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 "Washington":

"… e of the outsized influence lobbyists for health special interests have in Washington. As the Center for Public Integrity’s Joe Eaton pointed out in an excel …"

"… rence from Capitol Hill.   Eaton contrasted what is not happening in Washington, D.C. to improve the solvency of the Medicare program with what is happeni …"

"… to improve the solvency of the Medicare program with what is happening in Washington State to reduce unnecessary public spending on health care. Seven years a …"

"… te to reduce unnecessary public spending on health care. Seven years ago, Washington state lawmakers created a Health Technology Assessment program to evaluate …"

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 "Center for Responsive Politics":

"… get Gray elected. An analysis of campaign finance records provided by the Center for Responsive Politics found that Thompson and other donors who listed the accounting firm a …"

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 "driver":

"… g to get better value for their private health insurance dollars."The main driver here is financial," said Dr. Toby Cosgrove, CEO of the Cleveland Clinic, w …"

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"… rollments have been revoked and deactivated, and the latest that he billed Medicare was in 2010,” Cook said.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 "speaker":

"… s were the protectors of the government-run program they hold so dear.As a speaker at an especially contentious town hall meeting during the summer of 2009, …"

"… people had crammed into the school’s auditorium, not so much to hear the speakers as to express their opinions. Reform opponents were on one side of the au …"

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 "Medicaid":

"… ting in 2014 for a prospective pool of recipients including state workers, Medicaid recipients, individuals and small businesses. A similar public option wa …"

GAO takes on Medicare Advantage spending

By Fred Schulte

GAO will investigate program spending.

Excerpts from this story referencing "industry trade":

"… ned pay cuts to the health plans. America’s Health Insurance Plans, the industry trade group, spent nearly $5 million lobbying on a variety of issues, including …"

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 "Congress":

"… rmer California Governor Arnold Schwarzenegger, a Republican, Democrats in Congress decided as they worked on health care reform that providing coverage to th …"

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 "Medicare":

"… ated 78 million baby boomers in this country, I was delighted to hear that Medicare’s Hospital Trust Fund won’t run out of money until 2030 — 13 ye …"

"… attributed to the health care law, some of the provisions aimed at slowing Medicare spending, such as requiring Medicare to reduce payments to hospitals with …"

"… me of the provisions aimed at slowing Medicare spending, such as requiring Medicare to reduce payments to hospitals with high readmission rates, are likely he …"

"… elping. But the Hospital Trust Fund accounts for only about half of total Medicare spending. Most of the rest goes to cover physician fees, prescription drug …"

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 Services":

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

How Medicare Advantage plans code for cash

By Fred Schulte

Federal study criticizes Medicare Advantage and calls for changes.

Excerpts from this story referencing "Congress":

"… Further policy changes will likely be necessary,” the study concludes. Congress created Medicare Advantage in 2003 to encourage private insurance companie …"

"… stry and the fear of angering seniors also has largely quieted concerns in Congress that Medicare Advantage plans can be a poor value for taxpayers. Congress …"

"… Congress that Medicare Advantage plans can be a poor value for taxpayers. Congress recognized problems with Medicare Advantage coding as far back as 2005, wh …"

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 "Medicaid":

"… king new power to recover excessive charges. The Centers for Medicare and Medicaid Services says its wants to set up “a formal process to recoup overpaymen …"

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 "Medicaid Services":

"… at more needs to be done to protect tax dollars. Centers for Medicare and Medicaid Services (CMS) officials unveiled a new data analysis system to identify overpaymen …"

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 "Medicare":

"… te House, regardless of who is sitting in the Oval Office. The Center’s Medicare Advantage Money Grab investigation, led by veteran reporter Fred Schulte, …"

"… Federal officials made nearly $70 billion in “improper” payments to Medicare Advantage plans from 2008 to 2013, mostly overbillings, by manipulating or …"

"… lans from 2008 to 2013, mostly overbillings, by manipulating or misusing a Medicare payment tool called a “risk score.” From 2007 through 2011, Medicare …"

"… Medicare payment tool called a “risk score.” From 2007 through 2011, Medicare Advantage risk scores rose more than twice as fast as the average for peop …"

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 "UnitedHealth Group":

"… ify conditions that remain undiagnosed.” Terence Ohara, a spokesman for UnitedHealth Group, which owns the company, declined to address the financial impact of the v …"

"… its help create a “trusting and engaging relationship” with patients. UnitedHealth Group, which counts more than 3 million seniors in its Medicare Advantage plans, …"

Medicare Advantage lobbying machine steamrolls Congress

By Fred Schulte

Under pressure, Medicare Advantage critics morph into defenders.

