Running a five-star nursing home

By Jeff Kelly Lowenstein

Top-rated homes had more nurses, less turnover

Excerpts from this story referencing "Texas":

"… he homes analyzed. Bita Kash, professor of Health Policy and Management at Texas A & M University, said Medicaid’s comparatively low reimbursements h …"

More scrutiny coming for Medicare Advantage, Obamacare

By Fred Schulte

New round of audits coming; Obamacare too.

Another whistleblower suit alleges Medicare Advantage fraud

By Fred Schulte

California litigation alleges 'house calls" yielded false claims

Excerpts from this story referencing "Oregon":

"… isits to Medicare Advantage patients in Ohio, New York, California, Texas, Oregon and Virginia.   The four health plans “turned a blind eye to the tr …"

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 …"

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 "Health":

"… “upcoding.” Researcher Richard Kronick, director of the Department of Health and Human Services’ Agency for Healthcare Research and Quality, said off …"

"… ick, director of the Department of Health and Human Services’ Agency for Healthcare Research and Quality, said officials should consider tightening audit …"

"… ed to kill or scale back planned pay cuts to the Health plans. America’s Health Insurance Plans, the industry’s primary trade group, spent nearly $5 mil …"

"… p overpayments. Clare Krusing, director of communications for America’s Health Insurance Plans, did not respond directly to a question about the payment …"

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 "Congress":

"… until 2030 — 13 years later than projected in 2009, the year before Congress passed the Affordable Care Act. While it’s uncertain how much of that g …"

"… hts Center and Social Security Works — released a report suggesting that Congress could save taxpayers $141 billion over 10 years just by reauthorizing a pr …"

"… in the first year of the Part D program. The groups also recommended that Congress allow Medicare to create its own drug insurance plan that could directly n …"

"… s also contributed to soaring health care costs, especially for Medicare. Congress has also allowed health insurers to enrich themselves, in both lawful and …"

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":

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

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 "Comcast":

"… ished. Keep reading 9. Only 12% of eligible households have signed up for Comcast's affordable Internet program Back in 2011, Comcast wanted to ease feder …"

"… s have signed up for Comcast's affordable Internet program Back in 2011, Comcast wanted to ease federal approval of its merger with NBC Universal, so it pr …"

"… es. The program, called "Internet Essentials," helped show regulators that Comcast's corporate deal was in the public interest (and it made for good public r …"

"… s in the public interest (and it made for good public relations, too). Now Comcast wants to buy Time Warner, and this new merger begs the question — what h …"

How Medicare Advantage plans code for cash

By Fred Schulte

Federal study criticizes Medicare Advantage and calls for changes.

Excerpts from this story referencing "Congress":

"… Further policy changes will likely be necessary,” the study concludes. Congress created Medicare Advantage in 2003 to encourage private insurance companie …"

"… stry and the fear of angering seniors also has largely quieted concerns in Congress that Medicare Advantage plans can be a poor value for taxpayers. Congress …"

"… Congress that Medicare Advantage plans can be a poor value for taxpayers. Congress recognized problems with Medicare Advantage coding as far back as 2005, wh …"

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 "spokeswoman":

"… rule is made. “We are evaluating the proposal,” said Clare Krusing, a spokeswoman for America’s Health Insurance Plans, the industry’s trade group. Cong …"

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 "House Committee on Energy and Commerce":

"… mony prepared for a Wednesday hearing of the oversight subcommittee of the House Committee on Energy and Commerce. The hearing was called to assess fraud and abuse safeguards in Medicare, …"

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 "New York":

"… ok to the Brits when it comes to health care. In a research report by the New York-based Commonwealth Fund that evaluated the health care systems of several …"

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 "New York":

"… a day of lobbying — coordinated by AHIP.   Even Charles Schumer of New York, who chaired the Democratic Senatorial Campaign Committee from 2005-2009 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 "District of Columbia":

"… 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 reporter Fred Schulte, with …"

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 "House Committee on Energy and Commerce":

"… In a March 2014 memo to its members, the Democratic staff of the House Committee on Energy and Commerce accused the Medicare Advantage industry of making “exaggerated claims” …"

Health insurers have their way with regulators

By Fred Schulte

Billions in Medicare Advantage overpayments likely gone for good.

Excerpts from this story referencing "Cigna":

"… d they can lose money when risk-based payments don’t cover their costs. Cigna Healthcare of Arizona, for example, disputed the audit finding that it was …"

"… an $23 million for 2007. Calling the audit standards “fatally flawed,” Cigna said it actually lost about $800,000 that year treating the 100 patients w …"

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 …"

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 "Harvard University":

"… s won’t see federal auditors for years. Malcolm Sparrow, a professor at Harvard University’s John F. Kennedy School of Government and health fraud expert, said off …"

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 "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 …"

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 "Medicaid":

"… disabled people. Congress also created the federal and state-administered Medicaid program for the nation’s poor. Ever since, most of the rest of us have …"

"… ngress added a few years ago. The Canadian Medicare program is akin to our Medicaid program in that the provinces have broad latitude in administering benefit …"

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 of Health":

"… 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 efforts to imp …"

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 "Nashville":

"… owner eventually sold its assets in May 2012 to a venture capital firm in Nashville called CSHM LLC. The new owners say that problems found in 20 reports don …"

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 "Congressional Budget Office":

"… nationwide averaged 13 percent — or $1,100 per enrollee — in 2009. The Congressional Budget Office projected that year that the excess payments would total more than $150 bi …"

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 "Forbes":

"… e Medicaid Expansion to Worsen Hospital ER Burden,” said Bloomberg. And Forbes gave us this: “New Oregon Data: Expanding Medicaid Increases Usage of Em …"

"… ms, Undermining Central Rational for Obamacare.” “For years,” wrote Forbes columnist Avik Roy, “it has been the number one talking point of Obamaca …"

Pages