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 "Government":

"… m I would be taking the opportunity, Rathod said.” The Council of State Governments also offers up “suggested” state legislation, such as a bill to permi …"

Another whistleblower suit alleges Medicare Advantage fraud

By Fred Schulte

California litigation alleges 'house calls" yielded false claims

Excerpts from this story referencing "Medicare":

"… m of diagnosing “false and fraudulent” medical conditions that several Medicare Advantage plans allegedly used to overcharge the federal government by $1 …"

"… nta Ana, California-based firm sends medical professionals to the homes of Medicare Advantage members to assess their health. Silingo claims she was fired la …"

"… fornia, was unsealed by a judge late last month. The suit also names four Medicare Advantage insurance plans which, Silingo alleges, “turned a blind eye” …"

"… s lawsuit is likely to draw further attention to government oversight of Medicare Advantage plans. The health plans, an alternative to standard Medicare, ar …"

GAO takes on Medicare Advantage spending

By Fred Schulte

GAO will investigate program spending.

Excerpts from this story referencing "Health":

"… attorney with the Center for Medicare Advocacy in Washington. America’s Health Insurance Plans, the industry’s trade group, wouldn’t comment on the G …"

"… y lobbied to scale back planned pay cuts to the Health plans. America’s Health Insurance Plans, the industry trade group, spent nearly $5 million lobbyin …"

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 …"

Obamacare helps millions, but falls short in many ways

By Wendell Potter

The Affordable Care Act has reduced the ranks of the uninsured, but cost of care must be addressed.

Excerpts from this story referencing "Barack Obama":

"… ot just those who have become newly insured over the past year. President Barack Obama cited some of the impressive statistics last Thursday, the day after the o …"

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.

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 "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 "Congress":

"… gin requiring Medicare Advantage plans to report fraud to the government. Congress created Medicare Advantage in 2003 to encourage private insurance companie …"

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 "Massachusetts":

"… . a central part of his campaign for another high-profile job: governor of Massachusetts. Last week, Berwick got closer to that goal during the state’s Democrat …"

"… nvention when he became one of three candidates to qualify for the Sept. 9 Massachusetts primary. State Treasurer Steven Grossman and Attorney General Martha Coakl …"

"… d try to get a copy of the Commonwealth Fund report in the hands of every Massachusetts voter. And he might be tempted to send an “I told you so” note to a fe …"

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 "America":

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

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 "Karen Ignagni":

"… The proposal to restrict home visits didn’t sit well with health plans. Karen Ignagni, president of the industry’s powerful trade group, America’s Health In …"

Medicare Advantage lobbying machine steamrolls Congress

By Fred Schulte

Under pressure, Medicare Advantage critics morph into defenders.

Excerpts from this story referencing "Medicare":

"… ng their policies.” …"

"… have based on the benefits they were providing to seniors. So we cut what Medicare gives to these private insurance companies,” the Minnesota Democrat into …"

"… thanked by industry surrogates for their help in killing some of the same Medicare Advantage cuts he’d previously supported so forcefully. By most account …"

"… rs of Congress and the Obama administration, and a forceful flexing of the Medicare Advantage industry’s growing political might in Washington. John Gorman …"

Health insurers have their way with regulators

By Fred Schulte

Billions in Medicare Advantage overpayments likely gone for good.

Excerpts from this story referencing "Medicaid":

"… clined to comment beyond that. Officials from the Centers for Medicare and Medicaid Services (CMS), the HHS agency that actually runs the program, declined to …"

"… ely for the millions of seniors they sign up. The Centers for Medicare and Medicaid Services conducts its own periodic audits — separate from the HHS IG eff …"

New audits may recover missing millions — or not

By Fred Schulte

Secretive audits target some Medicare Advantage plans.

