste, fraud and abuse, said it would conduct “various reviews” of Medicare Advantage billing practices with an eye toward curbing overcharges. Result …"

"… lent sign ups. The Inspector General’s office did not say if individual Medicare Advantage plans would be audited, but indicated it would focus on concerns …"

GAO takes on Medicare Advantage spending

By Fred Schulte

GAO will investigate program spending.

Excerpts from this story referencing "Medicaid":

"… spring. GAO auditors will target efforts by the Centers for Medicare and Medicaid Services (CMS), which runs the senior care program, to ensure the privatel …"

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 …"

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 …"

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 "Center for Public Integrity":

"… ays privately run health plans a set monthly rate for each patient. As the Center for Public Integrity reported in a series of investigative reports this past June, about 16 mil …"

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 "Center for Public Integrity":

"… etwork bills,” he said in the sworn statement. In an interview with the Center for Public Integrity, Morphew said that Humana paid the bill, but only after “several months …"

"… bout one third of the elderly and disabled people eligible for Medicare. A Center for Public Integrity investigation published in June found as much as $70 billion of improper p …"

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 …"

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 "Center for Public Integrity":

"… icials have struggled to pay the senior care plans accurately for years. A Center for Public Integrity investigation published last month found that Medicare paid the health pla …"

"… ans are a good deal for taxpayers is a far more contentious question. The Center for Public Integrity’s analysis of Medicare Advantage plan data from 2007 through 2011 confir …"

"… een overpaid — and by how much — remains under wraps. In late May, the Center for Public Integrity sued the Department of Health and Human Services to make its aud …"

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 "Congress":

"… gin requiring Medicare Advantage plans to report fraud to the government. Congress created Medicare Advantage in 2003 to encourage private insurance companie …"

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 "America":

"… ose reductions. Having served on the strategic communications committee of America’s Health Insurance Plans, I can imagine how sophisticated and multi-pron …"

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 "Arizona":

"… .” …"

"… he said. Early, the independent insurance agent in Tucson who blogs on Arizona Medicare issues, said from her vantage point, the verdict among seniors is …"

"… Advantage plans maximize billing. Matrix Medical Network, of Scottsdale, Arizona, forecasts revenues topping $1 billion in the next few years from home vis …"

Medicare Advantage lobbying machine steamrolls Congress

By Fred Schulte

Under pressure, Medicare Advantage critics morph into defenders.

Excerpts from this story referencing "Mitt Romney":

"… te floor in praise of the Affordable Care Act. Franken rebuked Republican Mitt Romney for his 2012 presidential campaign promise to “restore those billions an …"

Health insurers have their way with regulators

By Fred Schulte

Billions in Medicare Advantage overpayments likely gone for good.

Excerpts from this story referencing "prosecutor":

"… s as part of a budget cut. Robert Trusiak, a former Department of Justice prosecutor, said that “at the very least” federal officials should have demanded …"

"… for the return of overdue books.   Trusiak, the former federal prosecutor, said CMS officials yielded too much ground to the industry and that these …"

New audits may recover missing millions — or not

By Fred Schulte

Secretive audits target some Medicare Advantage plans.

Excerpts from this story referencing "Arizona":

"… disclosed in a Securities and Exchange Commission filing that its plan in Arizona was selected. None of the health plans would comment. At issue is the accu …"

Medicare Advantage made simple: a glossary

By Fred Schulte

Definitions for lesser-known terms relating to Medicare.

Excerpts from this story referencing "CMS":

"… ther terms The Centers for Medicare and Medicaid Services: Referred to as CMS, this federal agency oversees Medicare and Medicaid, the government health …"

"… s Medicare and Medicaid, the government health plan for low income people. CMS is part of the Department of Health and Human Services. Dual Eligibles:&n …"

"… ent’s risk score— even if the health plan provides no added treatment. CMS officials proposed banning home visits for collecting risk data, but backe …"

"… unrecognized diseases that could boost risk scores and Medicare payments. CMS has proposed that health plans also report cases in which risk scores shou …"

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 "George W. Bush":

"… r later. Thomas Scully, who helped get the program running under President George W. Bush, said rates were generous in hopes of enticing insurers to expand their Me …"

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 "Josh Valdez":

"… hile the potential liability to the government “remained unaddressed.” …"

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 "Congress":

"… ervices and less for healthy people. Why were risk scores adopted?  Congress wanted to make sure health plans wouldn’t shy away from taking sicker pa …"