Running a five-star nursing home

By Jeff Kelly Lowenstein

Top-rated homes had more nurses, less turnover

Excerpts from this story referencing "Healthcare":

"… p; …"

More scrutiny coming for Medicare Advantage, Obamacare

By Fred Schulte

New round of audits coming; Obamacare too.

Excerpts from this story referencing "Inspector General":

"… ng under the Affordable Care Act. The Health and Human Services Office of Inspector General, which investigates Medicare and Medicaid waste, fraud and abuse, said it …"

"… es with an eye toward curbing overcharges. Results are due next year. The Inspector General also announced from five to ten new audits into Obamacare, ranging from th …"

"… ayments for new enrollees to controls to prevent fraudulent sign ups. The Inspector General’s office did not say if individual Medicare Advantage plans would be aud …"

"… n does not always support the diagnoses” (used to bill Medicare),” the Inspector General said. “Efforts for FY 2015 and beyond may include additional work examin …"

Another whistleblower suit alleges Medicare Advantage fraud

By Fred Schulte

California litigation alleges 'house calls" yielded false claims

Excerpts from this story referencing "Anthem":

"… re: Molina Healthcare of California; WellPoint, Inc., which operates  Anthem Blue Cross and Blue Shield; Health Net of California, Inc. and Alameda All …"

GAO takes on Medicare Advantage spending

By Fred Schulte

GAO will investigate program spending.

Excerpts from this story referencing "attorney":

"… airly while reducing wasteful overpayments,” said David A. Lipschutz, an attorney with the Center for Medicare Advocacy in Washington. America’s Health I …"

A call for more scrutiny of private Medicare Advantage plans

By Fred Schulte

Researchers say aggressive billing by private plans may require more scrutiny

Docs, drug companies, insurers drive up Medicare costs

By Wendell Potter

Commentary: reform drove down hospital costs, creating Medicare savings, but insurers, doctors and drug companies escaped cuts.

Medicare Advantage patients find themselves in regulatory limbo

By Fred Schulte

States lack oversight but feds are struggling to keep with fast-growing health plans.

Ten major findings from our investigations so far this year

By Jared Bennett and Sarah Whitmire

Investigations from the first half of 2014

Excerpts from this story referencing "Japan":

"… the financial industry’s proxy voices on Capitol Hill. Keep reading 3. Japan has no urgent plutonium needs, but a new plant will soon make more than 17 …"

"… on make more than 17,000 pounds of it each year Starting this October, a Japanese nuclear fuel plant 22 years in the making will begin churning out a nuc …"

"… e an energy source for the country. But the key word there is, eventually. Japan can't currently convert the explosive nuclear component. With that kind of …"

How Medicare Advantage plans code for cash

By Fred Schulte

Federal study criticizes Medicare Advantage and calls for changes.

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 "Ron Wyden":

"… n a statement.  Grassley said that he and Finance Committee Chairman Ron Wyden, D-Ore., have previously supported a competition to pay as much as $10 mil …"

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.

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.

Health insurance lobby keeps Medicare Advantage overpayments flowing

By Wendell Potter

Commentary: program bills are excessive, but don't expect reforms.

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 "Michigan":

"… 2011 federal lawsuit that she was fired from her job at Priority Health in Michigan after she refused an order from her supervisor to “only focus” on addi …"

Medicare Advantage lobbying machine steamrolls Congress

By Fred Schulte

Under pressure, Medicare Advantage critics morph into defenders.

Excerpts from this story referencing "Medicare":

"… ng their policies.” …"

"… have based on the benefits they were providing to seniors. So we cut what Medicare gives to these private insurance companies,” the Minnesota Democrat into …"

"… thanked by industry surrogates for their help in killing some of the same Medicare Advantage cuts he’d previously supported so forcefully. By most account …"

"… rs of Congress and the Obama administration, and a forceful flexing of the Medicare Advantage industry’s growing political might in Washington. John Gorman …"

Health insurers have their way with regulators

By Fred Schulte

Billions in Medicare Advantage overpayments likely gone for good.

Excerpts from this story referencing "Health":

"… s having serious heart disease.  It took years for the Department of Health and Human Services (HHS) inspector general to publish those findings, and …"

"… ing errors tied to a complex payment formula known as a “risk score.” Health plans collect medical data that is used to compute the Health risks for ea …"

"… and secretive that it remains unfathomable to many Health professionals. Health plans that cheat can face civil or criminal penalties, but federal officia …"

"… Advantage contracts, records show.  CMS is but one part of the giant Health and Human Services Department. The HHS Office of Inspector General is supp …"

New audits may recover missing millions — or not

By Fred Schulte

Secretive audits target some Medicare Advantage plans.

