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 Edwards":

"… n the middle of a pitched battle with Obama and former North Carolina Sen. John Edwards for the Democratic Party's presidential nomination. There were about 20 pe …"

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 "Massachusetts":

"… said Romney, who backed an individual health insurance mandate when he was Massachusetts governor, will have a hard time exploiting the ruling."Mitt Romney is the …"

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 "Congressional Budget Office":

"… ey have today. But the value of the vouchers would diminish over time. The Congressional Budget Office predicts that 65-year-olds would be paying 68 percent of their Medicare co …"

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 "Washington":

"… m debate, but it didn’t survive — and that was no accident. In Washington, lobbyists for insurance companies wanted to kill the public option, becau …"

"… ssions in a conference room at the Porter Novelli public relations firm in Washington, where plans were being developed to turn public attitudes against the Pat …"

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 "Texas":

"… elative to majority-white homes, the Center found. For Latinos, cities in Texas, among them El Paso and Brownsville, had daily registered nurse care level …"

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 "Health":

"… air, she'd wheel over to try to help other residents in the Chenal Heights Health and Rehabilitation Center in Little Rock. Irvin had been placed there by …"

"… ior vice president of quality and regulatory affairs for the American Health Care Association, the nursing home industry’s largest professional organ …"

"… after Sanders moved her from the Chenal Heights facility to the Sandalwood Healthcare nursing home in Little Rock in July 2012. Ultimately, Sanders filed s …"

"… ned the facility for its lack of staffing. Sean Mathis, a lawyer for Hope Healthcare, the firm that owns Sandalwood, said Sandalwood will “vigorously def …"

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 …"

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 "Congress":

"… subsidiary of New-Jersey based Aveta, Inc., denied the allegations. …"

"… ars every year. The Government Accountability Office, the watchdog arm of Congress, is conducting the probe at the request of the House Ways and Means Commit …"

"… care Advantage has grown explosively under the risk-scoring formula, which Congress put in place in 2004. Officials expect the program to cost taxpayers as mu …"

"… essive. The Medicare Advantage industry has enjoyed bipartisan support in Congress as the program has grown. In recent years, the industry has successfully l …"

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 "Health":

"… “upcoding.” Researcher Richard Kronick, director of the Department of Health and Human Services’ Agency for Healthcare Research and Quality, said off …"

"… ick, director of the Department of Health and Human Services’ Agency for Healthcare Research and Quality, said officials should consider tightening audit …"

"… ed to kill or scale back planned pay cuts to the Health plans. America’s Health Insurance Plans, the industry’s primary trade group, spent nearly $5 mil …"

"… p overpayments. Clare Krusing, director of communications for America’s Health Insurance Plans, did not respond directly to a question about the payment …"

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 "Congress":

"… until 2030 — 13 years later than projected in 2009, the year before Congress passed the Affordable Care Act. While it’s uncertain how much of that g …"

"… hts Center and Social Security Works — released a report suggesting that Congress could save taxpayers $141 billion over 10 years just by reauthorizing a pr …"

"… in the first year of the Part D program. The groups also recommended that Congress allow Medicare to create its own drug insurance plan that could directly n …"

"… s also contributed to soaring health care costs, especially for Medicare. Congress has also allowed health insurers to enrich themselves, in both lawful and …"

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 "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 "spokeswoman":

"… rule is made. “We are evaluating the proposal,” said Clare Krusing, a spokeswoman for America’s Health Insurance Plans, the industry’s trade group. Cong …"

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 "House Committee on Energy and Commerce":

"… mony prepared for a Wednesday hearing of the oversight subcommittee of the House Committee on Energy and Commerce. The hearing was called to assess fraud and abuse safeguards in Medicare, …"

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 "Medicaid":

"… posal to restrict these visits. Officials at the Centers for Medicare and Medicaid Services in Washington refused numerous requests for comment and declined …"

"… driving up Medicare’s costs. In February 2013, Centers for Medicare and Medicaid Services officials proposed flagging diagnoses written up from a home visi …"

Medicare Advantage lobbying machine steamrolls Congress

By Fred Schulte

Under pressure, Medicare Advantage critics morph into defenders.

Excerpts from this story referencing "House Committee on Energy and Commerce":

"… In a March 2014 memo to its members, the Democratic staff of the House Committee on Energy and Commerce accused the Medicare Advantage industry of making “exaggerated claims” …"

Health insurers have their way with regulators

By Fred Schulte

Billions in Medicare Advantage overpayments likely gone for good.

Excerpts from this story referencing "Cigna":

"… d they can lose money when risk-based payments don’t cover their costs. Cigna Healthcare of Arizona, for example, disputed the audit finding that it was …"

"… an $23 million for 2007. Calling the audit standards “fatally flawed,” Cigna said it actually lost about $800,000 that year treating the 100 patients w …"

New audits may recover missing millions — or not

By Fred Schulte

Secretive audits target some Medicare Advantage plans.

Excerpts from this story referencing "Medicaid":

"… een completed, or what the results might be. The Centers for Medicare and Medicaid Services (CMS), the agency that runs Medicare, has quietly conducted some …"

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 "Harvard University":

"… s won’t see federal auditors for years. Malcolm Sparrow, a professor at Harvard University’s John F. Kennedy School of Government and health fraud expert, said off …"

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 "Puerto Rican Medicare":

"… utive level job in April 2010 expecting to improve medical services at two Puerto Rican Medicare Advantage health plans owned by a subsidiary of New Jersey company: Aveta …"

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 "Government":

"… rcent growth overall between just two of the years in the data. Finally, a Government Accountability Office Report suggests it could be higher. A 3 percent aver …"

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 "Medicaid":

"… disabled people. Congress also created the federal and state-administered Medicaid program for the nation’s poor. Ever since, most of the rest of us have …"

"… ngress added a few years ago. The Canadian Medicare program is akin to our Medicaid program in that the provinces have broad latitude in administering benefit …"

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