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 "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 …"

Comparison shopping for a health plan

By Wendell Potter

California makes it easy to do your homework.

Excerpts from this story referencing "healthcare.gov":

"… work and want to compare costs among competing health plans, you can go to healthcare.gov, maintained by the U.S. Department of Health and Human Services, or a priv …"

A call for more scrutiny of private Medicare Advantage plans

By Fred Schulte

Researchers say aggressive billing by private plans may require more scrutiny

Excerpts from this story referencing "Medicine":

"… . Graber, a physician and president of the Society to Improve Diagnosis in Medicine.  “Patients don’t have any idea how they are being coded.” Gra …"

How a coal miner's autopsy proved a top doctor wrong

By Chris Hamby

When a coal miner's lungs finally gave out, his autopsy proved a top doctor was wrong — giving hope to thousands of other miners.

Excerpts from this story referencing "Medicine":

"… onary and critical care Medicine at the West Virginia University School of Medicine and, before that, ran the X-ray-reading program at the National Institute …"

New types of health care delivery are improving the 'patient experience'

By Wendell Potter

Commentary: eliminating role of insurers could improve health care delivery.

Excerpts from this story referencing "Medicare":

"… ederal government works with insurers in the same way to handle claims for Medicare beneficiaries. Gifford also told me he’s in discussions with a number o …"

"… ompanies, to some extent. And he noted that government entities, including Medicare and state governments, are following a similar path. It’s a path that l …"

"… ey Peninsula in California, which earlier this year began offering its own Medicare Advantage plan to serve area seniors through a subsidiary called Aspire. …"

Taking insurance companies out of health care

By Wendell Potter

If Boeing experiment flies, health care system could be transformed.

Excerpts from this story referencing "CEO":

"… eal with health insurers at all. I wrote a few months back that my former CEO at Cigna once said that what kept him up at night was the possibility that …"

"… News out of Seattle this summer undoubtedly has caused the big insurance CEOs to lose more than a bit of sleep. Boeing, the world’s largest aerospace …"

"… ecline to 6.4 percent, down from 7.6 percent in 2012. Mark Bertolini, the CEO of one of the other big insurers, Aetna, was quoted in the article as sayi …"

Dire predictions of endless waits for a doctor have proven unfounded

By Wendell Potter

Commentary: Obamacare has not resulted in long waits for a doctor.

National Academy of Sciences agrees with EPA that formaldehyde causes cancer

By David Heath

To the chemical industry's chagrin, a National Academy of Sciences review found that formaldehyde causes cancer.

Ten major findings from our investigations so far this year

By Jared Bennett and Sarah Whitmire

Investigations from the first half of 2014

How Medicare Advantage plans code for cash

By Fred Schulte

Federal study criticizes Medicare Advantage and calls for changes.

Excerpts from this story referencing "Obama administration":

"… apitol Hill and has successfully fought back efforts by the Obama administration to make substantial cuts to its payment rates. Lobbying by the insurance i …"

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 …"

Even low doses of arsenic trigger cancer in mice, study finds

By David Heath

Study by the National Institutes of Health found levels of arsenic similar to what some people consume caused cancer in mice.

Excerpts from this story referencing "cancer":

"… ses of arsenic and were surprised to find that many of them developed lung cancer, according to a study just published. What made the results so surprising …"

"… and Bangladesh have shown that people who drink high doses of arsenic get cancer skin, bladder and lung cancer. High levels of arsenic in well water in Ban …"

"… t people who drink high doses of arsenic get cancer skin, bladder and lung cancer. High levels of arsenic in well water in Bangladesh created one of the wor …"

"… the legal limit of arsenic in water each day, 730 will get lung or bladder cancer from it. Some scientists argue that there is a threshold dose, below whic …"

What to do if your drinking water contains arsenic

By David Heath

Millions of Americans unwittingly consume arsenic, a potent carcinogen also linked to IQ deficits in children, in their drinking water.

Medicare Advantage plans require more scrutiny

By Fred Schulte

Government inspector says private Medicare plans difficult to investigate due to lack of access to data.

Excerpts from this story referencing "insurance":

"… omplete data that would facilitate oversight” of the fast-growing health insurance plans. His comments came in testimony prepared for a Wednesday hearing of …"

"… e” Medicare. But Medicare Advantage plans, which are often run by large insurance companies and accept a set monthly fee from the government for each patien …"

"… y” and “difficulties with access to information” held by the private insurance companies. He wrote that fraud investigators have no central place to acce …"

"… ernment. Congress created Medicare Advantage in 2003 to encourage private insurance companies to jump into the senior care market without hesitation. Since th …"

Praise for UK-style health system vindicates spurned nominee

By Wendell Potter

Former Medicare chief's support for UK's health care system may win votes in race for governor of Massachusetts.