Excerpts from this story referencing "Medicaid":

"… een completed, or what the results might be. The Centers for Medicare and Medicaid Services (CMS), the agency that runs Medicare, has quietly conducted some …"

150 billion reasons Medicare Advantage matters

By Eleanor Bell

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

Excerpts from this story referencing "Medicare Advantage":

"… should be some accountability. …"

"… llion this year, but our latest investigation found that manipulation of a Medicare Advantage payment tool called a “risk score” is adding billions to the program's …"

"… journalist Fred Schulte. For more than a year, he’s been investigating Medicare Advantage, the government-backed alternative to Medicare for seniors run mostly by p …"

"… out that in a moment, but firstly Fred, let’s start from the beginning: Medicare Advantage was introduced by Congress more than a decade ago to stabilize health care …"

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 "consultant":

"… ping patients who were ill,” said Laurence Bishoff, a Boston health care consultant. Congress thought it saw a remedy in the Medicare Modernization Act of 20 …"

"… a former federal health official who is now a prominent Medicare Advantage consultant. Others blame the sheer complexity of risk-scoring for causing confusion …"

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 "Healthcare":

"… er government health official claims, he discovered that the plans — MMM Healthcare and PMC Medicare Choice — had been cheating Medicare out of hundreds of …"

"… ts 2012 annual financial report to insurance officials in Puerto Rico, MMM Healthcare stated that it had not been subject to a CMS payment audit. However, in l …"

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.

Excerpts from this story referencing "Medicare Advantage":

"… can answer it, we'll do so and add it here. …"

"… e will pay for. This option is called “fee-for-service.” By contrast, Medicare Advantage plans accept a set fee from the government for covering a person’s healt …"

"… nd eyeglasses and cost patients less out of pocket than standard Medicare. Medicare Advantage is growing rapidly and now serves about 16 million people, about a third o …"

"… hat are risk scores? A risk score is a formula the government uses to pay Medicare Advantage plans. The system is supposed to pay higher rates for sicker patients that …"

Methodology for 'Medicare Advantage Money Grab'

By David Donald and Erin Durkin

A behind-the-scenes look at the data analysis for the 'Medicare Advantage Money Grab' investigation.

Excerpts from this story referencing "Government":

"… rcent growth overall between just two of the years in the data. Finally, a Government Accountability Office Report suggests it could be higher. A 3 percent aver …"

Medicare Advantage made simple: a glossary

By Fred Schulte

Definitions for lesser-known terms relating to Medicare.

Center sues in an effort to make Medicare Advantage files public

By Fred Schulte

Center sues to make records public.

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 …"

GOP opposition to Obamacare baffles Dr. Sullivan

By Wendell Potter

Commentary: former HHS Secretary Sullivan says Obamacare resembles plan crafted by Republicans.

Excerpts from this story referencing "Secretary":

"… ne of the party’s most admired figures, former Health and Human Services Secretary Dr. Louis W. Sullivan. Speaking at the opening session of the Association …"

"… the former president of the Morehouse School of Medicine who served as HHS Secretary during the George H. W. Bush administration, noted that many of the major …"

"… tals like Atlanta’s Grady Memorial.   Since Sullivan’s tenure as Secretary of Health and Human Services ended in 1993, he has remained active in effo …"

"… th — as one of three GOP “trailblazers” (along with former Assistant Secretary of Labor William Brooks and former Ohio Supreme Court Judge Sara J. Harper …"

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.

Pay no attention to those insurance lobbyists behind the Medicare curtain!

By Wendell Potter

Commentary: 'grass-roots' campaign actually comes from health insurers.

Excerpts from this story referencing "Humana":

"… provision of the law. And for good reason. Insurers like UnitedHealth and Humana with a substantial number of Medicare Advantage enrollees are able to conv …"

"… ldman Sachs estimated a few years ago that 66 percent of the net income at Humana, where I used to work, came from its Medicare Advantage business.  N …"

Obamacare and emergency rooms: a bit of perspective needed

By Wendell Potter

Commentary: Oregon study cited by critics requires perspective.

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