GAO takes on Medicare Advantage spending

By Fred Schulte

GAO will investigate program spending.

Excerpts from this story referencing "industry trade":

"… ned pay cuts to the health plans. America’s Health Insurance Plans, the industry trade group, spent nearly $5 million lobbying on a variety of issues, including …"

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 "Medicaid Services":

"… nter for Public Integrity. Kronick said that the Centers for Medicare and Medicaid Services, the arm of HHS that oversees Medicare Advantage, had proposed as far back …"

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 "Medicare":

"… ederal government works with insurers in the same way to handle claims for Medicare beneficiaries. Gifford also told me he’s in discussions with a number o …"

"… ompanies, to some extent. And he noted that government entities, including Medicare and state governments, are following a similar path. It’s a path that l …"

"… ey Peninsula in California, which earlier this year began offering its own Medicare Advantage plan to serve area seniors through a subsidiary called Aspire. …"

'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 "Medicare":

"… forming her that her disability payments, those of her daughter, and their Medicare benefits were being cut off. The Social Security Administration said she l …"

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":

"… ated 78 million baby boomers in this country, I was delighted to hear that Medicare’s Hospital Trust Fund won’t run out of money until 2030 — 13 ye …"

"… attributed to the health care law, some of the provisions aimed at slowing Medicare spending, such as requiring Medicare to reduce payments to hospitals with …"

"… me of the provisions aimed at slowing Medicare spending, such as requiring Medicare to reduce payments to hospitals with high readmission rates, are likely he …"

"… elping. But the Hospital Trust Fund accounts for only about half of total Medicare spending. Most of the rest goes to cover physician fees, prescription drug …"

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 "Internet access":

"… federal approval of its merger with NBC Universal, so it promised to offer Internet access at a rate affordable to low-income families. The program, called "Internet …"

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 "Medicare":

"… lic. The case is pending. …"

"… ally, are seeking new power to recover excessive charges. The Centers for Medicare and Medicaid Services says its wants to set up “a formal process to reco …"

"… Center for Public Integrity investigation published last month found that Medicare paid the health plans nearly $70 billion in “improper” payments — mo …"

"… verstating the health risks of patients — from 2008 through 2013 alone. Medicare expects to pay more for sicker patients and less for those in good health …"

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 "law":

"… is actually a lobbyist and head of strategic communications for Dentons, a law firm representing the interests of zinc producer Jarden Zinc Products, a m …"

"… he Washington, D.C., address for Americans for Common Cents is the Dentons law firm. And the phone number listed for contacting the group is not in servi …"

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 "UnitedHealth Group":

"… ify conditions that remain undiagnosed.” Terence Ohara, a spokesman for UnitedHealth Group, which owns the company, declined to address the financial impact of the v …"

"… its help create a “trusting and engaging relationship” with patients. UnitedHealth Group, which counts more than 3 million seniors in its Medicare Advantage plans, …"

Medicare Advantage lobbying machine steamrolls Congress

By Fred Schulte

Under pressure, Medicare Advantage critics morph into defenders.

Excerpts from this story referencing "Center for Responsive Politics":

"… s industry over the past three election cycles, according to data from the Center for Responsive Politics. Franken alone has received at least $90,000 from the health services indu …"

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 "Medicare":

"… iday. The biggest gainer has been Humana, one of the largest operators of Medicare Advantage plans, whose share price has increased more than 53 percent over …"

Health insurers have their way with regulators

By Fred Schulte

Billions in Medicare Advantage overpayments likely gone for good.

Excerpts from this story referencing "Medicare":

"… ouch it you get nailed.” …"

"… indings signaled that billing errors could be deeply rooted within private Medicare Advantage plans — which contract with the federal government to care for …"

"… that these abuses could be wasting taxpayer dollars at a ferocious clip. Medicare expects to pay higher rates for legitimately sicker people who may require …"

"… rote.  In Arizona, a health plan collected thousands of dollars from Medicare to treat congestive heart failure in a patient seen for knee pain, accordi …"

New audits may recover missing millions — or not

By Fred Schulte

Secretive audits target some Medicare Advantage plans.

Excerpts from this story referencing "Medicare":

"… ieves. …"

"… s of millions of dollars for past overcharges and other billing mistakes. Medicare pays the health plans a set amount monthly for each person based on estima …"

"… o top $150 billion this year. The government audits are targeting chronic Medicare Advantage billing errors that federal officials blame for billions of doll …"

"… ts have yet been completed, or what the results might be. The Centers for Medicare and Medicaid Services (CMS), the agency that runs Medicare, has quietly co …"

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 "Puerto Rico":

"… the annual payments at the national level, the Center excluded payments in Puerto Rico, as do most researchers working with MA data, due to significantly differe …"

Medicare Advantage made simple: a glossary

By Fred Schulte

Definitions for lesser-known terms relating to Medicare.

Excerpts from this story referencing "Medicare":

"… ronic diseases such as diabetes and take other steps to manage their care. …"

"… any doctor they want and buy insurance policies to cover any gaps in what Medicare will pay for. Doctors bill Medicare for each service they provide. Medica …"

"… nce policies to cover any gaps in what Medicare will pay for. Doctors bill Medicare for each service they provide. Medicare Advantage: Nearly 16 million seni …"

"… dicare will pay for. Doctors bill Medicare for each service they provide. Medicare Advantage: Nearly 16 million seniors have joined about 700 insurance plans …"

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 "Medicare":

"… ee-part series. In South Florida, one of the nation’s top privately-run Medicare insurance plans faces a federal investigation into allegations that it ove …"

"… ivate health care plans for seniors ran up more than $100 million in added Medicare charges after asserting patients they signed up also were much sicker than …"

"… ormal — a claim many experts have challenged. In Rochester, New York, a Medicare plan was paid $41 million to treat people with serious diseases — even t …"

"… had those diseases. These health plans and hundreds of others are part of Medicare Advantage, a program created by Congress in 2003 to help stabilize health …"

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 "America":

"… rder has never faced such a dilemma. May was astonished to learn that many Americans, her cousin included, regularly postpone needed care because their insur …"

"… access health care system. May was not the only MP to share stories about Americans they’ve met who have fallen through the cracks of a system that fails …"

"… nd I in the health insurance industry worked over several decades to scare Americans about the Canadian system by perpetuating myths about long waits for med …"

"… enact reforms that would lead the country down a “slippery slope toward American-style health care.” The people I talked with were especially alarmed t …"

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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