States continue war over Obamacare

By Fred Schulte

State lawmakers at odds over hundreds of bills to either cripple or prop up Affordable Care Act.

Excerpts from this story referencing "Politics":

"… Barber, managing director of the National Institute on Money in State Politics in Helena, Montana, said “we know it (Obamacare) is “being debate …"

Health care findings you may have missed in 2014

By The Center for Public Integrity

$70 billion in "improper" Medicare Advantage payments and the problem shared by 80 percent of nursing homes.

Excerpts from this story referencing "Medicare":

"… ons. Keep reading …"

"… ar. If you weren't aware, you might have missed $70 billion in "improper" Medicare Advantage payments and the problem shared by 80 percent of all nursing hom …"

"…   1. $70 billion in 'improper' payments A Center investigation into Medicare Advantage uncovered how $70 billion in "improper" payments have been made …"

"… vantage uncovered how $70 billion in "improper" payments have been made to Medicare Advantage plans from 2008 to 2013. Most of these improper payments can be …"

Running a five-star nursing home

By Jeff Kelly Lowenstein

Top-rated homes had more nurses, less turnover

Excerpts from this story referencing "federal government":

"… cy in staffing contributed to Woodview’s earning the top rating from the federal government for overall quality — a 5-star score on a 5-star scale from Nursing Home …"

"… just before annual inspections in order to earn a higher rating from the federal government. Nursing home administrators and a leading industry group deny those charg …"

More scrutiny coming for Medicare Advantage, Obamacare

By Fred Schulte

New round of audits coming; Obamacare too.

Excerpts from this story referencing "Government":

"… hed up just $157,777 to settle the matter in December 2013, for instance. Government officials aren’t sure how much of the suspected overpayments to Medicare …"

Another whistleblower suit alleges Medicare Advantage fraud

By Fred Schulte

California litigation alleges 'house calls" yielded false claims

Excerpts from this story referencing "New York":

"… roblems with in-home health visits to Medicare Advantage patients in Ohio, New York, California, Texas, Oregon and Virginia.   The four health plans “t …"

GAO takes on Medicare Advantage spending

By Fred Schulte

GAO will investigate program spending.

Excerpts from this story referencing "Medicaid":

"… spring. GAO auditors will target efforts by the Centers for Medicare and Medicaid Services (CMS), which runs the senior care program, to ensure the privatel …"

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 "diseases":

"… ernment data never before made public to show wide variations in levels of diseases in some health plans, from complications of diabetes to serious depression …"

"… hich could account for some of the variation. But the aggressive coding of diseases means that the same patient costs the government more money in Medicare Ad …"

"… outliers” because they report abnormally high levels of codes for some diseases. “That should trigger a higher level of scrutiny,” Park said. The bil …"

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 "Medicare":

"… ated 78 million baby boomers in this country, I was delighted to hear that Medicare’s Hospital Trust Fund won’t run out of money until 2030 — 13 ye …"

"… attributed to the health care law, some of the provisions aimed at slowing Medicare spending, such as requiring Medicare to reduce payments to hospitals with …"

"… me of the provisions aimed at slowing Medicare spending, such as requiring Medicare to reduce payments to hospitals with high readmission rates, are likely he …"

"… elping. But the Hospital Trust Fund accounts for only about half of total Medicare spending. Most of the rest goes to cover physician fees, prescription drug …"

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 "official":

"… ervices (CMS) administrator Marilyn B. Tavenner. Swanson asked the federal official to “undertake an investigation of Humana’s practices and take appropri …"

"… gave CMS that power, thus preempting state laws and oversight. Minnesota officials don’t believe CMS should have a “monopoly” on oversight. “We thin …"

"… erminations by Medicare Advantage plans,” Wogsland said. “If they (CMS officials) don’t take action, there’s no other remedy.” Other state official …"

"… officials) don’t take action, there’s no other remedy.” Other state officials also have been frustrated by the limits on their authority. In October, C …"

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 "New York":

"… for shady characters from overseas looking to funnel their wealth through New York’s luxury real estate. Keep reading 8. Sixteen high court judges ruled …"

How Medicare Advantage plans code for cash

By Fred Schulte

Federal study criticizes Medicare Advantage and calls for changes.

