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 "Medicare":

"… the annual quality survey. The Center’s probe found that hard-to-locate Medicare cost reports filed by nursing homes show lower daily staffing levels, espe …"

"… n those reflected in Nursing Home Compare. In 2005 the federal Centers for Medicare and Medicaid Services cited Medicaid cost reports that contain much of the …"

"… ted Medicaid cost reports that contain much of the same information as the Medicare documents as being a more accurate source than the data collected by state …"

"… level of registered nurse care at those facilities calculated through the Medicare cost reports was just about 20 minutes a day. Medicare cost data was not a …"

Poorly rated nursing homes got HUD-guaranteed mortgages anyway

By Jeff Kelly Lowenstein

Hundreds of poorly rated facilities received mortgage guarantees.

Excerpts from this story referencing "Inspector General":

"… am — from the Government Accountability Office and HUD’s Office of the Inspector General — don’t seem to have made much difference. HUD spokesman Brian Sulliv …"

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 "Healthcare":

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

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

Methodology for our nursing homes investigation

By Jeff Kelly Lowenstein and Ben Wieder

Center compared self-reported staffing numbers with Medicare data

Excerpts from this story referencing "Medicare":

"… nursing home staffing, the Center for Public Integrity downloaded the 2012 Medicare cost reports for skilled nursing facilities. The Center extracted data abo …"

"… of The Gerontologist. The Center used data from the Centers for Medicare and Medicaid Services to calculate the number of standard survey inspectio …"

Running a five-star nursing home

By Jeff Kelly Lowenstein

Top-rated homes had more nurses, less turnover

Excerpts from this story referencing "Medicaid":

"… that are largely out of public view. In 2005 the Centers for Medicare and Medicaid Services, the agency responsible for nursing home oversight, said the Medi …"

"… caid Services, the agency responsible for nursing home oversight, said the Medicaid cost reports that have much of the same information as the Medicare docume …"

"… e, occupancy rate, ownership status and the percentage of days paid for by Medicaid. Those four dozen top-rated nursing homes differed little from the rest of …"

"… e of the top four dozen facilities: a lower percentage of days paid for by Medicaid, the federal health care assistance program for low-income Americans. Resi …"

More scrutiny coming for Medicare Advantage, Obamacare

By Fred Schulte

New round of audits coming; Obamacare too.

Excerpts from this story referencing "Congress":

"… Advantage program has grown rapidly under the risk-scoring formula, which Congress enacted in 2003. Officials expect Medicare Advantage to cost taxpayers as …"

Another whistleblower suit alleges Medicare Advantage fraud

By Fred Schulte

California litigation alleges 'house calls" yielded false claims

Excerpts from this story referencing "Medicare":

"… m of diagnosing “false and fraudulent” medical conditions that several Medicare Advantage plans allegedly used to overcharge the federal government by $1 …"

"… nta Ana, California-based firm sends medical professionals to the homes of Medicare Advantage members to assess their health. Silingo claims she was fired la …"

"… fornia, was unsealed by a judge late last month. The suit also names four Medicare Advantage insurance plans which, Silingo alleges, “turned a blind eye” …"

"… s lawsuit is likely to draw further attention to government oversight of Medicare Advantage plans. The health plans, an alternative to standard Medicare, ar …"

GAO takes on Medicare Advantage spending

By Fred Schulte

GAO will investigate program spending.

Excerpts from this story referencing "Washington":

"… d David A. Lipschutz, an attorney with the Center for Medicare Advocacy in Washington. America’s Health Insurance Plans, the industry’s trade group, wouldn …"

"… ntage groups. These private firms, known as Recovery Audit Contractors in Washington bureaucratese, have been pursuing fraud by doctors and hospitals for years …"

Comparison shopping for a health plan

By Wendell Potter

California makes it easy to do your homework.

Excerpts from this story referencing "Aetna":

"… of those plans are also nonprofits. The plans with the fewest stars were Aetna, Anthem Blue Cross, Cigna, Health Net and UnitedHealthcare of California, …"

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 "Congress":

"… an standard Medicare. The industry also enjoys wide bipartisan support in Congress and in recent years has successfully lobbied to kill or scale back planned …"

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 "Medicare":

"… ung people for the exact same policy. The law also benefits seniors on Medicare by closing the donut hole in the prescription drug benefit and by covering …"

"… nd by covering preventive care, including screenings, and it is saving the Medicare program billions of dollars by gradually reducing the extra amounts the go …"

"… unts the government has been paying private insurers to participate in the Medicare Advantage program. All that said, the law falls short in many ways. While …"

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 "CEO":

"… ies to provide back room services like claims processing. Dr. Joe Gifford, CEO of the Providence-Swedish ACO, told me his organization is working with Bl …"

