States continue war over Obamacare

By Fred Schulte

State lawmakers at odds over hundreds of bills to either cripple or prop up Affordable Care Act.

Excerpts from this story referencing "Politics":

"… Barber, managing director of the National Institute on Money in State Politics in Helena, Montana, said “we know it (Obamacare) is “being debate …"

Center’s Medicare Advantage Money Grab series wins Meyer Journalism Award

By William Gray

Center’s ground-breaking Medicare Advantage investigation named first-place winner of the 2014 Philip Meyer Journalism Award.

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

"… ollow @FredSchulte and @zubakskees on Twitter. …"

"… ;despite little evidence elderly patients received more treatment. “The Center for Public Integrity is extremely pleased to win the Philip Meyer Award for the second time in …"

Health care findings you may have missed in 2014

By The Center for Public Integrity

$70 billion in "improper" Medicare Advantage payments and the problem shared by 80 percent of nursing homes.

Excerpts from this story referencing "Medicare":

"… ons. Keep reading …"

"… ar. If you weren't aware, you might have missed $70 billion in "improper" Medicare Advantage payments and the problem shared by 80 percent of all nursing hom …"

"…   1. $70 billion in 'improper' payments A Center investigation into Medicare Advantage uncovered how $70 billion in "improper" payments have been made …"

"… vantage uncovered how $70 billion in "improper" payments have been made to Medicare Advantage plans from 2008 to 2013. Most of these improper payments can be …"

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 "California":

"… . Charlene Harrington, a retired nursing professor from the University of California San Francisco, said that the absence of any federal regulations establishi …"

"… ursing home chain Skilled Healthcare Group Inc. for failing to comply with California’s minimum nurse staffing requirements and misleading its residents and t …"

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 "Illinois":

"… for $12 million for the Alden Alma Nelson Manor nursing home in Rockford, Illinois. The Department of Housing and Urban Development (HUD) insured the loan t …"

"… federal government. Ohio had the largest number, 30, of these homes. Illinois, with 20 homes, was second. California was third. With $242 million worth …"

"… rent ownership, the former Woodstock Residence in suburban McHenry County, Illinois, now known as Crossroads Care Center Woodstock. In 2008 the state of Illi …"

"… nois, now known as Crossroads Care Center Woodstock. In 2008 the state of Illinois levied nearly $360,000 in fines against the Woodstock facility after learn …"

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 "Louisiana":

"… ported levels of registered nurse discrepancies were southern. Among them: Louisiana and Arkansas, two states where the average self-reported levels were at le …"

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 "federal government":

"… cy in staffing contributed to Woodview’s earning the top rating from the federal government for overall quality — a 5-star score on a 5-star scale from Nursing Home …"

"… just before annual inspections in order to earn a higher rating from the federal government. Nursing home administrators and a leading industry group deny those charg …"

More scrutiny coming for Medicare Advantage, Obamacare

By Fred Schulte

New round of audits coming; Obamacare too.

Excerpts from this story referencing "Government":

"… hed up just $157,777 to settle the matter in December 2013, for instance. Government officials aren’t sure how much of the suspected overpayments to Medicare …"

Another whistleblower suit alleges Medicare Advantage fraud

By Fred Schulte

California litigation alleges 'house calls" yielded false claims

Excerpts from this story referencing "New York":

"… roblems with in-home health visits to Medicare Advantage patients in Ohio, New York, California, Texas, Oregon and Virginia.   The four health plans “t …"

GAO takes on Medicare Advantage spending

By Fred Schulte

GAO will investigate program spending.

Excerpts from this story referencing "Health":

"… attorney with the Center for Medicare Advocacy in Washington. America’s Health Insurance Plans, the industry’s trade group, wouldn’t comment on the G …"

"… y lobbied to scale back planned pay cuts to the Health plans. America’s Health Insurance Plans, the industry trade group, spent nearly $5 million lobbyin …"

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 "diseases":

"… ernment data never before made public to show wide variations in levels of diseases in some health plans, from complications of diabetes to serious depression …"

"… hich could account for some of the variation. But the aggressive coding of diseases means that the same patient costs the government more money in Medicare Ad …"

"… outliers” because they report abnormally high levels of codes for some diseases. “That should trigger a higher level of scrutiny,” Park said. The bil …"

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 "Barack Obama":

"… ot just those who have become newly insured over the past year. President Barack Obama cited some of the impressive statistics last Thursday, the day after the o …"

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 "Alabama":

"… for alleged predatory lending that led to abandoned homes, but Birmingham, Alabama’s lawsuit failed, according to Kathleen Engel, a law professor at Suffol …"

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 "official":

"… ervices (CMS) administrator Marilyn B. Tavenner. Swanson asked the federal official to “undertake an investigation of Humana’s practices and take appropri …"

"… gave CMS that power, thus preempting state laws and oversight. Minnesota officials don’t believe CMS should have a “monopoly” on oversight. “We thin …"

"… erminations by Medicare Advantage plans,” Wogsland said. “If they (CMS officials) don’t take action, there’s no other remedy.” Other state official …"

"… officials) don’t take action, there’s no other remedy.” Other state officials also have been frustrated by the limits on their authority. In October, C …"

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 "Department of Labor":

"… en registered nurses, although most RNs now have bachelor’s degrees. The Department of Labor predicts that an additional 3 million pre-baccalaureate health care profes …"

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 "New York":

"… for shady characters from overseas looking to funnel their wealth through New York’s luxury real estate. Keep reading 8. Sixteen high court judges ruled …"

How Medicare Advantage plans code for cash

By Fred Schulte

Federal study criticizes Medicare Advantage and calls for changes.

Excerpts from this story referencing "Florida":

"… some plans than others. Holly J. Cassano, a medical coding consultant in Florida, said that the government’s decision to make the billing data public was …"

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 "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 "Medicare":

"… ederal officials need to step up efforts to investigate fraud and abuse in Medicare Advantage health plans treating millions of elderly Americans, a top gover …"

"… Commerce. The hearing was called to assess fraud and abuse safeguards in Medicare, which last year covered about 51 million people at a cost to taxpayers of …"

"… $50 billion of that amount was paid improperly, including $11.8 billion to Medicare Advantage plans. A Center for Public Integrity investigation published ea …"

"… ed earlier this month found as much as $70 billion of improper payments to Medicare Advantage plans from 2008 through last year. The Center’s investigation …"

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 "official":

"… including Google Ventures. The cottage industry is flourishing as federal officials struggle to prevent Medicare Advantage plans from overcharging the govern …"

"… based on inflated risk scores, according to government estimates. Federal officials last year suggested that home visits might play a role. They said they we …"

"… al of nearly half-a-million senior home visits in 2013. In April, though, officials bowed to industry pressure and backed off their earlier proposal to restr …"

"… health care for millions of Americans under the Affordable Care Act, which officials expect to contain costs. Behind the curtain The federal government pays …"

Medicare Advantage lobbying machine steamrolls Congress

By Fred Schulte

Under pressure, Medicare Advantage critics morph into defenders.

Excerpts from this story referencing "UnitedHealth Group":

"… top $150 billion. Some of the nation’s mightiest insurance carriers — UnitedHealth Group and Humana Inc. are two of the biggest — dominate the market and are dee …"

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 "Securities and Exchange Commission":

"… tals were disclosed in the proxy statements those companies filed with the Securities and Exchange Commission earlier this spring. When I handled financial communications for Cigna, t …"

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