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 …"

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.

Excerpts from this story referencing "Medicaid":

"… iscounts on prescription medicines for people covered by both Medicare and Medicaid. According to the advocacy groups, elimination of that program “resulted …"

"… As reported in POLITICO Magazine last week, the Centers for Medicare and Medicaid Services gave the AMA/Specialty Society Relative Value Scale Update Commit …"

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.

Excerpts from this story referencing "attorney general":

"… ware, there has been no formal enforcement action taken,” said Minnesota attorney general’s office spokesman Benjamin Wogsland. “We have very serious concerns t …"

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 "judge":

"… having tobacco This is judge Tim Irwin of Tennessee. As a juvenile court judge, he is admired for kind gestures like handing out stuffed animals to small …"

"… ough New York’s luxury real estate. Keep reading 8. Sixteen high court judges ruled in 26 cases despite having a financial conflict More than half of …"

"… despite having a financial conflict More than half of federal appellate judges, arbiters of the second-highest court in the U.S., reported owning stock …"

"… -highest court in the U.S., reported owning stock in 2012. We wondered how judges were keeping track of their holdings when cases involved a company they'd …"

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.

Excerpts from this story referencing "United States":

"… iled every other country studied. “Over the past decade, leaders in the United States have begun to recognize that the nation’s health care system is far more …"

"… monstrably better results,” the researchers wrote. “The claim that the United States has ‘the best health care system in the world’ is clearly not true.” …"

Health insurance lobby keeps Medicare Advantage overpayments flowing

By Wendell Potter

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

Excerpts from this story referencing "Democratic Senatorial Campaign Committee":

"… dinated by AHIP.   Even Charles Schumer of New York, who chaired the Democratic Senatorial Campaign Committee from 2005-2009 and is the third ranking Democrat in the Senate, has become …"

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 "Medicaid":

"… posal to restrict these visits. Officials at the Centers for Medicare and Medicaid Services in Washington refused numerous requests for comment and declined …"

"… driving up Medicare’s costs. In February 2013, Centers for Medicare and Medicaid Services officials proposed flagging diagnoses written up from a home visi …"

Medicare Advantage lobbying machine steamrolls Congress

By Fred Schulte

Under pressure, Medicare Advantage critics morph into defenders.

Excerpts from this story referencing "Medicaid":

"… ss who signed a February 2014 letter to Centers for Medicare and Medicaid Services Administrator Marilyn Tavenner supporting Medicare Advantage. The …"

Health insurers have their way with regulators

By Fred Schulte

Billions in Medicare Advantage overpayments likely gone for good.

Excerpts from this story referencing "UnitedHealth Group":

"… ion of claims and diagnoses.” PacifiCare, a division of insurance titan UnitedHealth Group, the nation’s largest Medicare Advantage contractor, hotly disputed audi …"

"… l chart confirmed the operation, no care for blood poisoning was evident. UnitedHealth Group fired back in a September 2010 letter that HHS had “exceeded its authori …"

"… predictions, it still caught the industry’s attention. Both Humana and UnitedHealth Group, the nation’s two biggest Medicare Advantage plans, have told investors …"

New audits may recover missing millions — or not

By Fred Schulte

Secretive audits target some Medicare Advantage plans.

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 "Washington":

"… ernment is doing so little to stop it. The report finds that not only has Washington known about this for years, but it has records of who’s responsible …"

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 "Florida":

"… being provided,” Cosgrove said. …"

"… al health officials to improve reporting of risk score data. In the South Florida case, government lawyers have been investigating Humana, Inc. for several …"

"… hysician Olivia Graves against Humana. Graves, who has practiced in South Florida for more than three decades, alleges that a Humana-owned clinic …"

"… hing to stop it.. The U.S. Attorney’s Office declined to join the South Florida case even though a federal judge granted it 11 requests for more time to i …"

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 "Puerto Rican Medicare":

"… utive level job in April 2010 expecting to improve medical services at two Puerto Rican Medicare Advantage health plans owned by a subsidiary of New Jersey company: Aveta …"

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.

Medicare Advantage made simple: a glossary

By Fred Schulte

Definitions for lesser-known terms relating to Medicare.

Excerpts from this story referencing "Health":

"… rnment Health plan for low income people. CMS is part of the Department of Health and Human Services. Dual Eligibles: The term refers to people who ar …"

"… These patients are generally considered the most costly to treat. In-Home Health Assessments: Medicare Advantage plans tout these free “house calls …"

"… $9,900 per person in 2011. Risk Adjustment Data Validation (RADV) audits: Health plans collect medical data used to calculate patient risk scores. But mist …"

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 …"

The Canadian health care system I disparaged

By Wendell Potter

Commentary: health care system up north is more efficient.

Excerpts from this story referencing "RAND Corporation":

"… itals, it is frequently cited for better health outcomes. For example, the RAND Corporation found in a 2004 study published in the Annals of Internal Medicine that th …"

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 "Medicaid":

"… ce plan if they are not eligible for a government program like Medicare or Medicaid — is among the most vilified by today’s GOP. “If they were supporti …"

"… orgia, where Sullivan was born and still lives, have refused to expand the Medicaid program to bring more low-incomes individuals and families into coverage, …"

"… erage, as the Affordable Care Act makes possible. Deal has said expanding Medicaid “is something our state cannot afford,” even with the federal governme …"

"… urnalists Thursday that, in his view, Georgia can’t afford not to expand Medicaid. Not only would the expansion bring hundreds of thousands of Georgians int …"

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.

Obamacare and emergency rooms: a bit of perspective needed

By Wendell Potter

Commentary: Oregon study cited by critics requires perspective.

Excerpts from this story referencing "Health":

"… ot reduce unnecessary ER visits. “Emergency Visits Seen Increasing with Health Law,” read the headline above the New York Times story last Thursday. …"

As glitches fade, Obamacare approval will rise

By Wendell Potter

Commentary: as website improves, customers are finding insurance deals.

Excerpts from this story referencing "cancer":

"… eaucratic black hole” for 37 days. It was an agonizing wait for Smith, a cancer survivor who — along with husband Larry — had to file for bankruptcy s …"

"… ll soon have affordable coverage —and that it can’t be canceled if her cancer returns, thanks to Obamacare — she still believes a single-payer, M …"

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 "Health":

"… n ObamaCare, Medicare, and public Health.  Sign up now to receive our Health newsletter. ------------------------- Still, the draft CMS fee proposal, …"

"… report. In the wake of the news reports, Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius threatened possible crimina …"

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

"… are specialists. Dr. Brent Wallace, chief medical officer of Intermountain Healthcare in Salt Lake City, wrote to CMS on Aug. 6. He argued that the $875 bun …"

Obamacare facts separated from spin by Wendell Potter,

By Bill Buzenberg

Navigating the politicized issue of the Affordable Care Act is made easier by Wendell Potter and

Excerpts from this story referencing "Kathleen Sebelius":

"… without federal tax credits. But even Health and Human Services Secretary Kathleen Sebelius has said that younger Americans would likely pay more on the exchanges, wh …"