More scrutiny coming for Medicare Advantage, Obamacare

By Fred Schulte

New round of audits coming; Obamacare too.

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

"… s to overbill the government are pending in federal courts. The Center for Public Integrity’s “Medicare Advantage Money Grab” series, published in June, reveale …"

"… d at nearly $650 million for 2007 alone — just for those six plans. The Center for Public Integrity’s investigation confirmed that federal officials, after years of hagglin …"

Another whistleblower suit alleges Medicare Advantage fraud

By Fred Schulte

California litigation alleges 'house calls" yielded false claims

GAO takes on Medicare Advantage spending

By Fred Schulte

GAO will investigate program spending.

Excerpts from this story referencing "Humana":

"… federal courts. In one case, Miami physician Olivia Graves alleged that a Humana-affiliated clinic had diagnosed an abnormally high number of patients with …"

"… not supported by the medical records.” The suit alleges that Humana knew about the practices and did nothing to stop the overcharging. The sui …"

"… care paid thousands of dollars for each patient who was wrongly diagnosed. Humana has denied the allegations. In a separate civil case, Josh Valdez, a …"

How Medicare Advantage plans code for cash

By Fred Schulte

Federal study criticizes Medicare Advantage and calls for changes.

Excerpts from this story referencing "insurance":

"… ncludes. Congress created Medicare Advantage in 2003 to encourage private insurance companies to venture into the senior care market, and has remained support …"

"… inistration to make substantial cuts to its payment rates. Lobbying by the insurance industry and the fear of angering seniors also has largely quieted concern …"

Center sues in an effort to make Medicare Advantage files public

By Fred Schulte

Center sues to make records public.

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 "Eric Holder":

"… ished a similar report. In the wake of the news reports, Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius threatened possi …"

ObamaCare oversight among health watchdog cuts

By Fred Schulte

Trims include ObamaCare oversight

Excerpts from this story referencing "official":

"… ” an agency document states. …"

"… e paid more than $3 billion from 2006 through 2010 for these products, but officials said they are abandoning plans to recover money improperly paid to drug c …"

"… evices used in the home, who manage to stay in business even after federal officials revoke their billing privileges. The durable medical equipment market has …"

"… t quickly figuring out how to exploit new health care initiatives and that officials have an obligation to “stay ahead” of them. “Otherwise three years …"

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 "Eric Holder":

"… Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder fired off a stern letter to five prominent medical groups threatening crim …"

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 "Eric Holder":

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

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 "Healthcare Information and Management Systems Society":

"… sultant who serves on a panel on fraud and abuse for the trade association Healthcare Information and Management Systems Society, or HIMSS, said that one of the selling points for electronic health recor …"

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 "Congress":

"… imize patient safety risks, but that the plan has not yet been provided to Congress. …"

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

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

"… to electronic health records is receiving new scrutiny in the wake of the Center for Public Integrity’s “Cracking the Codes” series, which found that thousands of medical …"

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 "energy":

"… D-Mich., Ways and Means health subcommittee chairman Joe Pitts, R-Pa. and energy health subcommittee chair Wally Herger, R-Calif.The Ways and Means Committ …"

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

Excerpts from this story referencing "Ways and Means Committee":

"… es while doing little if anything to improve health outcomes,” the House Ways and Means Committee said in a statement.Obama administration officials acknowledged the proble …"

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 "Eric Holder":

"… Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder notified five groups representing hospitals and medical professionals that …"

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 "Department of Justice":

"… misuse electronic health records to bill for services never provided. The Department of Justice, Department of Health and Human Services, the FBI and other law enforcemen …"

OPINION: Center series demonstrates dangers of 'captured' regulators

By Wendell Potter

Center series demonstrates dangers of special interest influence

Excerpts from this story referencing "Technology":

"… vernment, mainly the Office of National Coordinator for Health Information Technology, never imposed any controls over the IT industry as Technology companies s …"

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 "South Carolina":

"… da, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia and West Virginia. …"

Billing complexity spawns new industry

By Fred Schulte

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

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 "Louisville":

"… r paying emergency room codes. Leatrice Ford, an independent consultant in Louisville, Ky., who uses Medicare claims data to advise hospitals on their emergency …"

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 "Connecticut":

"… accurately and “do not facilitate upcoding.” ‘Improper Payments’ Connecticut doctor Stephen R. Levinson, who authored a major textbook on medical codin …"

"… as 2006. That year Medicare contractor First Coast Service Options chided Connecticut doctors who “frequently over-documented” to justify higher billing cod …"

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.

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 "Virginia":

"… on and garden variety fraud violations for years,” said William Mahon, a Virginia health care fraud expert. “This is the first time that anyone has quanti …"

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

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