GAO takes on Medicare Advantage spending

By Fred Schulte

GAO will investigate program spending.

Excerpts from this story referencing "Government Accountability Office":

"… mistakes estimated to cost taxpayers billions of dollars every year. The Government Accountability Office, the watchdog arm of Congress, is conducting the probe at the request of t …"

How Medicare Advantage plans code for cash

By Fred Schulte

Federal study criticizes Medicare Advantage and calls for changes.

Excerpts from this story referencing "Health":

"… years. Analyzing government data never before made public, Department of Health and Human Services researchers found that many plans exaggerate how sick t …"

"… are and Medicaid Services, part of HHS. Kronick directs the HHS Agency for Healthcare Research and Quality, whose mission is to improve Health care delivery …"

"… said Dr. David Wennberg, a researcher at the Dartmouth Institute for Health Policy and Clinical Practice who has studied Medicare billing trends. Hea …"

"… lth Policy and Clinical Practice who has studied Medicare billing trends. Health care fraud expert Malcolm Sparrow, a professor at Harvard’s Kennedy Scho …"

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 "The Wall Street Journal":

"… ng data and other records. In a 2009 case, the Center, in partnership with The Wall Street Journal, sued to obtain Medicare billing records for thousands of doctors and hosp …"

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 "physician":

"… mere existence of facility fees is contentious because they come on top of physician bills and hospital charges for tests, medicines and other supplies, and ha …"

"… ent codes being used were designed by the American Medical Association for physician billing, not emergency room services. Doctors pick one of the five-digit c …"

"… more they are paid. Hospitals have long complained that codes written for physicians don’t translate easily for pricing emergency room resources, but deny t …"

"… replace that with a flat charge of $88.31. Dr. Kevin Kavanagh, a retired physician who heads Health Watch USA, a patient advocacy group based in Kentucky, sa …"

ObamaCare oversight among health watchdog cuts

By Fred Schulte

Trims include ObamaCare oversight

Excerpts from this story referencing "Government":

"… m Sparrow, a professor at Harvard University’s John F. Kennedy School of Government and health fraud expert. “We’d save a huge number of taxpayer dollars …"

"… ning at a June 24 hearing of the Senate Committee on Homeland Security and Governmental Affairs. One official said at the hearing that existing staff was stretc …"

Feds 'listen' for sounds of Medicare billing abuse

By Fred Schulte

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

GOP senators call for overhaul of electronic health records program

By Fred Schulte

Report says $35 billion Obama administration stimulus program not working

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 "Eric Holder":

"… Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder warned five hospital and medical groups of their intent to ramp up investi …"

Feds tighten scrutiny of health records

By Fred Schulte

Feds increase scrutiny of how electronic systems affect billing

Excerpts from this story referencing "American Academy of Family Physicians":

"… s medicine enters the digital era.Dr. David Kibbe, a senior advisor to the American Academy of Family Physicians on digital medicine, said the digital records systems can be misused in or …"

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 "Secretary":

"… ed Nov. 12. The letter was sent to Department of Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder.“Hospitals share the …"

"… ices than they actually deliver — a practice known as “upcoding.”HHS Secretary Sebelius and Attorney General Eric Holder on Sept. 24 warned five hospital …"

"… y subcommittee, expressed concerns about safety in a Nov. 14 letter to HHS Secretary Sebelius. She noted that a year ago the Institute of Medicine had urged HH …"

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 "Secretary":

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

"… gun to appear.In an Oct. 4 letter, four Republican House members urged HHS Secretary Sebilius to suspend government payments to hospitals and doctors, arguing …"

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

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 "Eric Holder":

"… Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder notified five medical groups of their intention to ramp up investigative o …"

OPINION: Center series demonstrates dangers of 'captured' regulators

By Wendell Potter

Center series demonstrates dangers of special interest influence

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 "Florida":

"… ngs for the two highest codes—99214 and 99215— in 15 states, including Florida and Texas.The 99214 code requires two of three components: a detailed hist …"

"… What we’re pushing for is legislative oversight,” said Frank Cohen, a Florida consultant who assists doctors with coding and billing issues.  He sa …"

"… states covered by the proposed RAC audit are: Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, So …"

Billing complexity spawns new industry

By Fred Schulte

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

Excerpts from this story referencing "Senate Finance Committee":

"… illed for were medically necessary,” Locatell testified at the June 2001 Senate Finance Committee hearing.Despite much legislative hand-wringing and media attention — CBS …"

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 "Rochester":

"… Kelly, director of health information management at Unity Health System in Rochester, N.Y. To address the issue, Kelly said CMS should issue hospital-specific …"

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 "disease":

"… le to mine data from millions of patients to discover better ways to treat disease and improve the nation’s overall health. The initiative continues to pi …"

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 "Florida":

"… ard and netted higher fees as a result. A 1979 federal court injunction in Florida bars HHS from publicly releasing doctors’ names and Medicare reimburseme …"

Methodology for 'Cracking the Codes'

By David Donald

A glimpse into the data analysis for this investigation.

Excerpts from this story referencing "Palantir Technologies":

"… year in the analysis. …"

Judgment calls on billing make 'upcoding' prosecutions rare

By Fred Schulte

Authorities typically settle, and doctors often continue treating Medicare patients

Excerpts from this story referencing "Florida":

"… he assumption that what they do is more complex,” said Lester Perling, a Florida lawyer who has represented doctors in payment disputes. “That couldn’t …"

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

Excerpts from this story referencing "Government":

"… e health agencies and physicians, Levinson told a U.S. House Oversight and Government Reform subcommittee on Thursday. For example, 57 percent of claims for wh …"

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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