Excerpts from this story referencing "Center for Responsive Politics":

"… s industry over the past three election cycles, according to data from the Center for Responsive Politics. Franken alone has received at least $90,000 from the health services indu …"

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 …"

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 "Florida":

"… being provided,” Cosgrove said. …"

"… al health officials to improve reporting of risk score data. In the South Florida case, government lawyers have been investigating Humana, Inc. for several …"

"… hysician Olivia Graves against Humana. Graves, who has practiced in South Florida for more than three decades, alleges that a Humana-owned clinic …"

"… hing to stop it.. The U.S. Attorney’s Office declined to join the South Florida case even though a federal judge granted it 11 requests for more time to i …"

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 "Puerto Rico":

"… the annual payments at the national level, the Center excluded payments in Puerto Rico, as do most researchers working with MA data, due to significantly differe …"

Medicare Advantage made simple: a glossary

By Fred Schulte

Definitions for lesser-known terms relating to Medicare.

Excerpts from this story referencing "Medicare":

"… ronic diseases such as diabetes and take other steps to manage their care. …"

"… any doctor they want and buy insurance policies to cover any gaps in what Medicare will pay for. Doctors bill Medicare for each service they provide. Medica …"

"… nce policies to cover any gaps in what Medicare will pay for. Doctors bill Medicare for each service they provide. Medicare Advantage: Nearly 16 million seni …"

"… dicare will pay for. Doctors bill Medicare for each service they provide. Medicare Advantage: Nearly 16 million seniors have joined about 700 insurance plans …"

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 Services":

"… 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 for copi …"

The Canadian health care system I disparaged

By Wendell Potter

Commentary: health care system up north is more efficient.

Excerpts from this story referencing "Medicine":

"… RAND Corporation found in a 2004 study published in the Annals of Internal Medicine that the VHA outperformed all other sectors of the U.S. health care system …"

GOP opposition to Obamacare baffles Dr. Sullivan

By Wendell Potter

Commentary: former HHS Secretary Sullivan says Obamacare resembles plan crafted by Republicans.

Excerpts from this story referencing "Medicaid":

"… ce plan if they are not eligible for a government program like Medicare or Medicaid — is among the most vilified by today’s GOP. “If they were supporti …"

"… orgia, where Sullivan was born and still lives, have refused to expand the Medicaid program to bring more low-incomes individuals and families into coverage, …"

"… erage, as the Affordable Care Act makes possible. Deal has said expanding Medicaid “is something our state cannot afford,” even with the federal governme …"

"… urnalists Thursday that, in his view, Georgia can’t afford not to expand Medicaid. Not only would the expansion bring hundreds of thousands of Georgians int …"

Dental chain may be booted from Medicaid program

By David Heath

Small Smiles, under federal scrutiny for performing unnecessary dental treatments on children, could be barred from the Medicaid program.

Excerpts from this story referencing "Medicaid":

"… April 3, 2014: Small Smiles will no longer be allowed to serve patients on Medicaid started Sept. 30, affecting hundreds of thousands of children, the inspect …"

"… t doesn't plan to appeal the decision, which will bar the company from the Medicaid program for five years. Small Smiles, which has been under federal scruti …"

"… orming unnecessary dental treatments on children, could be barred from the Medicaid program beginning next month. The inspector general of the Department of …"

"… new dentist willing to treat them. Small Smiles will be excluded from the Medicaid program in early April unless it appeals the decision. The owner of the co …"

Pay no attention to those insurance lobbyists behind the Medicare curtain!

By Wendell Potter

Commentary: 'grass-roots' campaign actually comes from health insurers.

Excerpts from this story referencing "Medicaid":

"… k ever since trying to figure out how to keep the Centers for Medicare and Medicaid Services  (CMS) from carrying out that provision of the law. And for …"

Selective outrage over federal health care costs

By Wendell Potter

Commentary: Conservatives slam risk fund for insurers, but have nothing to say about Medicare Advantage.

Excerpts from this story referencing "insurance market":

"… r coverage through the exchanges would be folks previously shut out of the insurance market — people who were older and sicker than the population at large. Those p …"

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