GAO takes on Medicare Advantage spending

By Fred Schulte

GAO will investigate program spending.

Excerpts from this story referencing "Center for Public Integrity":

"… hing we have focused on before.” The GAO audit comes in the wake of the Center for Public Integrity’s “Medicare Advantage Money Grab” series published in June, which sh …"

"… ed at nearly $650 million for 2007 alone — just for those six plans. The Center for Public Integrity investigation confirmed in June that federal officials, after years of hag …"

"… year, or the results. So it’s not clear if any have been completed. The Center for Public Integrity in May sued CMS under the Freedom of Information Act, in part to …"

Comparison shopping for a health plan

By Wendell Potter

California makes it easy to do your homework.

Excerpts from this story referencing "Medicare":

"… om a private insurer unless we’re eligible for a government program like Medicare or Medicaid — you’d think it would be easy to discover which health pl …"

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 "director":

"… revenue, a practice known as “upcoding.” Researcher Richard Kronick, director of the Department of Health and Human Services’ Agency for Healthcare Re …"

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

"… ls have largely stumbled in trying to recoup overpayments. Clare Krusing, director of communications for America’s Health Insurance Plans, did not respond …"

Obamacare helps millions, but falls short in many ways

By Wendell Potter

The Affordable Care Act has reduced the ranks of the uninsured, but cost of care must be addressed.

Excerpts from this story referencing "Insurance":

"… years to come. Wendell Potter is the author of Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR is Killing Health Care and …"

New types of health care delivery are improving the 'patient experience'

By Wendell Potter

Commentary: eliminating role of insurers could improve health care delivery.

Excerpts from this story referencing "federal government":

"… his organization is working with Blue Cross of Illinois for that work. The federal government works with insurers in the same way to handle claims for Medicare benefici …"

'Zombie' homes haunt Florida neighborhoods

By Alison Fitzgerald and Jared Bennett

Neighborhoods devastated by thousands of abandoned homes as banks fail to follow through on foreclosures.

Excerpts from this story referencing "spokeswoman":

"… bstantial way for banks to redress the harm caused to communities,” said spokeswoman Nicole Navas. Jacksonville, St. Petersburg and many other cities nationwi …"

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 "federal government":

"… ssage of the Medicare Modernization Act in 2003, which created Part D, the federal government benefited from discounts on prescription medicines for people covered by b …"

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 …"

Dire predictions of endless waits for a doctor have proven unfounded

By Wendell Potter

Commentary: Obamacare has not resulted in long waits for a doctor.

Excerpts from this story referencing "Medicare":

"… says, if rather then repealing Obamacare, Congress would lift a freeze in Medicare’s support for physician-training positions that has been in effect since …"

Ten major findings from our investigations so far this year

By Jared Bennett and Sarah Whitmire

Investigations from the first half of 2014

Excerpts from this story referencing "Texas":

"… tal. Keep reading 5. “I believe if you're anti-oil and gas, you're anti-Texas” That's what Texas State Rep. Harvey Hilderbran had to say in referenc …"

"… I believe if you're anti-oil and gas, you're anti-Texas” That's what Texas State Rep. Harvey Hilderbran had to say in reference to one of America's b …"

"… water, but from the air they breathe. We wanted to know what, if anything, Texas was doing to monitor the potential health effects of residents who live ne …"

"… of residents who live near drilling sites. What did we find? Thousands of Texas oil and gas facilities are allowed to self-audit emissions without reporti …"

How Medicare Advantage plans code for cash

By Fred Schulte

Federal study criticizes Medicare Advantage and calls for changes.

Excerpts from this story referencing "spokeswoman":

"… ll. About 70 medical conditions can boost payment rates. Clare Krusing, a spokeswoman for America’s Health Insurance Plans, the industry’s trade group, said …"

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 "CMS":

"… d less for those in good health using a formula known as a risk score. But CMS largely trusts health plans to identify and return any money paid in error …"

"… th plans to identify and return any money paid in error. In its proposal, CMS acknowledges it lacks a process for routinely going after these overpaymen …"

"… stimate that Medicare loses billions annually as a result. How much money CMS expects to recover also remains unclear. CMS said the health plans could b …"

"… as a result. How much money CMS expects to recover also remains unclear. CMS said the health plans could be on the hook for overpayments dating back si …"

Saving the penny makes cents for zinc-backed front group

By Erin Quinn

'Broad-based' group created to save the penny from extinction turns out to be backed by a company that supplies metal to make the coins.

Excerpts from this story referencing "Washington":

"… t in service. …"

"… Common Cents is not a registered nonprofit, nor is it a business entity in Washington, D.C. In fact, it really only exists on paper and in cyberspace. ACC has t …"

"… he worked at B&D Consulting and, more recently, Dentons. These days, Washington reporters and policymakers can barely fire up their email without being be …"

"… Sloan, the executive director of Citizens for Responsibility and Ethics in Washington, a nonprofit watchdog group. Sloan also believes the number of front grou …"

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 …"

Praise for UK-style health system vindicates spurned nominee

By Wendell Potter

Former Medicare chief's support for UK's health care system may win votes in race for governor of Massachusetts.

