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 "Medicaid":

"… Home Compare to Medicare cost reports, which the Centers for Medicare and Medicaid Services say are more accurate indications of staffing levels, to show whi …"

More scrutiny coming for Medicare Advantage, Obamacare

By Fred Schulte

New round of audits coming; Obamacare too.

Excerpts from this story referencing "Medicaid":

"… uman Services Office of Inspector General, which investigates Medicare and Medicaid waste, fraud and abuse, said it would conduct “various reviews” of Med …"

"… ilities” in a wide range of Obamacare programs; the work plan noted that Medicaid, the health plan for low income people, is growing explosively under the h …"

"… owing explosively under the health reform law. “Protecting an expanding Medicaid program from fraud, waste, and abuse takes on a heightened urgency as the …"

Another whistleblower suit alleges Medicare Advantage fraud

By Fred Schulte

California litigation alleges 'house calls" yielded false claims

Excerpts from this story referencing "Anita Silingo":

"… harge the federal government by $1 billion or more. The suit was filed by Anita Silingo, a former compliance officer for Mobile Medical Examination Services, Inc. …"

GAO takes on Medicare Advantage spending

By Fred Schulte

GAO will investigate program spending.

Excerpts from this story referencing "Recovery Audit Contractor":

"… billing fraud by Medicare Advantage groups. These private firms, known as Recovery Audit Contractors in Washington bureaucratese, have been pursuing fraud by doctors and hosp …"

How Medicare Advantage plans code for cash

By Fred Schulte

Federal study criticizes Medicare Advantage and calls for changes.

Excerpts from this story referencing "diabetes":

"… billing for an inordinately high number of patients with complications of diabetes. Despite its broad implications for Medicare spending, the study by HHS r …"

"… . Even more striking, according to the study, is how much higher reported diabetes rates have been in certain health plans than others. The study tracked rap …"

"… began, up to last year, and made them public for the first time. Overall, diabetes with serious complications, which pays higher rates, was reported as much …"

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 "Medicaid":

"… r reporter Fred Schulte requested records from the Centers of Medicare and Medicaid Services (CMS), an arm of HHS, in a May 21, 2013, letter. The letter asked …"

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 "Medicaid":

"… vites overcharges. Now in a major turnabout, the Centers for Medicare and Medicaid Services are seeking tighter controls over the fees as part of a plan to r …"

ObamaCare oversight among health watchdog cuts

By Fred Schulte

Trims include ObamaCare oversight

Excerpts from this story referencing "Medicare":

"… Health and Human Services Office of Inspector General, which investigates Medicare and Medicaid waste, fraud and abuse, is in the process of  losing a t …"

"… ions of new members under Obamacare. ● A review of drugs marketed under Medicare Part D without first being approved by the Food and Drug Administration fo …"

"… approved by the Food and Drug Administration for safety and effectiveness. Medicare paid more than $3 billion from 2006 through 2010 for these products, but o …"

"… enditures. The audit was to target merchants in South Florida, a hotbed of Medicare and Medicaid fraud.  ------------------------- Don’t miss a single …"

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 "Medicare":

"… doctors and hospitals could be using electronic health records to overbill Medicare, top government officials swung into action. U.S. Health and Human Servic …"

"… an merited — a practice is known as “upcoding.” But the Centers for Medicare and Medicaid Services, which reports to Sebelius, is taking a much less co …"

"… of the plan, citing a range of concerns from patient privacy to stepped-up Medicare billing fraud. Their report noted that many medical experts believe the d …"

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 "Medicare":

"… ectronic medical records, citing concerns from patient privacy to possible Medicare billing fraud. The report issued Tuesday by the half-dozen Republicans co …"

"… igital systems may be increasing unnecessary medical tests and billings to Medicare. The government has not demanded that the various digital systems be able …"

"… al professionals have steadily billed higher rates for treating seniors on Medicare over the last decade — adding $11 billion or more to their fees. The Ce …"

"… overed a broad range of costly billing errors and abuses that have plagued Medicare for years—from confusion over how to pick proper payment codes to outrig …"

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 "Medicare":

"… be prompting some doctors and hospitals to improperly bill higher fees to Medicare. An investigation into those billing questions — which convened a hearin …"

"… al professionals have steadily billed higher rates for treating seniors on Medicare over the last decade — adding $11 billion or more to their fees. The inv …"

"… adding $11 billion or more to their fees. The investigation suggested that Medicare billing errors and abuses are worsening as doctors and hospitals switch to …"

"… re than $10 billion has been spent. Just over half the doctors now billing Medicare are using digital records. But critics of the initiative have claimed for …"

Feds tighten scrutiny of health records

By Fred Schulte

Feds increase scrutiny of how electronic systems affect billing

Excerpts from this story referencing "Medicare":

"… ruary 2009.  …"

"… y on electronic medical records to bill for their services.The Centers for Medicare and Medicaid Services has directed its auditors to look more closely to ma …"

"… inflate bills — a practice known as “upcoding.”The stakes are high. Medicare spent more than $33.5 billion in 2010 using these numeric codes for servic …"

"… tpatient hospital or nursing home care. More than half the doctors billing Medicare were using electronic records in 2011, and that number has since grown fur …"

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 "Medicine":

"… tter to HHS Secretary Sebelius. She noted that a year ago the Institute of Medicine had urged HHS to develop a plan to minimize patient safety risks, but that …"

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 "Electronic medical record":

"… p;Wednesday, in announcing investigative priorities for the coming year.“Electronic medical records can improve quality of care and efficiency and help us uncover cases of f …"

