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 "health":

"… plan to step up and pay the lion’s share of the bill. Morphew said the health plan had told him over the phone he would owe just $450 for the two days h …"

"… at Humana has largely fixed any problems. Medicare pays the privately run health plans — an alternative to traditional Medicare — a set monthly rate fo …"

"… er payments to Medicare Advantage plans from 2008 through last year. Many health plans also collect monthly fees directly from patients and may charge co-p …"

"… s a year — about one in ten — of the 300 operating. CMS proposed that health plans conduct and pay for self-audits with the goal that each organization …"

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 "insurance":

"… Advantage and introduced risk scores in 2003 as a way to encourage private insurance companies to jump into the senior care market. The program now insures som …"

"… this year. The plans, many of them run by some of the nation’s largest insurance companies, are popular because they often provide extra benefits, such as …"

"… ut the scores crept back up in 2011. Critics argue that even as the health insurance industry lobbies Congress to stave off further rate cuts, it remains overp …"

Medicare Advantage lobbying machine steamrolls Congress

By Fred Schulte

Under pressure, Medicare Advantage critics morph into defenders.

Excerpts from this story referencing "Medicare Advantage":

"… ng their policies.” …"

"… thanked by industry surrogates for their help in killing some of the same Medicare Advantage cuts he’d previously supported so forcefully. By most accounts it was a …"

"… rs of Congress and the Obama administration, and a forceful flexing of the Medicare Advantage industry’s growing political might in Washington. John Gorman, a top Me …"

"… ge industry’s growing political might in Washington. John Gorman, a top Medicare Advantage consultant, hailed the lobbying victory in early 2013 as a “direct refle …"

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 "diseases":

"… e visits also can be profitable for the health plans when they uncover new diseases that raise a patient’s risk score— even if the health plan provides no …"

"… ulation that would have banned home health assessments which uncovered new diseases but didn’t lead to any more treatment. Retrospective Chart Reviews:&nbs …"

"… s” electronic patient medical files looking for evidence of unrecognized diseases that could boost risk scores and Medicare payments. CMS has proposed that …"

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

OPINION: drug firms say no to rebates, despite billions in new revenue from Part D

By Wendell Potter

Part D brought drug companies billions, but they say the sky is falling

Excerpts from this story referencing "Medicare Part D":

"… also eligible for Medicaid because of their low incomes.  Before the Medicare Part D drug program was created in 2006, the pharmaceutical industry paid rebates …"

"… s." And this: “The President has again proposed to upend the successful Medicare Part D prescription drug program by imposing government price controls on it.” …"

OPINION: Big Pharma's stranglehold on Washington

By Wendell Potter

Pharmaceutical firms are getting their money's worth on Capitol Hill.

Medicare: An entitlement out of control

By David Nather

If Congress had known in 1965 how expensive Medicare would become, it might not have approved the program in the first place. So Lyndon John

Excerpts from this story referencing "gross domestic product":

"… e could cause the national debt to swell up to more than two-thirds of the gross domestic product in just the next decade.For years, experts have also warned that Medicare …"

"… now, the national debt is a little more than half the size of America’s gross domestic product, and it could grow to as much as two thirds of GDP in just 10 years. And M …"

Medicare patients received expired, terminated drugs

By Joe Eaton

Medicare patients in 2006-07 likely received more than $112 million worth of expired prescription drugs or drugs that have been pulled from

GAO says Medicare regulator followed the rules in Humana smackdown

By Joe Eaton

The Government Accountability Office is siding with Medicare administrators in a dispute with Humana Inc.— the nation’s largest private heal

Drug makers' dime funds Congressional travel

By Robert Brodsky

Pharmaceutical companies, affiliated trade groups spent more than $600,000 on trips

Excerpts from this story referencing "Medicare":

"… ug-makers. Almost all of those same legislators voted in favor of the 2003 Medicare Prescription Drug Act, which led to a windfall of profits for the industry …"

"… hRMA-sponsored trips were taken in 2003, prior to the November vote on the Medicare prescription drug bill. The legislation created a taxpayer-funded prescrip …"

"… bout."The debate over possible conflicts of interest is highlighted by the Medicare Prescription Drug, Improvement and Modernization Act of 2003.Relman, a for …"

"… rmaceutical companies stood to benefit financially from the passage of the Medicare bill.Still, many members sponsoring bills have elected to maintain their p …"

Drug industry influence timeline

What the pharmaceutical industry has gotten on its political investment

Excerpts from this story referencing "George W. Bush":

"… bate on a bill designed to strengthen the FDA.In late September, President George W. Bush signs into law the Food and Drug Administration Amendments Act (FDAAA …"

"… ket entry of generic medications, stalls in Congress.On Dec. 21, President George W. Bush signs into law an extension of the State Children's Health Insurance Progr …"