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 "Vermont":

"… ie about. Consider this. In a Wall Street Journal op-ed last week, former Vermont Gov. Howard Dean, also a former doctor, wrote that the IPAB “is essentia …"

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 "Senate Majority Leader":

"… an presidential candidate Sen. John McCain ($13,800 in the 2008 cycle) and Senate Majority Leader Harry Reid ($9,600 in 2009). Thompson himself made political contribution …"

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 "Medicare":

"… their own small business.Seniors also benefit from the law through better Medicare coverage for those with high prescription costs, and no copayments for pre …"

"… als, nursing homes, and many other service providers may struggle once the Medicare cuts used to finance the law really start to bite.Illegal immigrants are n …"

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

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"… rollments have been revoked and deactivated, and the latest that he billed Medicare was in 2010,” Cook said.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

"… ustry and backed by House Speaker Newt Gingrich and Senate Majority Leader Trent Lott, gave Medicare beneficiaries the option of getting their benefits through …"

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 "official":

"… on the job in Connecticut. The Hartford Courant last week quoted an NFIB official as saying that “SustiNet’s faults go beyond the problem of dup …"

GAO takes on Medicare Advantage spending

By Fred Schulte

GAO will investigate program spending.

Excerpts from this story referencing "Miami":

"… dicare Advantage insurers are stacking up in federal courts. In one case, Miami physician Olivia Graves alleged that a Humana-affiliated clinic had diagno …"

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 "Humana":

"… utives of the two biggest Medicare Advantage plans, UnitedHealth Group and Humana, vowed to fight any further rate cuts. The two insurers control about 40 p …"

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 "Governor":

"… at with folks hanging off the sides of the ship." …"

"… nuary 2007 that was similar to the one enacted in Massachusetts under then-Governor Mitt Romney. Schwarzenegger’s plan had one notable difference: it would …"

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 Rights Center":

"… ld ever hope to have. Late last month, two of the advocacy groups — the Medicare Rights Center and Social Security Works — released a report suggesting that Congress c …"

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 "Humana":

"… n Minnesota retiree Doug Morphew needed surgery last year, he expected his Humana Medicare Advantage plan to step up and pay the lion’s share of the bill. …"

"… operation to repair an aortic aneurysm. Less than a month later, however, Humana hit him with a bill for $6,461.66, claiming the surgery was not covered be …"

"… ks part-time as a transportation industry consultant. “I am insulted by Humana’s runaround. It seems as though Humana is denying my claims hoping that …"

"… consultant. “I am insulted by Humana’s runaround. It seems as though Humana is denying my claims hoping that I will give up and pay the out-of-network …"

How Medicare Advantage plans code for cash

By Fred Schulte

Federal study criticizes Medicare Advantage and calls for changes.

Excerpts from this story referencing "Analyzing government":

"… eating elderly patients — and have gotten away with doing it for years. Analyzing government data never before made public, Department of Health and Human Services res …"

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 "insurance":

"… Advantage and introduced risk scores in 2003 as a way to encourage private insurance companies to jump into the senior care market. The program now insures som …"

"… this year. The plans, many of them run by some of the nation’s largest insurance companies, are popular because they often provide extra benefits, such as …"

"… ut the scores crept back up in 2011. Critics argue that even as the health insurance industry lobbies Congress to stave off further rate cuts, it remains overp …"

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 "insurance":

"… omplete data that would facilitate oversight” of the fast-growing health insurance plans. His comments came in testimony prepared for a Wednesday hearing of …"

"… e” Medicare. But Medicare Advantage plans, which are often run by large insurance companies and accept a set monthly fee from the government for each patien …"

"… y” and “difficulties with access to information” held by the private insurance companies. He wrote that fraud investigators have no central place to acce …"

"… ernment. Congress created Medicare Advantage in 2003 to encourage private insurance companies to jump into the senior care market without hesitation. Since th …"

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 "New York":

"… a day of lobbying — coordinated by AHIP.   Even Charles Schumer of New York, who chaired the Democratic Senatorial Campaign Committee from 2005-2009 a …"

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 "Virginia":

"… plans are paid fairly for taking on that responsibility. Scott Weiner, a Virginia Medicare billing expert, said health plans that don’t bill aggressively …"

"… , said Brian Wise, chief executive officer of Advance Health in Chantilly, Virginia. “I know there is a lot of good happening. People who are in danger are …"

Medicare Advantage lobbying machine steamrolls Congress

By Fred Schulte

Under pressure, Medicare Advantage critics morph into defenders.

