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 "Health":

"… in: An Insurance Company Insider Speaks Out on How Corporate PR is Killing Health Care and Deceiving Americans and Obamacare: What’s in It for M …"

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 Advantage":

"… to provide incentives for health insurance companies to participate in the Medicare Advantage program and administer the Medicare drug program. The Affordable Care Act …"

"… ch themselves, in both lawful and unlawful ways, since the creation of the Medicare Advantage program in 1997.  Under this program, Medicare pays privately run he …"

"… CPI investigation uncovered as much as $70 billion of improper payments to Medicare Advantage plans from 2008 through last year. Will Congress act to save taxpayers bi …"

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 "Health":

"… a 2008 speech commemorating the 60th anniversary of the U.K.’s National Health Service (NHS). The headline of a story on the website of the conservative …"

"… out Berwick at the time: “CMS Nominee Favors Government-Run Rationing of Health Care.” The story went on to quote Berwick as having said in England, …"

"… several countries on dozens of performance measures, the U.K.’s National Health Service ranked No. 1 in the world. The U.S. didn’t come close to the top …"

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 …"

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 "Health":

"… mplications of diabetes to a history of heart trouble that’s flared up. Health plans can profit because Medicare pays them higher rates for sicker patien …"

"… ng to a report prepared for the insurance industry’s trade association. Health plans argue that home visits help them meet a patient’s total Health car …"

"… n Ignagni, president of the industry’s powerful trade group, America’s Health Insurance Plans, in a March 7, 2014 letter to CMS argued that the agency h …"

"… nment limits public access to billing data. But risk scores at one plan, XLHealth Corp., based in Maryland, jumped by at least 20 percent between 2007 and t …"

Medicare Advantage lobbying machine steamrolls Congress

By Fred Schulte

Under pressure, Medicare Advantage critics morph into defenders.

Excerpts from this story referencing "Health":

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

"… thriving. The Health insurance industry’s main trade group, America’s Health Insurance Plans, or AHIP, funds its own “grassroots” lobbying group an …"

Health insurers have their way with regulators

By Fred Schulte

Billions in Medicare Advantage overpayments likely gone for good.

Excerpts from this story referencing "Health":

"… s having serious heart disease.  It took years for the Department of Health and Human Services (HHS) inspector general to publish those findings, and …"

"… ing errors tied to a complex payment formula known as a “risk score.” Health plans collect medical data that is used to compute the Health risks for ea …"

"… and secretive that it remains unfathomable to many Health professionals. Health plans that cheat can face civil or criminal penalties, but federal officia …"

"… Advantage contracts, records show.  CMS is but one part of the giant Health and Human Services Department. The HHS Office of Inspector General is supp …"

New audits may recover missing millions — or not

By Fred Schulte

Secretive audits target some Medicare Advantage plans.

Excerpts from this story referencing "Medicare Advantage":

"… ieves. …"

"… o top $150 billion this year. The government audits are targeting chronic Medicare Advantage billing errors that federal officials blame for billions of dollars in “ …"

"… recoup as much as $370 million from overpayments allegedly made to the 30 Medicare Advantage plans during 2011, according to CMS. However, that figure is well below p …"

"… ral, which acts as a watchdog over CMS, has done some of its own audits of Medicare Advantage. It estimated much higher losses in six plan audits it conducted starting …"

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 "George W. Bush":

"… rtment of Health and Human Services from 2001 through 2003 under President George W. Bush. He also was a health policy adviser to Republican Mitt Romney during the …"

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 "Medicare Advantage":

"… can answer it, we'll do so and add it here. …"

"… e will pay for. This option is called “fee-for-service.” By contrast, Medicare Advantage plans accept a set fee from the government for covering a person’s healt …"

"… nd eyeglasses and cost patients less out of pocket than standard Medicare. Medicare Advantage is growing rapidly and now serves about 16 million people, about a third o …"

"… hat are risk scores? A risk score is a formula the government uses to pay Medicare Advantage plans. The system is supposed to pay higher rates for sicker patients that …"

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 "health insurance":

"… l us that. …"

"… y’s DNA. I told the lawmakers and others how my colleagues and I in the health insurance industry worked over several decades to scare Americans about the Canadian …"

"… with were especially alarmed to learn that millions of Americans who have health insurance file for bankruptcy every year primarily because of medical debt. Most of …"

The Canadian health care system I disparaged

By Wendell Potter

Commentary: health care system up north is more efficient.

Excerpts from this story referencing "Medicine":

"… RAND Corporation found in a 2004 study published in the Annals of Internal Medicine that the VHA outperformed all other sectors of the U.S. health care system …"

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 "oil":

"… population growth.  Under this scenario, fast-growing provinces like oil-rich Alberta would fare much better than the relatively small, slow-growin …"

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":

"… ne of the party’s most admired figures, former Health and Human Services Secretary Dr. Louis W. Sullivan. Speaking at the opening session of the Association …"

"… the former president of the Morehouse School of Medicine who served as HHS Secretary during the George H. W. Bush administration, noted that many of the major …"

"… 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 effo …"

"… th — as one of three GOP “trailblazers” (along with former Assistant Secretary of Labor William Brooks and former Ohio Supreme Court Judge Sara J. Harper …"

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.

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 "Goldman Sachs":

"… to convert those excess payments into hefty profits. Financial analysts at Goldman Sachs estimated a few years ago that 66 percent of the net income at Humana, whe …"

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.

Reader-approved analysis from Wendell Potter

By Sarah Whitmire

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

The benefits of Obamacare in the simplest terms

By Wendell Potter

Consumer protections are about to kick in.

OPINION: making the tough health care calls

By Wendell Potter

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

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?

Excerpts from this story referencing "Orrin Hatch":

"… from doctors. During the 2009 debate over health reform legislation, Sen. Orrin Hatch, R-Utah, echoed the claims of comparative effectiveness research detractor …"

ObamaCare oversight among health watchdog cuts

By Fred Schulte

Trims include ObamaCare oversight

Excerpts from this story referencing "medical devices":

"… ppliers of costly durable medical equipment, such as wheelchairs and other medical devices used in the home, who manage to stay in business even after federal offici …"

Medicare fraud outrunning enforcement efforts

By Fred Schulte

Agency couldn't investigate 1,200 complaints, and more cuts coming.

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