Excerpts from this story referencing "Massachusetts":

"… . a central part of his campaign for another high-profile job: governor of Massachusetts. Last week, Berwick got closer to that goal during the state’s Democrat …"

"… nvention when he became one of three candidates to qualify for the Sept. 9 Massachusetts primary. State Treasurer Steven Grossman and Attorney General Martha Coakl …"

"… d try to get a copy of the Commonwealth Fund report in the hands of every Massachusetts voter. And he might be tempted to send an “I told you so” note to a fe …"

Get involved: Help Medicare Advantage investigation go further with donations and news tips

Join us in finding problems with Medicare Advantage billing, “risk scores”, or home visits.

Home is where the money is for Medicare Advantage plans

By Fred Schulte

Medicare Advantage home visits may not improve health, but boost risk scores and cost taxpayers billions.

Excerpts from this story referencing "Health":

"… mplications of diabetes to a history of heart trouble that’s flared up. Health plans can profit because Medicare pays them higher rates for sicker patien …"

"… ng to a report prepared for the insurance industry’s trade association. Health plans argue that home visits help them meet a patient’s total Health car …"

"… n Ignagni, president of the industry’s powerful trade group, America’s Health Insurance Plans, in a March 7, 2014 letter to CMS argued that the agency h …"

"… nment limits public access to billing data. But risk scores at one plan, XLHealth Corp., based in Maryland, jumped by at least 20 percent between 2007 and t …"

150 billion reasons Medicare Advantage matters

By Eleanor Bell

Reporter Fred Schulte discusses his investigation into billions of dollars misspent on Medicare Advantage plans.

Why Medicare Advantage costs taxpayers billions more than it should

By Fred Schulte, David Donald and Erin Durkin

Critics warned of billing abuse in Medicare Advantage health plans, but oversight is lagging.

Excerpts from this story referencing "lobbyist":

"… nally tried to overpay them a little bit,” said Scully, now a Washington lobbyist with numerous health care industry clients. Health status was added to ot …"

Whistleblower suit says health plan cheated government out of more than $1 billion

By Fred Schulte

Lawsuit: executives worried health plan would be ‘screwed’ if feds heard of overcharges.

Excerpts from this story referencing "Medicaid":

"… be “screwed” if it was audited by the federal Centers for Medicare and Medicaid Services, especially if the review reached back to 2007. She said overchar …"

Explaining Medicare Advantage, and why it matters to you

By Fred Schulte and Sarah Whitmire

Explaining risk scores, Medicare Advantage and what alleged overbilling could mean for the Affordable Care Act.

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 …"

A different way of thinking about health care

By Wendell Potter

Commentary: Canadians take pride in their health care system.

Excerpts from this story referencing "Medicare":

"… ensure the continued financial viability of their system, which they call Medicare, no one in Ottawa of any ideological stripe would dare suggest doing much …"

The Canadian health care system I disparaged

By Wendell Potter

Commentary: health care system up north is more efficient.

Excerpts from this story referencing "Medicine":

"… RAND Corporation found in a 2004 study published in the Annals of Internal Medicine that the VHA outperformed all other sectors of the U.S. health care system …"

American-style health care system pushed in Canada

By Wendell Potter

Canada's conservative Prime Minister Stephen Harper wants to remake nation's health care system.

The health care industry's campaign of fear, uncertainty and doubt

By Wendell Potter

Commentary: health insurers use a host of tactics to erode support for Obamacare.

Excerpts from this story referencing "health insurance premiums":

"… paign taking shape. But let’s first go back to the spring of 2007. Both health insurance premiums and the number of uninsured Americans were continuing to skyrocket. Polls …"

Dental chain may be booted from Medicaid program

By David Heath

Small Smiles, under federal scrutiny for performing unnecessary dental treatments on children, could be barred from the Medicaid program.

Excerpts from this story referencing "dentist":

"… It could force thousands of children in low-income families to find a new dentist willing to treat them. Small Smiles will be excluded from the Medicaid pr …"

"… roblems at Small Smiles clinics. Small Smiles was first accused of paying dentists bonuses to hit production targets in a 2007 television news report. The C …"

Dizzying array of options in Obamacare can lead to expensive mistakes

By Wendell Potter

Commentary: Health insurers offer a wide range of plans on exchanges, customers should pay attention to the details.

Excerpts from this story referencing "cancer":

"… ket obligations would be if she had to be hospitalized during the year. A cancer survivor, Donna knew there would be a chance she might get sick again and …"

GOP megadonor Harold Simmons bankrolled liberal causes

By Dave Levinthal

The charitable foundation of the late Harold Simmons contributed big bucks to Planned Parenthood, other left-leaning causes in 2012.

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