Another whistleblower suit alleges Medicare Advantage fraud

By Fred Schulte

California litigation alleges 'house calls" yielded false claims

Excerpts from this story referencing "federal government":

"… ons that several Medicare Advantage plans allegedly used to overcharge the federal government by $1 billion or more. The suit was filed by Anita Silingo, a former comp …"

Corporations, advocacy groups spend big on ballot measures

By Liz Essley Whyte

Corporations and national advocacy groups are throwing big dollars behind TV ads before voters decide 158 state ballot measures.

Excerpts from this story referencing "North Dakota":

"… ing clubs, is trailing behind, with only about $58,000 spent. In North Dakota, the Nature Conservancy and the Audubon Society, among others, have lent t …"

"… ould dedicate some of the state’s oil tax revenues to land preservation. North Dakotans for Clean Water, Wildlife and Parks has ponied up nearly $485,400 for ad …"

California coverage plan for undocumented echoes earlier call by Schwarzenegger

By Wendell Potter

Commentary: former governor supported plan allowing coverage for undocumented residents.

Excerpts from this story referencing "Phil Angelides":

"… been re-elected in a landslide, winning 56 percent of the vote to Democrat Phil Angelides’ 38.9 percent. Schwarzenegger’s reasoning was that undocumented immig …"

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 "Medicare":

"… ung people for the exact same policy. The law also benefits seniors on Medicare by closing the donut hole in the prescription drug benefit and by covering …"

"… nd by covering preventive care, including screenings, and it is saving the Medicare program billions of dollars by gradually reducing the extra amounts the go …"

"… unts the government has been paying private insurers to participate in the Medicare Advantage program. All that said, the law falls short in many ways. While …"

New types of health care delivery are improving the 'patient experience'

By Wendell Potter

Commentary: eliminating role of insurers could improve health care delivery.

Excerpts from this story referencing "University of Washington":

"… providing both coverage and care to many Boeing employees, along with UW (University of Washington) Medicine — without an insurance firm. Officials at Providence-Swedish t …"

Health insurers turning into who knows what?

By Wendell Potter

Commentary: health insurers are transforming themselves — but into what?

Excerpts from this story referencing "Insurance":

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

Taking insurance companies out of health care

By Wendell Potter

If Boeing experiment flies, health care system could be transformed.

Excerpts from this story referencing "America":

"… What Everyone Needs to Know About the Affordable Care Act. …"

"… at Cigna once said that what kept him up at night was the possibility that Americans — business leaders in particular — would ultimately conclude that in …"

"… s that are employer-driven. You can be certain that big employers all over America will be paying close attention. If the Boeing ACO experiment demonstrates …"

"… nsider Speaks Out on How Corporate PR is Killing Health Care and Deceiving Americans and Obamacare: What’s in It for Me? What Everyone Needs to K …"

GOP’s Senate hopes energized by Koch network ad blitz

By Michael Beckel

How many TV ads have groups connected to the billionaire brothers aired in your state?

Excerpts from this story referencing "Arkansas":

"… 0 ads in Louisiana, 5,800 ads in Iowa, 4,900 ads in Michigan, 4,700 ads in Arkansas, 4,600 ads in Colorado, 3,600 ads in Alaska and 2,400 ads in Oregon, accor …"

"… de assistance. Kermit Parks, chairman of Union County Republican Party in Arkansas, called the anti-Obamacare ads from Americans for Prosperity that criticiz …"

"… ll spent.” Steve Lux, chairman of the Saline County Republican Party in Arkansas, agrees. “Obviously everybody says they hate negative ads, but they do …"

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 "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.

Excerpts from this story referencing "Iowa":

"… ssor at the University of Texas at Austin.  Sen. Charles Grassley, R-Iowa, said that refining the payment system to keep those costs in check is a …"

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 "Medicaid Services":

"… at more needs to be done to protect tax dollars. Centers for Medicare and Medicaid Services (CMS) officials unveiled a new data analysis system to identify overpaymen …"

Credit rating industry dodges reforms, despite role in financial meltdown

By Alison Fitzgerald

Despite playing a central role in the economic collapse, firms that gave inflated ratings to toxic bonds remain untouched by reforms.

Excerpts from this story referencing "Finance":

"… al Reserve, the Securities and Exchange Commission and the Federal Housing Finance Agancy are busy coming up with alternative ways to measure creditworthines …"

"… lly three or four ratings,” said Guy Cecala, CEO of Inside Mortgage Finance, a trade publication that tracks mortgage-backed securities. “You never …"

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 "Medicare Advantage":

"… itizens who called Arizona insurance agent Denise Early wondered why their Medicare Advantage health plans were eager to send a doctor to visit them at home. A few wor …"

"… e cottage industry is flourishing as federal officials struggle to prevent Medicare Advantage plans from overcharging the government by billions of dollars every year, …"

"… has found. Medicare made nearly $70 billion in “improper” payments to Medicare Advantage plans from 2008 through 2013, mostly overbillings based on inflated risk s …"

"… ons posed in writing. Limiting the house calls could have cut payments to Medicare Advantage plans by nearly $3 billion a year, according to a report prepared for the …"

Medicare Advantage lobbying machine steamrolls Congress

By Fred Schulte

Under pressure, Medicare Advantage critics morph into defenders.

