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 "Barack Obama":

"… to three people who were at the event. Other recipients include President Barack Obama ($14,500 in the 2008 cycle), former Democratic presidential candidate and …"

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 "Health":

"… mild encouragement' — it is a gun to the head," he said.The law says the Health and Human Services Department can withhold a state's entire Medicaid allot …"

"… upheld, could cause trouble in future cases."So in the end, the Affordable Health Care Act survives largely unscathed. But the court's commerce clause and s …"

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 "Medicaid":

"… d him to be immediately kicked out of the program.Centers for Medicare and Medicaid spokesman Brian Cook said the senators are mistaken. Conrad’s “enrollm …"

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 "Medicaid":

"… rt of reform that would require all Americans not eligible for Medicare or Medicaid to buy coverage from them, they did not like the provision that would elim …"

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 "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 "co-director":

"… g Medicare Advantage risk scores is a perfect scam,” said Patrick Burns, co-director of Taxpayers Against Fraud in Washington. “You simply systematically up- …"

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 "Center for Public Integrity":

"… health foundation that supports community-based organizations — and the Center for Public Integrity as well — found that 54 percent of voters favor allowing undocumented re …"

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 "United States":

"… not only has created the severe shortage of primary care physicians in the United States, but it has also contributed to soaring health care costs, especially for …"

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 …"

How Medicare Advantage plans code for cash

By Fred Schulte

Federal study criticizes Medicare Advantage and calls for changes.

Excerpts from this story referencing "Medicaid":

"… last month on an online research site run by the Centers for Medicare and Medicaid Services, part of HHS. Kronick directs the HHS Agency for Healthcare Resea …"

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 "Ron Wyden":

"… n a statement.  Grassley said that he and Finance Committee Chairman Ron Wyden, D-Ore., have previously supported a competition to pay as much as $10 mil …"

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":

"… 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 o …"

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 "Democratic Senatorial Campaign Committee":

"… dinated by AHIP.   Even Charles Schumer of New York, who chaired the Democratic Senatorial Campaign Committee from 2005-2009 and is the third ranking Democrat in the Senate, has become …"

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 "Washington":

"… se visits. Officials at the Centers for Medicare and Medicaid Services in Washington refused numerous requests for comment and declined to answer questions pos …"

"… ts to continue has played only a bit part in a howling political debate in Washington over cutting Medicare Advantage rates. Yet it could cost taxpayers billion …"

Medicare Advantage lobbying machine steamrolls Congress

By Fred Schulte

Under pressure, Medicare Advantage critics morph into defenders.

Excerpts from this story referencing "White House":

"… nce companies.” Medicare Advantage was also a target of a February 2010 White House health reform plan which asserted that the insurers “have game …"

"… ment system in ways [that] drive up the public cost of the program.” The White House added: “All of this is why Medicare Advantage has become a very profitab …"

Health insurers have their way with regulators

By Fred Schulte

Billions in Medicare Advantage overpayments likely gone for good.

Excerpts from this story referencing "Washington":

"… pens because federal officials have kept most audit results confidential. Washington health-care lawyer Thomas C. Hill said insiders have known of …"

"… ”  Patrick Burns, a co-director of Taxpayers Against Fraud, a Washington-based group, said that only stiff penalties will protect taxpayers from ge …"

New audits may recover missing millions — or not

By Fred Schulte

Secretive audits target some Medicare Advantage plans.

Excerpts from this story referencing "Health":

"… ld stall any repayment orders for years. CMS is part of the Department of Health and Human Services (HHS). The HHS Office of Inspector General, which acts …"

"… rs that the plan was among the 30 selected for review this year. Samaritan Health Plan, based in central Oregon with 6,500 members, also was picked, accordi …"

"… on with 6,500 members, also was picked, according to a company newsletter. Health Net, Inc. disclosed in a Securities and Exchange Commission filing that it …"

"… V audits underway amid criticism from the industry over the details. Group Health, a non-profit plan that operates in Washington state and Idaho, argued in …"

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 "United States":

"… e elderly. But the plans have sharply driven up costs in many parts of the United States — larding on tens of billions of dollars in overcharges and other suspec …"

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 "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 "Medicaid":

"… hly premiums average about $35. Other terms The Centers for Medicare and Medicaid Services: Referred to as CMS, this federal agency oversees Medicare and Me …"

"… id Services: Referred to as CMS, this federal agency oversees Medicare and Medicaid, the government health plan for low income people. CMS is part of the Depa …"

"… les: The term refers to people who are eligible both for Medicare and Medicaid because they have low incomes. These patients are generally considered the …"

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":

"… 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 …"

The Canadian health care system I disparaged

By Wendell Potter

Commentary: health care system up north is more efficient.

Excerpts from this story referencing "Health":

"… of our Medicare system and our other single-payer program — the Veterans Health Administration — both of which consistently out-perform private insurers …"

"… o push for the adoption of a nationwide drug benefit. As for the Veterans Health Administration, which owns and operates its own hospitals, it not only get …"

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 "Secretary":

"… ne of the party’s most admired figures, former Health and Human Services Secretary Dr. Louis W. Sullivan. Speaking at the opening session of the Association …"

"… 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 …"

"… tals like Atlanta’s Grady Memorial.   Since Sullivan’s tenure as Secretary of Health and Human Services ended in 1993, he has remained active in effo …"

"… th — as one of three GOP “trailblazers” (along with former Assistant Secretary of Labor William Brooks and former Ohio Supreme Court Judge Sara J. Harper …"

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 "Washington":

"… his fall.   …"

"… care Choices started appearing last week on buses and subway trains and on Washington TV stations warning that seniors will face higher costs, fewer benefits an …"

"… ate insurers for years. Brian Biles, professor of health policy at George Washington University, explained in testimony before the Senate Committee on Aging la …"

"… ine, “Seniors are Watching,” is this warning: “In 2010, Seniors saw Washington cut Medicare Advantage funding by $200 billion, causing rate cuts that alr …"

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 "Medicaid":

"… Government Accountability Office explains it, the Centers for Medicare and Medicaid Services (CMS) adjusts the monthly payments it sends to private insurers t …"

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