GAO takes on Medicare Advantage spending

By Fred Schulte

GAO will investigate program spending.

Excerpts from this story referencing "Congress":

"… subsidiary of New-Jersey based Aveta, Inc., denied the allegations. …"

"… ars every year. The Government Accountability Office, the watchdog arm of Congress, is conducting the probe at the request of the House Ways and Means Commit …"

"… care Advantage has grown explosively under the risk-scoring formula, which Congress put in place in 2004. Officials expect the program to cost taxpayers as mu …"

"… essive. The Medicare Advantage industry has enjoyed bipartisan support in Congress as the program has grown. In recent years, the industry has successfully l …"

How Medicare Advantage plans code for cash

By Fred Schulte

Federal study criticizes Medicare Advantage and calls for changes.

Excerpts from this story referencing "CEO":

"… iscuss, but the data is in black and white and speaks volumes,” Cassano, CEO of Accucode Consulting, wrote in an email. Medicare Advantage enjoys soli …"

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 "Medicare":

"… nd Human Services, seeking a wide range of records concerning oversight of Medicare Advantage health insurance plans for senior citizens. The suit, filed tod …"

"… equires a response within 20 working days.  “The information about Medicare Advantage that we are asking for should be readily available to the taxpay …"

"… g our request,” said Bill Buzenberg, the Center’s Executive Director. Medicare Advantage, a privately-run alternative to standard Medicare, has enrolled …"

"… ive Director. Medicare Advantage, a privately-run alternative to standard Medicare, has enrolled nearly 16 million elderly and disabled persons at an annual …"

Feds propose shakeup for emergency room billing

By Fred Schulte

Proposal seeks to counter alleged over-billing with standardized rate

Excerpts from this story referencing "Kathleen Sebelius":

"… orts, Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius threatened possible criminal prosecution for doctors and hospitals caught …"

ObamaCare oversight among health watchdog cuts

By Fred Schulte

Trims include ObamaCare oversight

Feds 'listen' for sounds of Medicare billing abuse

By Fred Schulte

Baltimore session looks at role of electronic health records in higher medical bills.

Excerpts from this story referencing "Kathleen Sebelius":

"… ent officials swung into action. U.S. Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder fired off a stern letter to five prominen …"

GOP senators call for overhaul of electronic health records program

By Fred Schulte

Report says $35 billion Obama administration stimulus program not working

Excerpts from this story referencing "Kathleen Sebelius":

"… process known as “upcoding.” U.S. Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder last September notified five medical grou …"

Electronic medical records probed for over-billing

By Fred Schulte

Are feds doing all they can to ferret out waste from move to electronic records?

Excerpts from this story referencing "Kathleen Sebelius":

"… . In a Sept. 24 letter, Department of Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder warned five hospital and medical groups o …"

Feds tighten scrutiny of health records

By Fred Schulte

Feds increase scrutiny of how electronic systems affect billing

Excerpts from this story referencing "Medicare fraud":

"… ruary 2009.  …"

Hospitals request government help in curbing possible billing abuses

By Fred Schulte

Federal help sought to create billing guidelines and oversee electronic medical records

Excerpts from this story referencing "Kathleen Sebelius":

"… . The letter was sent to Department of Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder.“Hospitals share the administration’s …"

IMPACT: HHS IG pledges focus on Medicare billing abuse involving electronic records

By Fred Schulte

HHS inspector general announces focus on Medicare billing abuse involving electronic records

IMPACT: Administration official asks for Medicare billing review

By Fred Schulte

Administration official wants to know if electronic health records are causing Medicare over-billing

Excerpts from this story referencing "Kathleen Sebelius":

"… ”In a Sept. 24 letter, Department of Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder warned five hospital and medical groups o …"

Top House Republicans demand suspension of electronic medical records program

By Fred Schulte

Top House Republicans want program suspended until government demands that systems communicate

Suit alleges retaliation for exposure of upcoding

By Fred Schulte

Nevada woman claims she was fired after questioning hospital's bills

Excerpts from this story referencing "Kathleen Sebelius":

"… g health care costs. On Sept. 24, U.S. Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder notified five groups representing hospita …"

IMPACT: Cabinet officials signal crackdown on Medicare billing abuse

By Fred Schulte and Joe Eaton

Sebelius, Holder signal new scrutiny in wake of Center series

Excerpts from this story referencing "Kathleen Sebelius":

"… costly services than they deliver.U.S. Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder notified five medical groups of their int …"

OPINION: Center series demonstrates dangers of 'captured' regulators

By Wendell Potter

Center series demonstrates dangers of special interest influence

Excerpts from this story referencing "American Medical Association":

"… d state levels in which special interests — in this case groups like the American Medical Association — dominate regulatory bodies that set the rules and make important decis …"

Grassley says providers who overbill Medicare are draining its finances

By Fred Schulte

Grassley says providers charging too much threaten program's shaky finances

Excerpts from this story referencing "Medicaid":

"… ically requires 40 minutes.A spokesperson for the Centers for Medicare and Medicaid Services, which runs Medicare,  said the proposal to step up audits …"

Billing complexity spawns new industry

By Fred Schulte

Thousands now employed as professional coders, but oversight is lacking.