"… ng a national company come in and tell us how to do it,” the company’s CEO, Scott Kelly, told the Monterey County Weekly. This trend is not new …"

'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 "Jacksonville":

"… ca informed her it was foreclosing on her tiny yellow ranch-style house in Jacksonville, Florida, after the 45-year-old mother of three fell behind on her payment …"

"… alth clinics. Young’s case is particularly harsh, but not unique. Jacksonville’s poor neighborhoods are dotted with abandoned houses stuck in foreclosu …"

"… nding properties. ‘These houses are unsafe’ When you call the city of Jacksonville’s main phone number, the first option offered by an automated system is …"

"… the houses] get infested with rodents,” Lee said. Driving around north Jacksonville, Allison Albert, a lawyer at Jacksonville Area Legal Aid who is repre …"

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 "insurance":

"… er physician fees, prescription drugs and to provide incentives for health insurance companies to participate in the Medicare Advantage program and administer …"

"… roups also recommended that Congress allow Medicare to create its own drug insurance plan that could directly negotiate drug prices in the same way as another …"

"… e drug companies for campaign support,” he said. He could have included insurance companies and physicians and host of other special interests on that list. …"

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 …"

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 "Bureau of Labor Statistics":

"… assistants are joining the medical work force every year. According to the Bureau of Labor Statistics, physician assistants — who can do anything from physical exams to order …"

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 "Arsenic":

"… ly 300,000 participants have signed up for the program. Keep reading 10. Arsenic is 17 times more potent than the EPA reports, and they've known it since 2 …"

How Medicare Advantage plans code for cash

By Fred Schulte

Federal study criticizes Medicare Advantage and calls for changes.

Excerpts from this story referencing "diseases":

"… tial health benefits.” In short, the numbers of patients diagnosed with diseases which result in higher payments increased far faster at many Medicare Adva …"

"… imate fate uncertain.   CMS has cut back payments levels for several diseases that appear to have prompted upcoding by Medicare Advantage plans. But the …"

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 "Medicare":

"… d by industry. For example, advertisements placed by the “Coalition for Medicare Choices” on buses, in subway trains and on Washington TV stations warn t …"

"… is “preserving and strengthening the high quality coverage options that Medicare Advantage plans provide,” and features pictures of smiling senior citize …"

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 …"

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 "Commonwealth Fund":

"… when it comes to health care. In a research report by the New York-based Commonwealth Fund that evaluated the health care systems of several countries on dozens of p …"

"… didn’t come close to the top. It finished dead last. In fact, since the Commonwealth Fund began assessing the world’s health care systems in 2004, the U.S. has co …"

"… adopting and adapting is the very one Don Berwick is romantic about. The Commonwealth Fund’s report includes 80 indicators grouped into five dimensions of performa …"

"… nkings. But for now, if I were Don Berwick, I’d try to get a copy of the Commonwealth Fund report in the hands of every Massachusetts voter. And he might be tempted …"

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 "Medicaid":

"… ry source was quoted as saying that, "If CMS (the Centers for Medicare and Medicaid Services) doesn't keep Medicare Advantage payment rates flat next year, it …"

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 "information technology":

"… s, an investment firm whose managing partner and CEO is former Bush health information technology czar Dr. David Brailer, has a stake in CenseoHealth, which does more …"

Medicare Advantage lobbying machine steamrolls Congress

By Fred Schulte

Under pressure, Medicare Advantage critics morph into defenders.

Excerpts from this story referencing "Barack Obama":

"… milked the system for richer payments than they deserved. President-elect Barack Obama suggested big changes were on the horizon during a Dec. 11, 2008, press co …"

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 "UnitedHealth Group":

"… na, Centene, Cigna, Health Net, Humana, Molina, Triple-S Management Corp., UnitedHealth Group, Universal American, Wellcare, and WellPoint) nine saw their stocks close …"

New audits may recover missing millions — or not

By Fred Schulte

Secretive audits target some Medicare Advantage plans.

Excerpts from this story referencing "Securities and Exchange Commission":

"… picked, according to a company newsletter. Health Net, Inc. disclosed in a Securities and Exchange Commission filing that its plan in Arizona was selected. None of the health plans wou …"

Health insurers have their way with regulators

By Fred Schulte

Billions in Medicare Advantage overpayments likely gone for good.

Excerpts from this story referencing "Pennsylvania":

"… e heart failure in a patient seen for knee pain, according to auditors. In Pennsylvania, a person treated for blurry vision was charted as having serious heart di …"

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 "insurance":

"… king not only for that; we’re asking for the names of companies, and big insurance companies that have been billing and how they’ve been billing and who’ …"

"… invade the privacy of a doctor.  But when you’re talking about huge insurance companies we don’t see how that, how there should be any privacy there. …"

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