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

Excerpts from this story referencing "Washington":

"… ect scam,” said Patrick Burns, co-director of Taxpayers Against Fraud in Washington. “You simply systematically up-code conditions and that results in massi …"

"… g involved, the Medicare Advantage payment dispute is the sort of issue in Washington that barely registers outside of a small circle of policy wonks and indust …"

"… y lobbyists, who often rule the day in influencing government policy. In a Washington meeting last week, executives of the two biggest Medicare Advantage plans, …"

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 "White House":

"… he hospital companies, physician organizations and drug makers in ways the White House and members of both parties in Congress were not willing to do in 2009 bec …"

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 "Jay Rockefeller":

"… insurers. Some lawmakers, including Rep. Henry Waxman, D-Calif., and Sen. Jay Rockefeller, D-W.Va., wanted to include language in the law that would have allowed Me …"

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 "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 "United States":

"… iled every other country studied. “Over the past decade, leaders in the United States have begun to recognize that the nation’s health care system is far more …"

"… monstrably better results,” the researchers wrote. “The claim that the United States has ‘the best health care system in the world’ is clearly not true.” …"

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 "White House":

"… how its lobbyists almost always get what they want out of Congress and the White House, regardless of who is sitting in the Oval Office. The Center’s Medicare …"

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 "chronic diseases":

"… rson a year, more for people in poor health, including those with multiple chronic diseases. The billing process is extremely complicated. More than 70 health condit …"

Medicare Advantage lobbying machine steamrolls Congress

By Fred Schulte

Under pressure, Medicare Advantage critics morph into defenders.

Excerpts from this story referencing "Obama administration":

"… a stunning policy reversal for many Democratic members of Congress and the Obama administration, and a forceful flexing of the Medicare Advantage industry’s growing pol …"

Health insurers have their way with regulators

By Fred Schulte

Billions in Medicare Advantage overpayments likely gone for good.

Excerpts from this story referencing "Inspector General":

"… part of the giant Health and Human Services Department. The HHS Office of Inspector General is supposed to backstop CMS and act as a watchdog to make sure that taxpay …"

"… said, adding: “Even when we catch it, nobody gets spanked.”  HHS Inspector General’s Office spokesman Donald White wouldn’t comment on the audits except …"

"… plan attacked the auditors’ methodology in a December 2010 letter to an Inspector General’s Office official. The health plan said the auditors’ finding that it …"

"… Cosgrove said. Sympathetic ear While the industry clashed with the HHS Inspector General’s Office, it found a sympathetic ear at CMS. Rather than hammer the heal …"

New audits may recover missing millions — or not

By Fred Schulte

Secretive audits target some Medicare Advantage plans.

Excerpts from this story referencing "Oregon":

"… 30 selected for review this year. Samaritan Health Plan, based in central Oregon with 6,500 members, also was picked, according to a company newsletter. He …"

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.

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 "Health":

"… r stories. …"

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 "Medicare":

"… ensure the continued financial viability of their system, which they call Medicare, no one in Ottawa of any ideological stripe would dare suggest doing much …"

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 "Insurance":

"… e campaign behind the scenes was the trade association, America’s Health Insurance Plans. With help from a right-wing Canadian outfit called the Fraser Insti …"

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.

Excerpts from this story referencing "Health":

"… pecial interests collaborated under the auspices of organizations like the Healthcare Leadership Council, a coalition that encompasses executives from insur …"

"… ting were representatives of the industry’s big trade group, America’s Health Insurance Plans, and one of its PR firms, APCO Worldwide. The AHIP and APC …"

"… a front group, initially funded by the pharmaceutical industry and called Health Care America, to begin the scare campaign. Such a campaign wouldn’t be e …"

"… so steps would need to be taken to make the media and public believe that Health Care America was really a grassroots organization. One of the first targe …"

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.

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 "Massachusetts":

"… what was thought to be a safe seat for Democrats in a special election in Massachusetts on January 19 to succeed the late Sen. Ted Kennedy. Reform advocates were …"

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.

Excerpts from this story referencing "National Association of Insurance Commissioners":

"… and I are friends. We both have served as consumer representatives to the National Association of Insurance Commissioners. Joe still performs that role, in addition to his day job at CAHC. Joe an …"

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 "Center for Public Integrity":

"… fluence lobbyists for health special interests have in Washington. As the Center for Public Integrity’s Joe Eaton pointed out in an excellent piece last week, one of the reas …"

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 "federal government":

"… lanning to run their own exchanges, while the rest will be operated by the federal government or in state-federal partnerships.    ● An investigation to de …"

"… responsible for oversight of 24 cents out of every tax dollar spent by the federal government. While sequestration has played a part, the IG’s funding problems are a …"

Medicare fraud outrunning enforcement efforts

By Fred Schulte

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

Excerpts from this story referencing "Obama administration":

"… nment waste and cutting health care costs have been top priorities for the Obama administration. The Department of Health and Human Services Office of Inspector General …"

"… h records and billing software has contributed to the higher charges. The Obama administration has often touted its record for cracking down on health care fraud, pointi …"

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