Excerpts from this story referencing "Medicare":

"… dely respected physician and health policy expert, to lead the Centers for Medicare and Medicaid Services (CMS). Despite having broad support among other heal …"

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 …"

Get involved: Help Medicare Advantage investigation go further with donations and news tips

Join us in finding problems with Medicare Advantage billing, “risk scores”, or home visits.

Excerpts from this story referencing "Medicare":

"… y Gordon Witkin.      …"

"… ls that billions of tax dollars are wasted every year through leakage of a Medicare payment tool called a "risk score". Get involved   If you are a hea …"

"… are a health professional or medical coder and have a story to tell about Medicare Advantage billing issues or “risk scores”, please send Fred Schul …"

"… res”, please send Fred Schulte an email. If you are a patient in a Medicare Advantage plan and have been scheduled for a “home visit” let us know …"

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 "federal government":

"… t close to 16 million elderly and disabled people under contracts with the federal government. The health plans tout the voluntary, free annual physicals as a major ne …"

"… Care Act, which officials expect to contain costs. Behind the curtain The federal government pays Medicare Advantage plans a monthly fee for each patient to cover all …"

Medicare Advantage lobbying machine steamrolls Congress

By Fred Schulte

Under pressure, Medicare Advantage critics morph into defenders.

Excerpts from this story referencing "Minnesota":

"… So we cut what Medicare gives to these private insurance companies,” the Minnesota Democrat intoned in a Dec. 13, 2012, speech on the Senate floor in praise …"

Skyrocketing salaries for health insurance CEOs

By Wendell Potter

Commentary: soaring compensation, rising stock prices don't justify higher premiums.

Excerpts from this story referencing "WellPoint":

"… -S Management Corp., UnitedHealth Group, Universal American, Wellcare, and WellPoint) nine saw their stocks close near 52-week highs this past Friday. The big …"

"… e is up 31 percent, Cigna’s 32 percent. United’s is up 28 percent. And WellPoint’s is up 39 percent. But it is the CEO compensation that has been the mo …"

Health insurers have their way with regulators

By Fred Schulte

Billions in Medicare Advantage overpayments likely gone for good.

Excerpts from this story referencing "federal government":

"… es. Four years ago, Medicare auditors came to an alarming conclusion: the federal government shouldn’t have paid a half-dozen insurance plans hundreds of millions of …"

"… rooted within private Medicare Advantage plans — which contract with the federal government to care for nearly 16 million elderly Americans — and that these abuses …"

New audits may recover missing millions — or not

By Fred Schulte

Secretive audits target some Medicare Advantage plans.

Excerpts from this story referencing "lawyer":

"… reviewed by the Center for Public Integrity. Mary Inman, a San Francisco lawyer who represents whistleblowers, said officials have been concerned for year …"

150 billion reasons Medicare Advantage matters

By Eleanor Bell

Reporter Fred Schulte discusses his investigation into billions of dollars misspent on Medicare Advantage plans.

Excerpts from this story referencing "Medicare":

"… should be some accountability. …"

"… llion this year, but our latest investigation found that manipulation of a Medicare Advantage payment tool called a “risk score” is adding billions to the …"

"… journalist Fred Schulte. For more than a year, he’s been investigating Medicare Advantage, the government-backed alternative to Medicare for seniors run m …"

"… een investigating Medicare Advantage, the government-backed alternative to Medicare for seniors run mostly by private companies. At the heart of the story ar …"

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 Services":

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

Medicare Advantage made simple: a glossary

By Fred Schulte

Definitions for lesser-known terms relating to Medicare.

Excerpts from this story referencing "diabetes":

"… Medicare Advantage plans that enroll people with chronic diseases such as diabetes and take other steps to manage their care. …"

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 "diabetes":

"… nbsp;that a Humana-owned clinic diagnosed patients with conditions such as diabetes with complications, which boosted Medicare payments. She alleged that thos …"

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 …"

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 …"

A different way of thinking about health care

By Wendell Potter

Commentary: Canadians take pride in their health care system.

Excerpts from this story referencing "Medicare":

"… ensure the continued financial viability of their system, which they call Medicare, no one in Ottawa of any ideological stripe would dare suggest doing much …"

Feds investigating allegations that Humana Inc. overcharged Medicare Advantage program

By Fred Schulte

Whistleblower suit at center of Medicare Advantage overbilling allegations.

Excerpts from this story referencing "Medicare":

"… it overbilled the government for treating elderly patients enrolled in its Medicare Advantage plans, court records reveal. The status of the investigations i …"

"… urt records. Humana, which insures more than 2 million people through the Medicare Advantage plans, is also the target of two Florida whistleblower civil law …"

"… Louisville, Kentucky, is a major federal contractor. Last year, Humana’s Medicare Advantage contracts in Florida alone covered about 415,200 seniors at a co …"

"… , according to the company. Nationwide, Humana treated just over 2 million Medicare Advantage patients last year. The consequences of the legal cases could b …"

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