Another whistleblower suit alleges Medicare Advantage fraud

By Fred Schulte

California litigation alleges 'house calls" yielded false claims

Excerpts from this story referencing "Center for Public Integrity":

"… controversial, largely due to their impact on Medicare costs. In June, a Center for Public Integrity investigation found that home visits were flourishing as federal …"

GAO takes on Medicare Advantage spending

By Fred Schulte

GAO will investigate program spending.

Excerpts from this story referencing "Medicaid":

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

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 "Medicine":

"… . Graber, a physician and president of the Society to Improve Diagnosis in Medicine.  “Patients don’t have any idea how they are being coded.” Gra …"

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 "United States":

"… not only has created the severe shortage of primary care physicians in the United States, but it has also contributed to soaring health care costs, especially for …"

How Medicare Advantage plans code for cash

By Fred Schulte

Federal study criticizes Medicare Advantage and calls for changes.

Excerpts from this story referencing "Florida":

"… some plans than others. Holly J. Cassano, a medical coding consultant in Florida, said that the government’s decision to make the billing data public was …"

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 "insurance":

"… Advantage and introduced risk scores in 2003 as a way to encourage private insurance companies to jump into the senior care market. The program now insures som …"

"… this year. The plans, many of them run by some of the nation’s largest insurance companies, are popular because they often provide extra benefits, such as …"

"… ut the scores crept back up in 2011. Critics argue that even as the health insurance industry lobbies Congress to stave off further rate cuts, it remains overp …"

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 "insurance":

"… omplete data that would facilitate oversight” of the fast-growing health insurance plans. His comments came in testimony prepared for a Wednesday hearing of …"

"… e” Medicare. But Medicare Advantage plans, which are often run by large insurance companies and accept a set monthly fee from the government for each patien …"

"… y” and “difficulties with access to information” held by the private insurance companies. He wrote that fraud investigators have no central place to acce …"

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

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 "Congress":

"… xpayers out of $70 billion in just five years. You would think members of Congress in both parties would be so outraged they’d be launching their own inves …"

"… industry is and 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 …"

"… a secret that the government has been overpaying the private insurers. The Congressional Budget Office has provided lawmakers with estimates of the overpaymen …"

"… s would face higher costs, fewer benefits and a loss of provider choice if Congress and the Obama administration didn’t act to keep plan rate cuts from goin …"

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 insurance":

"… are deeply invested in keeping Medicare Advantage alive and thriving. The health insurance industry’s main trade group, America’s health insurance Plans, or AHIP …"

"… Low end care A generation ago, putting elderly people into privately-run health insurance plans, the forerunners of Medicare Advantage, was a tough sell. It didn’ …"

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 "Medicaid":

"… een completed, or what the results might be. The Centers for Medicare and Medicaid Services (CMS), the agency that runs Medicare, has quietly conducted some …"

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.

Excerpts from this story referencing "Medicaid":

"… y of the $70 billion in "improper" payments? The Centers for Medicare and Medicaid Services, which runs the program, has broad authority to recoup overpaymen …"

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 "Medicaid":

"… r reporter Fred Schulte requested records from the Centers of Medicare and Medicaid Services (CMS), an arm of HHS, in a May 21, 2013, letter. The letter asked …"

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 "Medicaid":

"… disabled people. Congress also created the federal and state-administered Medicaid program for the nation’s poor. Ever since, most of the rest of us have …"

"… ngress added a few years ago. The Canadian Medicare program is akin to our Medicaid program in that the provinces have broad latitude in administering benefit …"

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 "Republican National Committee":

"… s and reduce health care disparities among people of color. Honored by the Republican National Committee in February — Black History Month — as one of three GOP “trailblazer …"

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 insurance premiums":

"… paign taking 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 skyrocket. Polls …"

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.

Excerpts from this story referencing "U.S. Government Accountability Office":

"… up the tab and transfers money to the private insurer every month. As the U.S. Government Accountability Office explains it, the Centers for Medicare and Medicaid Services (CMS) adjusts …"

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 "Scott Brown":

"… and other special interests had taken its toll. It even helped Republican Scott Brown win what was thought to be a safe seat for Democrats in a special election …"

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 "Obama":

"… e hope you find value in some of his best analysis and explanation of Obamacare.   Guess which Obamacare provisions were actually thought up by …"

"… his best analysis and explanation of Obamacare.   Guess which Obamacare provisions were actually thought up by Republicans? From May 13, 2013 …"

"… s compete online for customers.” Read the rest   The fiction of Obamacare 'rate shock', from Sept. 3, 2013 “I predict that beginning Oct. 1, …"

"… nstituents who believe their policies have grown more expensive because of Obamacare.” Read the rest   Drug companies have armies of lobbyists, …"

The benefits of Obamacare in the simplest terms

By Wendell Potter

Consumer protections are about to kick in.

Excerpts from this story referencing "Obama":

"… relating to U.S. health care reform  Since 2010, the year President Obama signed the Affordable Care Act, more than $400 million has been spent by t …"

"… defend and explain the legislation.   The vast majority of that anti-Obamacare advertising has been misleading and in many cases downright false, but …"

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

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 "Ted Stevens":

"… ongress meddling with coverage policy, including the case of the late Sen. Ted Stevens of Alaska, who at the behest of the PET scan industry almost single-handed …"

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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