Excerpts from this story referencing "American Medical Association":

"… writing down all the work they do, or out of fear of being audited.But the American Medical Association, which wrote the billing codes and controls their use, also has raised the …"

Hospitals grab at least $1 billion in extra fees for emergency room visits

By Joe Eaton and David Donald

Center probe suggests facilities have taken advantage of government’s failure to set billing standards.

Excerpts from this story referencing "American Medical Association":

"… s using a set of codes developed and licensed for physician billing by the American Medical Association — so-called Current Procedural Terminology, or CPT, codes. The lack of s …"

"… is reticent to sign off on an outside group’s system, as it has with the American Medical Association, which licenses the use of the CPT codes it owns and administers. In writ …"

"… t form 2008. Unlike hospital billing, CMS requires that physicians follow American Medical Association criteria for billing emergency room evaluation and management services. Th …"

Growth of electronic medical records eases path to inflated bills

By Fred Schulte

Billing software helps medical professionals document higher fees.

Excerpts from this story referencing "health insurers":

"… , the 23-member group, which included representatives from medical groups, health insurers and government, warned against approving software that assisted doctors in …"

How doctors and hospitals have collected billions in questionable Medicare fees

By Fred Schulte and David Donald

Center investigation suggests cost from upcoding and other abuses likely tops $11 billion.

Excerpts from this story referencing "Medicare fraud":

"… Obama administration has made a significant commitment to cracking down on Medicare fraud and abuse, officials don’t appear to have an aggressive strategy for cut …"

Methodology for 'Cracking the Codes'

By David Donald

A glimpse into the data analysis for this investigation.

Excerpts from this story referencing "American Medical Association":

"… ure Terminology Evaluation and Management (E and M) codes published by the American Medical Association and used by most providers when filing their claims. Within each set are t …"

Judgment calls on billing make 'upcoding' prosecutions rare

By Fred Schulte

Authorities typically settle, and doctors often continue treating Medicare patients

HHS IG report highlights docs' questionable billing of Medicare

By Fred Schulte

HHS IG report says thousand of doctors billing feds at rates beyond the norm

Medicare fraud: What you need to know

By Sarah Whitmire

Last week's biggest-ever Medicare fraud bust nabbed 107 care providers, but how does this effort stack up?

Excerpts from this story referencing "Medicare fraud":

"… that directs Medicare spending in often-inefficient ways.The big story in Medicare fraud last week was an unprecedented bust of 107 doctors, nurses and social work …"

"… , as reported by the Associated Press. Though the crackdown was huge, Medicare fraud is believed to cost up to $90 billion annually, the scams associated with …"

"… 011 alone) in medical services that never happened.Places to learn more:“Medicare fraud rampant in South Florida”, by The Miami Herald, August 3, 2008“11 …"

"… th Florida”, by The Miami Herald, August 3, 2008“111 charged with Medicare fraud in 9 cities” by The Washington Times, February 17, 2011“Feds Figh …"

Senators want more aggressive action to curb rampant Medicare fraud

By Joe Eaton

Hatch, Coburn, says federal health program for the elderly isn't weeding out scamsters, bad doctors

$100 million for artificial legs and feet in question

By Alexandra Duszak

Medicare IG report bares $100 million in questionable costs for artificial legs, feet

Medicare paid $47.9 billion for unneeded, miscoded or undocumented health care

By Alexandra Duszak

Medicare spent almost $50 billion on unneeded, undocumented or miscoded health care

GAO: Almost a tenth of Medicare spending was improper

By Laurel Adams

An estimated $48 billion went to improper Medicare payments last year, out of the $509 billion spent on health care for elderly and disabled

Medicare fraud included phantom services, equipment

By Laurel Adams

A sampling of Medicare providers who were overpaid by $206 million in 2007-08 showed some billed the government for phantom services or for

Excerpts from this story referencing "Medicare fraud":

"… f the providers were located in U.S. Attorney districts that have set up a Medicare fraud team.Following are other new watchdog reports released by the Government A …"

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