Excerpts from this story referencing "Florida":

"… some plans than others. Holly J. Cassano, a medical coding consultant in Florida, said that the government’s decision to make the billing data public was …"

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 "Medicare":

"… lic. The case is pending. …"

"… ally, are seeking new power to recover excessive charges. The Centers for Medicare and Medicaid Services says its wants to set up “a formal process to reco …"

"… Center for Public Integrity investigation published last month found that Medicare paid the health plans nearly $70 billion in “improper” payments — mo …"

"… verstating the health risks of patients — from 2008 through 2013 alone. Medicare expects to pay more for sicker patients and less for those in good health …"

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 "Medicare":

"… ederal officials need to step up efforts to investigate fraud and abuse in Medicare Advantage health plans treating millions of elderly Americans, a top gover …"

"… Commerce. The hearing was called to assess fraud and abuse safeguards in Medicare, which last year covered about 51 million people at a cost to taxpayers of …"

"… $50 billion of that amount was paid improperly, including $11.8 billion to Medicare Advantage plans. A Center for Public Integrity investigation published ea …"

"… ed earlier this month found as much as $70 billion of improper payments to Medicare Advantage plans from 2008 through last year. The Center’s investigation …"

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 "Medicare":

"… dely respected physician and health policy expert, to lead the Centers for Medicare and Medicaid Services (CMS). Despite having broad support among other heal …"

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 "Medicare":

"… te House, regardless of who is sitting in the Oval Office. The Center’s Medicare Advantage Money Grab investigation, led by veteran reporter Fred Schulte, …"

"… Federal officials made nearly $70 billion in “improper” payments to Medicare Advantage plans from 2008 to 2013, mostly overbillings, by manipulating or …"

"… lans from 2008 to 2013, mostly overbillings, by manipulating or misusing a Medicare payment tool called a “risk score.” From 2007 through 2011, Medicare …"

"… Medicare payment tool called a “risk score.” From 2007 through 2011, Medicare Advantage risk scores rose more than twice as fast as the average for peop …"

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 "Medicare":

"… y Gordon Witkin.      …"

"… ls that billions of tax dollars are wasted every year through leakage of a Medicare payment tool called a "risk score". Get involved   If you are a hea …"

"… are a health professional or medical coder and have a story to tell about Medicare Advantage billing issues or “risk scores”, please send Fred Schul …"

"… res”, please send Fred Schulte an email. If you are a patient in a Medicare Advantage plan and have been scheduled for a “home visit” let us know …"

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 "official":

"… including Google Ventures. The cottage industry is flourishing as federal officials struggle to prevent Medicare Advantage plans from overcharging the govern …"

"… based on inflated risk scores, according to government estimates. Federal officials last year suggested that home visits might play a role. They said they we …"

"… al of nearly half-a-million senior home visits in 2013. In April, though, officials bowed to industry pressure and backed off their earlier proposal to restr …"

"… health care for millions of Americans under the Affordable Care Act, which officials expect to contain costs. Behind the curtain The federal government pays …"

Medicare Advantage lobbying machine steamrolls Congress

By Fred Schulte

Under pressure, Medicare Advantage critics morph into defenders.

Excerpts from this story referencing "UnitedHealth Group":

"… top $150 billion. Some of the nation’s mightiest insurance carriers — UnitedHealth Group and Humana Inc. are two of the biggest — dominate the market and are dee …"

Health insurers have their way with regulators

By Fred Schulte

Billions in Medicare Advantage overpayments likely gone for good.

Excerpts from this story referencing "Government":

"… are accurate. James Cosgrove, who directs the health care division of the Government Accountability Office, the watchdog arm of Congress, said that federal hea …"

New audits may recover missing millions — or not

By Fred Schulte

Secretive audits target some Medicare Advantage plans.

Excerpts from this story referencing "Arizona":

"… disclosed in a Securities and Exchange Commission filing that its plan in Arizona was selected. None of the health plans would comment. At issue is the accu …"

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 "insurance":

"… king not only for that; we’re asking for the names of companies, and big insurance companies that have been billing and how they’ve been billing and who’ …"

"… invade the privacy of a doctor.  But when you’re talking about huge insurance companies we don’t see how that, how there should be any privacy there. …"

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 "Medicaid":

"… vantage has faced much less scrutiny. The federal Centers for Medicare and Medicaid Services didn’t try to recoup overpayments until 2012, eight years after …"

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.

Excerpts from this story referencing "Government":

"… rcent growth overall between just two of the years in the data. Finally, a Government Accountability Office Report suggests it could be higher. A 3 percent aver …"

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 "Bill Buzenberg":

"… paying public. There’s no excuse for  ignoring our request,” said Bill Buzenberg, the Center’s Executive Director. Medicare Advantage, a privately-run a …"

The Canadian health care system I disparaged

By Wendell Potter

Commentary: health care system up north is more efficient.

Excerpts from this story referencing "insurance":

"… know I always will be. Over the course of a two-decade career as a health insurance executive, I spent hours and hours implementing my industry’s ongoing pr …"

"… ial governments to create the country’s publicly funded universal health insurance system — known as Medicare — our lawmakers in Washington were establis …"

"… s poor. Ever since, most of the rest of us have had to deal with private insurance companies and pay whatever they felt like charging us for coverage. Canadi …"

"… ybody in every audience I stood before gasped when I told them that health insurance premiums in the U.S. increased 131 percent between 1999 and 2009 — the m …"

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.

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 …"

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