Excerpts from this story referencing "inspector":

"… that couldn’t be verified through a patient’s medical record. The HHS inspector general audits are more worrisome to the industry than the CMS audits &nbs …"

"… nd often draw media notice and attention from members of Congress. But the inspector general’s office has said it won’t be conducting any more of its revie …"

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 "Healthcare":

"… er government health official claims, he discovered that the plans — MMM Healthcare and PMC Medicare Choice — had been cheating Medicare out of hundreds of …"

"… ts 2012 annual financial report to insurance officials in Puerto Rico, MMM Healthcare stated that it had not been subject to a CMS payment audit. However, in l …"

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 "Congress":

"… ervices and less for healthy people. Why were risk scores adopted?  Congress wanted to make sure health plans wouldn’t shy away from taking sicker pa …"

Center sues in an effort to make Medicare Advantage files public

By Fred Schulte

Center sues to make records public.

A different way of thinking about health care

By Wendell Potter

Commentary: Canadians take pride in their health care system.

Excerpts from this story referencing "South Carolina":

"… s high deductible, would be among the first to tell us that. …"

The Canadian health care system I disparaged

By Wendell Potter

Commentary: health care system up north is more efficient.

American-style health care system pushed in Canada

By Wendell Potter

Canada's conservative Prime Minister Stephen Harper wants to remake nation's health care system.

Excerpts from this story referencing "gross domestic product":

"… payment to the provinces would be pegged to the growth in the country’s gross domestic product, usually considerably less than 6 percent, but no less than 3 percent. Ha …"

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 "Republican Party":

"… ies afford coverage, just as the Affordable Care Act does. “But now the Republican Party is attacking the same concept,” he said. “I’m not for that kind of p …"

The health care industry's campaign of fear, uncertainty and doubt

By Wendell Potter

Commentary: health insurers use a host of tactics to erode support for Obamacare.

Excerpts from this story referencing "APCO Worldwide":

"… trade group, America’s Health Insurance Plans, and one of its PR firms, APCO Worldwide. The AHIP and APCO staffers briefed us on the tactics they were recommendi …"

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 "America":

"… f the ads is the real tenant of 601 Pennsylvania Avenue., N.W., Suite 500: America’s Health Insurance Plans, which is one of the best-funded and influentia …"

Selective outrage over federal health care costs

By Wendell Potter

Commentary: Conservatives slam risk fund for insurers, but have nothing to say about Medicare Advantage.

Opponents' missteps locked in Obamacare's future

By Wendell Potter

COMMENTARY: Republicans overplayed their hand, just as WellPoint did in 2010.

Excerpts from this story referencing "Obama administration":

"… re Act would not go forward. Their victory did not come about because the Obama administration or Democrats in Congress has successfully carried out a winning strategy b …"

Reader-approved analysis from Wendell Potter

By Sarah Whitmire

Revisit some of the best analysis from former health insurance exec-turned-whistleblower, Wendell Potter.

Excerpts from this story referencing "aerospace industry":

"… 4 billion lobbying Congress over the same time frame while the defense and aerospace industry spent $662 million, a fourth of Big Pharma’s total.” Read the rest …"

The benefits of Obamacare in the simplest terms

By Wendell Potter

Consumer protections are about to kick in.

Excerpts from this story referencing "Maine":

"… her father. Maggie’s dad is Joe Ditré, executive director of Portland, Maine-based Consumers for Affordable Health Care, a nonprofit advocacy group. Di …"

"… rant to update the organization’s website and to produce a video to tell Mainers what they need to know about the state’s insurance marketplace and how …"

"… ew and drew and drew, everything from computers and keyboards to a smiling Maine family. Then she edited it all down to 3 minutes and 26 seconds and record …"

"… amilies earning up to $94,000 and that 90 percent of the 133,000 uninsured Mainers will qualify for a subsidy. What was the most challenging thing to draw …"

OPINION: making the tough health care calls

By Wendell Potter

Independent Payment Advisory Board may be best hope for trimming costs, eliminating unnecessary procedures.

Excerpts from this story referencing "Medicaid":

"… o Medicare. Even though the program is run by the Centers for Medicare and Medicaid Services, members of Congress frequently exert their influence over that a …"

"… dical procedures and devices paid for by taxpayers to cover state workers, Medicaid recipients and the people receiving benefits through the state’s workers …"

The other Washington could hold the key to Medicare's cost crisis

By Joe Eaton

Washington state won't pay for medical procedures that don't work. Why can't Medicare do that?

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