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 "Center for Public Integrity":

"… ays privately run health plans a set monthly rate for each patient. As the Center for Public Integrity reported in a series of investigative reports this past June, about 16 mil …"

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 "Congress":

"… e legal authority to impose sanctions on Medicare Advantage carriers. When Congress created the Medicare Advantage option in 2003, it gave CMS that power, thu …"

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 "Medicare":

"… ut reporting to the state. Keep reading 6. About a third of all people on Medicare are covered by health plans that are susceptible to billing abuse Americ …"

"… ealth insurance plans are simply claiming they are. Our investigation into Medicare Advantage found that billions of tax dollars are wasted every year through …"

"… nd that billions of tax dollars are wasted every year through leakage of a Medicare payment tool called a “risk score.” The formula is supposed to pay hea …"

How Medicare Advantage plans code for cash

By Fred Schulte

Federal study criticizes Medicare Advantage and calls for changes.

Excerpts from this story referencing "CEO":

"… iscuss, but the data is in black and white and speaks volumes,” Cassano, CEO of Accucode Consulting, wrote in an email. Medicare Advantage enjoys soli …"

Feds seek new authority to recoup Medicare Advantage overcharges

By Fred Schulte

Impact: Feds act to recoup overcharges following Center investigation.

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 "Medicaid":

"… at more needs to be done to protect tax dollars. Centers for Medicare and Medicaid Services (CMS) officials unveiled a new data analysis system to identify o …"

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 "Washington":

"… he might be tempted to send an “I told you so” note to a few folks in Washington. …"

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 "Health":

"… ns. Having served on the strategic communications committee of America’s Health Insurance Plans, I can imagine how sophisticated and multi-pronged the ind …"

"… terparts in the Medicare fee-for-service program.” The effort paid off. Health plan executives and financial analysts were happy that the relatively mino …"

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 "Erin Durkin":

"… Center reporter Fred Schulte, with data analysis by David Donald and Erin Durkin, and edited by Gordon Witkin.      …"

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 "Securities and Exchange Commission":

"… in additional significant funding declines,” according to a Feb. 24 Securities and Exchange Commission filing. The company heralded home visits as a “critical program.” Spo …"

Medicare Advantage lobbying machine steamrolls Congress

By Fred Schulte

Under pressure, Medicare Advantage critics morph into defenders.

Excerpts from this story referencing "Center for Responsive Politics":

"… s industry over the past three election cycles, according to data from the Center for Responsive Politics. Franken alone has received at least $90,000 from the health services indu …"

Health insurers have their way with regulators

By Fred Schulte

Billions in Medicare Advantage overpayments likely gone for good.

Excerpts from this story referencing "Securities and Exchange Commission":

"… estors they could be ordered to cough up significant refunds, according to Securities and Exchange Commission filings. Humana reported to the SEC in November that “certain” of its …"

New audits may recover missing millions — or not

By Fred Schulte

Secretive audits target some Medicare Advantage plans.

Excerpts from this story referencing "Securities and Exchange Commission":

"… picked, according to a company newsletter. Health Net, Inc. disclosed in a Securities and Exchange Commission filing that its plan in Arizona was selected. None of the health plans wou …"

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 "federal judge":

"… Attorney’s Office declined to join the South Florida case even though a federal judge granted it 11 requests for more time to investigate. They argued lawyers a …"

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.

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.

Excerpts from this story referencing "Health":

"… e-For-Service Data. Brian Biles, an MD and professor in the Department of Health Policy at George Washington University, and Giselle Casillas, an MPP and s …"

"… llment remains relatively stable that month. Because of regulations in the Health Insurance Portability and Accountability Act (HIPAA), small Medicare Advan …"

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 "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 "New York Times":

"… ded workforce, Sullivan says, is oral health. In an op-ed in The New York Times in April 2012, Sullivan called on more states to follow Ala …"

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 "Kool Smiles":

"… ic Integrity and PBS Frontline exposed similar practices at another chain, Kool Smiles, in a 2012 report titled “Dollars and Dentists.” Small Smiles’s own …"

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 "Medicaid":

"… k ever since trying to figure out how to keep the Centers for Medicare and Medicaid Services  (CMS) from carrying out that provision of the law. And for …"

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.

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 "Kathleen Sebelius":

"… orts, Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius threatened possible criminal prosecution for doctors and hospitals caught …"

Obamacare facts separated from spin by Wendell Potter, FactCheck.org

By Bill Buzenberg

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

Excerpts from this story referencing "Wendell Potter":

"… bsp; …"

"… istortions, including misleading advertising, seem to be ramping up. Enter Wendell Potter the Center for Public Integrity’s own myth-buster. Wendell is a for …"

"… ant to know is that most Americans will not be affected by the changes. As Wendell Potter has explained, in a country of 315 million people, “only 15 million — …"

"… -time job Thank goodness there are careful purveyors of the truth, such as Wendell Potter and FactCheck.org, to help us all with this process. Until next week, Bil …"

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