Excerpts from this story referencing "Medicare Rights Center":

"… the Senate in 2008. Stacey Sanders, federal policy director with the Medicare Rights Center in Washington, a nonprofit consumer service organization, criticized …"

Health insurers have their way with regulators

By Fred Schulte

Billions in Medicare Advantage overpayments likely gone for good.

Excerpts from this story referencing "inspector":

"… nbsp; It took years for the Department of Health and Human Services (HHS) inspector general to publish those findings, and government officials have yet to pr …"

"… d.   And despite the bundle of taxpayer dollars on the line, the HHS inspector general didn’t do any more audits, and decided in 2013 to scrap similar …"

"… btain those audits. The CMS policy means that those six audits by the HHS inspector general — which does publish its findings — stand as the only public a …"

"… etailing Medicare Advantage billing practices over the past decade. Those inspector general’s audits began late in 2008. Drafts weren’t presented to the h …"

New audits may recover missing millions — or not

By Fred Schulte

Secretive audits target some Medicare Advantage plans.

Excerpts from this story referencing "inspector":

"… that couldn’t be verified through a patient’s medical record. The HHS inspector general audits are more worrisome to the industry than the CMS audits &nbs …"

"… nd often draw media notice and attention from members of Congress. But the inspector general’s office has said it won’t be conducting any more of its revie …"

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 "America":

"… nated by private insurers, Medicare Advantage now covers nearly 16 million Americans at a cost expected to top $150 billion this year. Many seniors choose th …"

"… fairly for their services. Clare Krusing, director of communications for America’s Health Insurance Plans, said that the industry trade group is “worki …"

"… vidual doctors were paid by Medicare. The decision drew criticism from the American Medical Association, which has argued that it violated the privacy of doc …"

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 "general counsel":

"… tor Daniel E. Straus, have been affiliated with both companies. Innovacare general counsel Christopher J. Joyce declined to discuss the corporate structure. Straus, …"

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 …"

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 "Medicaid":

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

Medicare Advantage made simple: a glossary

By Fred Schulte

Definitions for lesser-known terms relating to Medicare.

Excerpts from this story referencing "disease":

"… e visits also can be profitable for the health plans when they uncover new diseases that raise a patient’s risk score— even if the health plan provides n …"

"… In other words, a health plan cannot just write down that a patient has a disease and seek extra payments from Medicare. The plan must also show that its do …"

"… ulation that would have banned home health assessments which uncovered new diseases but didn’t lead to any more treatment. Retrospective Chart Reviews:&nb …"

"… s” electronic patient medical files looking for evidence of unrecognized diseases that could boost risk scores and Medicare payments. CMS has proposed that …"

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 "Bill Buzenberg":

"… paying public. There’s no excuse for  ignoring our request,” said Bill Buzenberg, the Center’s Executive Director. Medicare Advantage, a privately-run a …"

The Canadian health care system I disparaged

By Wendell Potter

Commentary: health care system up north is more efficient.

Excerpts from this story referencing "Toronto":

"… 013 the average employer-based family policy cost $16,351. At one stop in Toronto, I was asked if there was anything about the U.S. system that Canadians sh …"

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 "HHS Secretary":

"… an, the former president of the Morehouse School of Medicine who served as HHS Secretary during the George H. W. Bush administration, noted that many of the major …"

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 "insurance":

"… ge,” the alternative to traditional Medicare that is operated by private insurance companies. The real sponsor of the ads is the real tenant of 601 Pennsylv …"

"… g and PR outfits in the nation’s capital. As I noted last week, several insurance companies make a boatload of money by participating in the Medicare Advant …"

"… And there was this thinly veiled threat in the POLITICO story from “an insurance industry source familiar with the campaign:” “If CMS doesn’t keep M …"

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":

"… wn as the Medicare Advantage program. …"

"… s by conservatives that Obamacare will actually result in a bailout of big insurance companies. Under the headline, “Bailing Out Health Insurers and Helping …"

"… it potential initial losses of insurers selling policies on the new health insurance exchanges. I reminded the FOX producer that Republicans have been support …"

"… Act knew that insurers would be reluctant to participate in the new health insurance exchanges — also called marketplaces — if the government didn’t crea …"