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 "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 …"

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 "Medicare":

"… ers taxpayer dollars and does little, if anything, to improve outcomes for Medicare.” The letter urges Sebelius to suspend payments under the program until …"

"… r more than $10 billion has been spent. About half the doctors now billing Medicare are using digital records.Many medical leaders also hope digital records r …"

"… al revolution has prompted doctors and hospitals to bill higher charges to Medicare.The Center for Public Integrity’s “Cracking the Codes”  series, …"

"… al professionals have steadily billed higher rates for treating seniors on Medicare over the last decade — adding $11 billion or more to their fees.The Cent …"

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 "Medicare":

"… lers suspected the small Nevada hospital where she worked was overcharging Medicare and other health insurers for some emergency room services.Sellers ran Bou …"

"… s health information department, which helped apply the complex series of Medicare billing codes doctors and hospitals must use to get paid for treating the …"

"… igit billing codes, developed by the American Medical Association, to bill Medicare for hundreds of millions of office visits and other services. Hospitals us …"

"… gency room and outpatient physician charges and other fees. In past years, Medicare has for the most part paid medical bills with few questions asked, even th …"

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 "Medicare":

"… stepping up scrutiny  for doctors and hospitals that may be cheating Medicare by using electronic health records to improperly bill the health plan for …"

"… al professionals have steadily billed higher rates for treating seniors on Medicare over the last decade — adding $11 billion or more to their fees.The Cent …"

"… overed a broad range of costly billing errors and abuses that have plagued Medicare for years—from confusion over how to pick proper payment codes to outrig …"

"… proper payment codes to outright overcharges. The findings indicated that Medicare billing problems are worsening as doctors and hospitals switch to electron …"

OPINION: Center series demonstrates dangers of 'captured' regulators

By Wendell Potter

Center series demonstrates dangers of special interest influence

Excerpts from this story referencing "Medicaid":

"… affecting them. In many regards,  the Centers for  Medicare and Medicaid Services (CMS) has become a “captured agency” as a result of decisions …"

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 "Tennessee":

"… isiana, 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.

Excerpts from this story referencing "Medicare":

"… go, Dr. Kathryn Locatell’s testimony at a U.S. Senate hearing on alleged Medicare billing abuses generated a rush of media coverage, but little lasting refo …"

"… file with irrelevant details as a means to justify higher, more lucrative, Medicare billing codes.“The information presented to us at the seminars did not i …"

"… cials are still struggling to make sure doctors code accurately and charge Medicare only for treatments that are medically necessary, a Center for Public Inte …"

"… er for Public Integrity investigation has found.The Center’s analysis of Medicare billing records found that more than 7,500 doctors billed the two top payi …"

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 "Medicine":

"… professor of Medicine at the University of Pennsylvania Perelman School of Medicine, a member of the panel, said there are a number of possible causes for the …"

"… rgency physician and associate professor in the Emory University School of Medicine, examined data from the Centers for Disease Control and Prevention’s Nat …"

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 "Medicare":

"… , appear to be prompting some doctors and hospitals to bill higher fees to Medicare for treating seniors. The federal government’s campaign to wire up medi …"

"… sharing that helps cut down on wasteful spending and medical errors. Yet Medicare regulators also acknowledge they are struggling to rein in a surge of aggr …"

"… cently documented how some health professionals have seemingly manipulated Medicare billing codes to gain higher fees. The investigation unmasked thousands of …"

"… s can influence pay scales known as “Evaluation and Management” codes. Medicare spent more than $33.5 billion in 2010 using these numeric codes for servic …"

Methodology for 'Cracking the Codes'

By David Donald

A glimpse into the data analysis for this investigation.

Excerpts from this story referencing "Medicaid":

"… s analyzed Medicare claims data obtained from the Centers for Medicare and Medicaid Services (CMS).For privacy purposes and other reasons, the Center was limi …"

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 "Medicaid":

"… consultant who spent three decades at the federal Centers for Medicare and Medicaid Services and served as its acting administrator in the early months of the …"

"… April of next year.The indictment alleges that Chirban billed Medicare and Medicaid, the government health plan for the poor, for tens of thousands of patient …"

"… most lucrative billing codes.The doctor billed more than 57,000 claims to Medicaid alone between September 2006 and April 2010. Prosecutors allege that most …"

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 "Medicaid":

"… n Washington. McClellan, a former director of the Centers for Medicare and Medicaid Services, or CMS, said the agency must send a message that it “won’t s …"

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

Excerpts from this story referencing "Congress":

"… ly those who provide routine medical services in their offices.In 1989, as Congress was struggling to control rising physician fees, it set up a Medicare phys …"

"… and actual outlay.But every year, in what is known as the “doctor fix” Congress steps in to prevent doctor fees from being reduced. Many critics argue tha …"

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":

"… llas Morning News [PAYWALL], February 28, 2012 …"

"… at questionable billing practices and political interference that directs Medicare spending in often-inefficient ways.The big story in Medicare fraud last we …"

"… 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 socia …"

"… , 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 …"

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

Excerpts from this story referencing "Medicaid":

"… he letter to Donald Berwick, administrator of the Centers for Medicare and Medicaid Services (CMS), Sen. Orrin Hatch, R-Utah, and Sen. Tom Coburn, R-Oklahoma, …"

$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

Excerpts from this story referencing "Medicaid":

"… e risk that a claim is fraudulent increases.The Centers for Medicare & Medicaid Services, the federal agency that administers Medicare, contracts with num …"

Pages