GAO takes on Medicare Advantage spending

By Fred Schulte

GAO will investigate program spending.

Excerpts from this story referencing "Government Accountability Office":

"… mistakes estimated to cost taxpayers billions of dollars every year. The Government Accountability Office, the watchdog arm of Congress, is conducting the probe at the request of t …"

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 "Washington":

"… ect scam,” said Patrick Burns, co-director of Taxpayers Against Fraud in Washington. “You simply systematically up-code conditions and that results in massi …"

"… g involved, the Medicare Advantage payment dispute is the sort of issue in Washington that barely registers outside of a small circle of policy wonks and indust …"

"… y lobbyists, who often rule the day in influencing government policy. In a Washington meeting last week, executives of the two biggest Medicare Advantage plans, …"

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 "Health":

"… Jepsen called for federal officials to “aggressively scrutinize” UnitedHealthcare’s decision to drop a large number of doctors from its Medicare Advan …"

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 "Washington":

"… outh and the many misleading ways special interests push an agenda in Washington.  Until then, we wanted to review some of the top findings from our …"

How Medicare Advantage plans code for cash

By Fred Schulte

Federal study criticizes Medicare Advantage and calls for changes.

Excerpts from this story referencing "Health":

"… years. Analyzing government data never before made public, Department of Health and Human Services researchers found that many plans exaggerate how sick t …"

"… are and Medicaid Services, part of HHS. Kronick directs the HHS Agency for Healthcare Research and Quality, whose mission is to improve Health care delivery …"

"… said Dr. David Wennberg, a researcher at the Dartmouth Institute for Health Policy and Clinical Practice who has studied Medicare billing trends. Hea …"

"… lth Policy and Clinical Practice who has studied Medicare billing trends. Health care fraud expert Malcolm Sparrow, a professor at Harvard’s Kennedy Scho …"

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 "Health":

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

"… s were presented at a conference of the American Society of Health Economists in Los Angeles on June 25. “Our study is the first that can …"

"… late May, the Center for Public Integrity sued the Department of Health and Human Services to make its audits and other records public. The case i …"

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 "Health":

"… or says. Gary Cantrell, a deputy Inspector General with the Department of Health and Human Services said reviews are “hampered by a lack of accurate, tim …"

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 "Center for Public Integrity":

"… o earnings,” to use Wall Street jargon. …"

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 "George W. Bush":

"… declined to be interviewed. Thomas A. Scully, who led CMS under President George W. Bush, serves on Matrix’s board and is a general partner in the investment fir …"

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 "disease":

"… ia, a person treated for blurry vision was charted as having serious heart disease.  It took years for the Department of Health and Human Services (HHS …"

"… ngress wanted to systematically pay more for people with chronic or costly diseases, such as cancer and diabetes with complications, and less for those in ro …"

"… heir patients were­ — or failing to document that patients actually had diseases the plans were paid to treat, according to CMS. Overall, Medicare paid th …"

"… e paid fairly. Medicare tried to predict the costs of treating a range of diseases, including those likely to require expensive treatment and adjusted payme …"

New audits may recover missing millions — or not

By Fred Schulte

Secretive audits target some Medicare Advantage plans.

Excerpts from this story referencing "Center for Public Integrity":

"… he end of last year, according to government sampling data reviewed by the Center for Public Integrity. Mary Inman, a San Francisco lawyer who represents whistleblowers, said o …"

"… ficial. The letter was signed by four other senior Democrats as well. The Center for Public Integrity’s independent analysis of government data confirmed that in 2011 more th …"

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 "physician":

"… cult it would be for health plans to oversee. “We have more than 18,000 physicians submitting claims to us every day. We audit a portion of the claims and m …"

"… overnment investigators reviewing a whistleblower lawsuit filed in 2010 by physician Olivia Graves against Humana. Graves, who has practiced in South Florida …"

"… h up information about huge health care corporations than about individual physicians. The doctor billing data covers about $77 billion in taxpayer spending fo …"

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.

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.

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 Insurance Portability and Accountability Act":

"… llment remains relatively stable that month. Because of regulations in the Health Insurance Portability and Accountability Act (HIPAA), small Medicare Advantage plans with 10 or less people are omitted …"

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.

Excerpts from this story referencing "The Wall Street Journal":

"… ng data and other records. In a 2009 case, the Center, in partnership with The Wall Street Journal, sued to obtain Medicare billing records for thousands of doctors and hosp …"

The Canadian health care system I disparaged

By Wendell Potter

Commentary: health care system up north is more efficient.

GOP opposition to Obamacare baffles Dr. Sullivan

By Wendell Potter

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

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 "Government Accountability Office":

"… boatload of money by participating in the Medicare Advantage program. The Government Accountability Office noted in a recent report that the federal government spent about $135 bill …"

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 "photographer":

"… e and I are both self-employed small sole proprietors,” wrote Freukes, a photographer. “This will be the first time in our married lives we will have health i …"

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 "physician":

"… mere existence of facility fees is contentious because they come on top of physician bills and hospital charges for tests, medicines and other supplies, and ha …"

"… ent codes being used were designed by the American Medical Association for physician billing, not emergency room services. Doctors pick one of the five-digit c …"

"… more they are paid. Hospitals have long complained that codes written for physicians don’t translate easily for pricing emergency room resources, but deny t …"

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

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.

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