Another whistleblower suit alleges Medicare Advantage fraud

By Fred Schulte

California litigation alleges 'house calls" yielded false claims

Excerpts from this story referencing "Health":

"… nd eye” to the practices. The Health plans named in the suit are: Molina Healthcare of California; WellPoint, Inc., which operates  Anthem Blue Cross …"

"… ; WellPoint, Inc., which operates  Anthem Blue Cross and Blue Shield; Health Net of California, Inc. and Alameda Alliance for Health.  None would …"

"… s and Blue Shield; Health Net of California, Inc. and Alameda Alliance for Health.  None would comment. MedXM chief executive officer Sy Zahedi called …"

GAO takes on Medicare Advantage spending

By Fred Schulte

GAO will investigate program spending.

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 "Center for Public Integrity":

"… k score] adjustment,” Kronick said in response to questions posed by the Center for Public Integrity. (Kronick required that questions be submitted in writing and responded to …"

"… s and that results in massive profits across a population over time.” A Center for Public Integrity investigation published in June found that Medicare made ne …"

"… ther positively or negatively, on health care quality,” Kronick told the Center for Public Integrity. Kronick said that the Centers for Medicare and Medicaid Services, the ar …"

"… or may not be coming down the road,” said spokesman Raymond Thorn. (The Center for Public Integrity in May sued CMS under the Freedom of Information Act to compel the agency …"

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 "Insurance":

"… years to come. Wendell Potter is the author of Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR is Killing Health Care and …"

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 "federal government":

"… ssage of the Medicare Modernization Act in 2003, which created Part D, the federal government benefited from discounts on prescription medicines for people covered by b …"

How Medicare Advantage plans code for cash

By Fred Schulte

Federal study criticizes Medicare Advantage and calls for changes.

Excerpts from this story referencing "diabetes":

"… billing for an inordinately high number of patients with complications of diabetes. Despite its broad implications for Medicare spending, the study by HHS r …"

"… . Even more striking, according to the study, is how much higher reported diabetes rates have been in certain health plans than others. The study tracked rap …"

"… began, up to last year, and made them public for the first time. Overall, diabetes with serious complications, which pays higher rates, was reported as much …"

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.

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.

Health insurance lobby keeps Medicare Advantage overpayments flowing

By Wendell Potter

Commentary: program bills are excessive, but don't expect reforms.

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 "Medicaid":

"… posal to restrict these visits. Officials at the Centers for Medicare and Medicaid Services in Washington refused numerous requests for comment and declined …"

"… driving up Medicare’s costs. In February 2013, Centers for Medicare and Medicaid Services officials proposed flagging diagnoses written up from a home visi …"

Medicare Advantage lobbying machine steamrolls Congress

By Fred Schulte

Under pressure, Medicare Advantage critics morph into defenders.

Excerpts from this story referencing "Medicaid":

"… ss who signed a February 2014 letter to Centers for Medicare and Medicaid Services Administrator Marilyn Tavenner supporting Medicare Advantage. The …"

Health insurers have their way with regulators

By Fred Schulte

Billions in Medicare Advantage overpayments likely gone for good.

Excerpts from this story referencing "Department of Justice":

"… similar future reviews as part of a budget cut. Robert Trusiak, a former Department of Justice prosecutor, said that “at the very least” federal officials should hav …"

New audits may recover missing millions — or not

By Fred Schulte

Secretive audits target some Medicare Advantage plans.

Excerpts from this story referencing "Inspector General":

"… rt of the Department of Health and Human Services (HHS). The HHS Office of Inspector General, which acts as a watchdog over CMS, has done some of its own audits of Med …"

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 "Puerto Rican Medicare":

"… utive level job in April 2010 expecting to improve medical services at two Puerto Rican Medicare Advantage health plans owned by a subsidiary of New Jersey company: Aveta …"

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 "CEO":

"… r thousands of dollars. Meanwhile, back in the states, Karen Ignagni, the CEO of America’s Health Insurance Plans, claimed during a recent C-SPAN inte …"

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.

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 "New York Times":

"… ded workforce, Sullivan says, is oral health. In an op-ed in The New York Times in April 2012, Sullivan called on more states to follow Ala …"

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 "insurance":

"… ealthcare Leadership Council, a coalition that encompasses executives from insurance companies, drug and medical device makers, biotech firms and hospitals. I …"

"… w because I participated in many meetings of the HLC during my years as an insurance industry executive. The campaign of fear, uncertainty and doubt — or FU …"

"… aking shape. But let’s first go back to the spring of 2007. Both health insurance premiums and the number of uninsured Americans were continuing to skyrocke …"

"… lear the point that Americans were losing confidence in the private health insurance market. As I described in my book, Deadly Spin, McInturff’s first slide …"

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 "Insurance":

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

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 "insurance":

"… wn as the Medicare Advantage program. …"

"… s by conservatives that Obamacare will actually result in a bailout of big insurance companies. Under the headline, “Bailing Out Health Insurers and Helping …"

"… it potential initial losses of insurers selling policies on the new health insurance exchanges. I reminded the FOX producer that Republicans have been support …"

"… Act knew that insurers would be reluctant to participate in the new health insurance exchanges — also called marketplaces — if the government didn’t crea …"

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 "Medicare":

"… Potter column, or Center for Public Integrity investigation on ObamaCare, Medicare, and public health.  Sign up now to receive our Health newsletter. -- …"

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 "bank":

"… ssary. And health insurance executives will be laughing all the way to the bank.” Read the rest   Finally, plain English from health insurance …"

"… spend millions to obfuscate, simple explanation doesn't have to break the bank, from Sept. 9, 2013 “People who have an agenda, motivated by political …"

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.

Excerpts from this story referencing "Congress":

"… nd other health care special interests have pretty much had their way with Congress when it comes to Medicare. Even though the program is run by the Centers f …"

"… ogram is run by the Centers for Medicare and Medicaid Services, members of Congress frequently exert their influence over that agency to protect or enhance th …"

"… ance their campaigns.   It is because of this meddling by members of Congress that Medicare pays for procedures, medications and medical devices that ha …"

"… ug’s performance. During the health care reform debate, some members of Congress, Sen. Jay Rockefeller, D-W.Va, in particular, felt something com …"

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 "Oregon":

"… ,” Berenson said. Washington saves, Washington spends Like Washington, Oregon and Minnesota also have public committees that use safety, effectiveness a …"

"… to, said Mark Gibson, director of the Center for Evidence-based Policy at Oregon Health & Science University, which staffs an evidence-based decision a …"

ObamaCare oversight among health watchdog cuts

By Fred Schulte

Trims include ObamaCare oversight

Excerpts from this story referencing "Medicare":

"… Health and Human Services Office of Inspector General, which investigates Medicare and Medicaid waste, fraud and abuse, is in the process of  losing a t …"

"… ions of new members under Obamacare. ● A review of drugs marketed under Medicare Part D without first being approved by the Food and Drug Administration fo …"

"… approved by the Food and Drug Administration for safety and effectiveness. Medicare paid more than $3 billion from 2006 through 2010 for these products, but o …"

"… enditures. The audit was to target merchants in South Florida, a hotbed of Medicare and Medicaid fraud.  ------------------------- Don’t miss a single …"

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