Another whistleblower suit alleges Medicare Advantage fraud

By Fred Schulte

California litigation alleges 'house calls" yielded false claims

Excerpts from this story referencing "Anita Silingo":

"… harge the federal government by $1 billion or more. The suit was filed by Anita Silingo, a former compliance officer for Mobile Medical Examination Services, Inc. …"

GAO takes on Medicare Advantage spending

By Fred Schulte

GAO will investigate program spending.

Excerpts from this story referencing "Medicaid Services":

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

A call for more scrutiny of private Medicare Advantage plans

By Fred Schulte

Researchers say aggressive billing by private plans may require more scrutiny

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 "Congress":

"… until 2030 — 13 years later than projected in 2009, the year before Congress passed the Affordable Care Act. While it’s uncertain how much of that g …"

"… hts Center and Social Security Works — released a report suggesting that Congress could save taxpayers $141 billion over 10 years just by reauthorizing a pr …"

"… in the first year of the Part D program. The groups also recommended that Congress allow Medicare to create its own drug insurance plan that could directly n …"

"… s also contributed to soaring health care costs, especially for Medicare. Congress has also allowed health insurers to enrich themselves, in both lawful and …"

How Medicare Advantage plans code for cash

By Fred Schulte

Federal study criticizes Medicare Advantage and calls for changes.

Excerpts from this story referencing "Medicaid":

"… last month on an online research site run by the Centers for Medicare and Medicaid Services, part of HHS. Kronick directs the HHS Agency for Healthcare Resea …"

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 "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 "head":

"… g the 60th anniversary of the U.K.’s National Health Service (NHS). The headline of a story on the website of the conservative Heartland Institute summ …"

"… is not in session, and that is what Obama did. He appointed Berwick as CMS head when Congress recessed for the July 4th holiday in 2010. He served until D …"

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 …"

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 "Florida":

"… s nearly $450 a month for a 75-year-old woman living in Miami-Dade County, Florida, according to the Coleman Consulting Group, based in neighboring Broward C …"

"… roves and Medicare’s payment should be reduced. Coleman Consulting, the Florida billing experts, said doctors often document a diagnosis of cancer after i …"

"… the owners of America’s Health Choice Medical Plans Inc. in Vero Beach, Florida. The government accused the health plan of bilking Medicare out of million …"

Medicare Advantage lobbying machine steamrolls Congress

By Fred Schulte

Under pressure, Medicare Advantage critics morph into defenders.

Excerpts from this story referencing "insurance":

"… were providing to seniors. So we cut what Medicare gives to these private insurance companies,” the Minnesota Democrat intoned in a Dec. 13, 2012, speech on …"

"… restore those billions and billions of dollars in overpayments to private insurance companies for no reason, for no good effect, just so that, I guess, these …"

"… companies for no reason, for no good effect, just so that, I guess, these insurance companies could have more profit.” Yet less than four months later, Fra …"

"… Indeed. Congress created Medicare Advantage in 2003 to encourage private insurance companies to jump into the senior care market without hesitation. Since th …"

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":

"… ieves. …"

"… s of millions of dollars for past overcharges and other billing mistakes. Medicare pays the health plans a set amount monthly for each person based on estima …"

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

"… ts have yet been completed, or what the results might be. The Centers for Medicare and Medicaid Services (CMS), the agency that runs Medicare, has quietly co …"

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.

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 "Arnold Schwarzenegger":

"… ’s testimony clearly resonated. Legislators in Sacramento sent then-Gov. Arnold Schwarzenegger two bills that would establish a single payer system in the California — …"

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 …"

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 "Ottawa":

"… m by refusing to renew a 10-year compact between the federal government in Ottawa and the 13 provincial governments, which are largely responsible for admin …"

"… the poorer provinces have been getting a proportionally larger check from Ottawa than the richer provinces. What Harper is proposing as an alternative is …"

"… ues to be accessible and affordable, but the U.S. model is not the example Ottawa and the provinces should follow. …"

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 "Medicaid":

"… ce plan if they are not eligible for a government program like Medicare or Medicaid — is among the most vilified by today’s GOP. “If they were supporti …"

"… orgia, where Sullivan was born and still lives, have refused to expand the Medicaid program to bring more low-incomes individuals and families into coverage, …"

"… erage, as the Affordable Care Act makes possible. Deal has said expanding Medicaid “is something our state cannot afford,” even with the federal governme …"

"… urnalists Thursday that, in his view, Georgia can’t afford not to expand Medicaid. Not only would the expansion bring hundreds of thousands of Georgians int …"

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 "Health":

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

"… g out that provision of the law. And for good reason. Insurers like UnitedHealth and Humana with a substantial number of Medicare Advantage enrollees are a …"

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.

Excerpts from this story referencing "Health":

"… a bailout of big insurance companies. Under the headline, “Bailing Out Health Insurers and Helping Obamacare,” The Weekly Standard on Monday urged Rep …"

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 "Ted Cruz":

"… llying behind the President. This unity — along with the fact that Sen. Ted Cruz, R-Texas, and other Republicans who forced the government shutdo …"

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.

Excerpts from this story referencing "executive director":

"… ve video she did as a favor for her father. Maggie’s dad is Joe Ditré, executive director of Portland, Maine-based Consumers for Affordable Health Care, a nonprofit …"

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?

Excerpts from this story referencing "Medicaid Services":

"… nt health or are not worth the price tag. But the Centers for Medicare and Medicaid Services (CMS), the agency that administers the program, has for the most part fail …"

"… or ineffective procedures. Most importantly, the Centers for Medicare and Medicaid Services have no authority to consider cost in their coverage policy decisions. By …"

"… cisions are actually made in Washington, D.C. The Centers for Medicare and Medicaid Services administers the program, but the nuts-and-bolts processes of running the p …"

ObamaCare oversight among health watchdog cuts

By Fred Schulte

Trims include ObamaCare oversight

Excerpts from this story referencing "Inspector General":

"… ffordable Care Act. The Department of Health and Human Services Office of Inspector General, which investigates Medicare and Medicaid waste, fraud and abuse, is in th …"

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