Another whistleblower suit alleges Medicare Advantage fraud

By Fred Schulte

California litigation alleges 'house calls" yielded false claims

Excerpts from this story referencing "physician":

"… eir visit, they report their exam findings to the patient’s primary care physician. But home visits also are controversial, largely due to their impact on M …"

"… isits were conducted. The lawsuit names nearly 70 nurse practitioners and physician assistants whom she claims were not properly supervised by doctors. Some e …"

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 …"

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 "Medicaid Services":

"… formal complaint, and about two dozen others, to Centers for Medicare and Medicaid Services (CMS) administrator Marilyn B. Tavenner. Swanson asked the federal officia …"

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 "Insurance":

"… boost payment rates. Clare Krusing, a spokeswoman for America’s Health Insurance Plans, the industry’s trade group, said the higher billing resulted from …"

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":

"… the proposal,” said Clare Krusing, a spokeswoman for America’s Health Insurance Plans, the industry’s trade group. Congress created Medicare Advantage a …"

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 "Congress":

"… ws presidents to make short-term appointments without Senate approval when Congress is not in session, and that is what Obama did. He appointed Berwick as CMS …"

"… session, and that is what Obama did. He appointed Berwick as CMS head when Congress recessed for the July 4th holiday in 2010. He served until December of 201 …"

"… lth insurance industry’s friends on both sides of the political aisle in Congress would never have allowed that to happen — Berwick has not backed down fr …"

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 "Humana":

"… not come as a shock to me. During my two decades in the industry, at both Humana and Cigna, I came to understand just how much of a cash cow the Medicare A …"

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.

Excerpts from this story referencing "U.S. District Court":

"… e and billing histories. As a result, the Center filed suit against HHS in U.S. District Court of the District of Columbia in late May. The series is reported by Center …"

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 "Dallas":

"… according to McCallum, a co-founder of CenseoHealth, who retired from the Dallas-based home visit company last year. McCallum stressed that home visits sh …"

Medicare Advantage lobbying machine steamrolls Congress

By Fred Schulte

Under pressure, Medicare Advantage critics morph into defenders.

Excerpts from this story referencing "Marco Rubio":

"… e stepped up their longstanding support of Medicare Advantage. Florida’s Marco Rubio, in a Senate speech in August of last year, said a Medicare Adva …"

Health insurers have their way with regulators

By Fred Schulte

Billions in Medicare Advantage overpayments likely gone for good.

Excerpts from this story referencing "Aetna":

"… which operates in more than a dozen states and is owned by insurance giant Aetna. Within a week of the decision, the company freed up $133 million it had h …"

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 "journalist":

"… nts are.  That's the key finding of a new Center report by journalist Fred Schulte. For more than a year, he’s been investigating Medicare Ad …"

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 "Josh Valdez":

"… hile the potential liability to the government “remained unaddressed.” …"

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 "Medicaid":

"… y of the $70 billion in "improper" payments? The Centers for Medicare and Medicaid Services, which runs the program, has broad authority to recoup overpaymen …"

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 "Medicaid":

"… hly premiums average about $35. Other terms The Centers for Medicare and Medicaid Services: Referred to as CMS, this federal agency oversees Medicare and Me …"

"… id Services: Referred to as CMS, this federal agency oversees Medicare and Medicaid, the government health plan for low income people. CMS is part of the Depa …"

"… les: The term refers to people who are eligible both for Medicare and Medicaid because they have low incomes. These patients are generally considered the …"

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 "Washington":

"… ;Dr. Brian Biles, a professor in the Department of Health Policy at George Washington University, whose Freedom of Information Act lawsuits shook loose limited …"

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

"… rnment, including a criminal investigation by the Department of Justice in Washington and a criminal case involving the U.S. Attorney’s branch office in West …"

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 "U.S. District Court":

"… tage health insurance plans for senior citizens. The suit, filed today in U.S. District Court in Washington under the Freedom of Information Act, argues that officials …"

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 "Republicans":

"… of the Affordable Care Act are based on the reform proposals he and other Republicans crafted more than two decades ago. “Many of the features of the Afforda …"

"… to say that the plan he developed in 1991 with help and support from other Republicans — including those who are leading the charge against Obamacare today — …"

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 "inspector":

"… edicaid started Sept. 30, affecting hundreds of thousands of children, the inspector general of the Department of Health and Human Services announced today. CS …"

"… dren, could be barred from the Medicaid program beginning next month. The inspector general of the Department of Health and Human Services notified the chain …"

"… mpliance,” the company said. Sen. Charles Grassley, R-Iowa, praised the inspector general’s decision. Last year, Grassley encouraged the inspector general …"

"… sed the inspector general’s decision. Last year, Grassley encouraged the inspector general to cut Small Smiles out of the Medicaid program after a yearlong i …"

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.

As glitches fade, Obamacare approval will rise

By Wendell Potter

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

Excerpts from this story referencing "Michael Moore":

"… might be because you’ve seen her in the movies. When she wrote filmmaker Michael Moore about her plight, he included her in the 2007 documentary, SiCKO. Since th …"

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 "CMS":

"… w proposal, though still preliminary, is already drawing fire on its own. CMS officials want to replace five escalating price codes hospitals can choose …"

"… receive our Health newsletter. ------------------------- Still, the draft CMS fee proposal, first released in July, has already drawn sharp critiques fr …"

"… major change.” ‘Upcoding’ prevention In presenting the changes, CMS appears to be searching for a foolproof way to prevent hospitals from pick …"

"… e known as “upcoding.” Hospitals deny they engage in upcoding.   CMS used claims Medicare paid during 2012 to calculate the proposed new rate a …"

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