Excerpts from this story referencing "Medicare Advantage":

"… ng their policies.” …"

"… thanked by industry surrogates for their help in killing some of the same Medicare Advantage cuts he’d previously supported so forcefully. By most accounts it was a …"

"… rs of Congress and the Obama administration, and a forceful flexing of the Medicare Advantage industry’s growing political might in Washington. John Gorman, a top Me …"

"… ge industry’s growing political might in Washington. John Gorman, a top Medicare Advantage consultant, hailed the lobbying victory in early 2013 as a “direct refle …"

150 billion reasons Medicare Advantage matters

By Eleanor Bell

Reporter Fred Schulte discusses his investigation into billions of dollars misspent on Medicare Advantage plans.

Excerpts from this story referencing "insurance":

"… king not only for that; we’re asking for the names of companies, and big insurance companies that have been billing and how they’ve been billing and who’ …"

"… invade the privacy of a doctor.  But when you’re talking about huge insurance companies we don’t see how that, how there should be any privacy there. …"

Shameful coverage of Obamacare's real impacts

By Wendell Potter

Commentary: Obamacare coverage that doesn't inform.

Excerpts from this story referencing "insurance":

"… ts — the so-called Medical Loss Ratio. Prior to the passage of the law, insurance company executives — who consider what they spend on medical care to be …"

"… ordable Care Act passed. “No more pre-existing condition clauses … and insurance companies had to refund some of what we paid if they didn’t spend enough …"

Forcing health insurers to do what's right

By Wendell Potter

Commentary: Policyholders benefit from Obamacare provision.

Excerpts from this story referencing "insurance":

"… eir health insurance payments. …"

"… een benefiting since Congress enacted reforms in 2010 that changed the way insurance companies operate. Among the practices I brought to the panel’s attenti …"

"… ed to explore the issue further. After examining years of reports filed by insurance companies, the committee found that, as Rockefeller said Wednesday, “man …"

"… found that, as Rockefeller said Wednesday, “many of the policies health insurance companies were selling to families and businesses were just not a good val …"

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 …"

U.S. Chamber targets Dems in state attorney general races

By Ben Wieder

Why are powerful business interests underwriting ads in AG races in the states?

Excerpts from this story referencing "Maine":

"… General Program at Columbia Law School and the former attorney general of Maine. Second, attorneys general are charged with bringing consumer protection …"

Keeping an eye on insurance companies that refuse to pay claims

By Wendell Potter

Commentary: Arizona case resolved after victim became a 'squeaky wheel'

Excerpts from this story referencing "Aetna":

"… hird-degree burns. Two days after he was discharged, he got a letter from Aetna telling him that the company didn’t believe his injuries were “suffici …"

"… be there for him if he ever had an emergency. Faraci filed an appeal, but Aetna executives wouldn’t budge. They said in their denial letter that Faraci …"

"… etter that Faraci’s coverage extended only to services and supplies that Aetna — not his doctors or hospital staff — deems medically necessary. Fara …"

"… king Channel 12 to intervene paid off. The independent examiner ruled that Aetna should pay half of Faraci’s hospitalization. Soon after that, Aetna told …"

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 …"

Federal judges plead guilty

By Reity O'Brien, Kytja Weir and Chris Young

Judges acknowledge conflicts of interest Center found in 26 cases.

Excerpts from this story referencing "The Washington Post":

"… ch courts began implementing in 2007, followed a number of stories in The Washington Post that identified instances in which federal judges ruled on cases desp …"

Meet the Banking Caucus, Wall Street's secret weapon in Washington

By Daniel Wagner and Alison Fitzgerald

Industry campaign cash flows to pro-bank activists in Congress, yielding big returns.

Excerpts from this story referencing "lobbyist":

"… -person committee staff, dozens of congressional colleagues and legions of lobbyists lined up to beat back any attempt to impose new discipline on the industr …"

"… 9-page law designed to prevent another failure. There are more than 2,000 lobbyists for financial firms and trade groups and many are spreading money around …"

"… wmakers under constant pressure to raise money, Miller said, deep-pocketed lobbyists “don’t have to worry about having access to members, because all you …"

"… ting with a strict, top-down style, Hensarling’s staff, with the help of lobbyists, orchestrates hearings, decides which proposals by regulators merit a let …"

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":

"… mbia — During the year leading up to the 2008 presidential primaries, my insurance industry colleagues and I were working hard to influence the debate on hea …"

"… erican donors, AHIP put together a three-ring binder of talking points for insurance company executives  to use in speeches and media interviews. The con …"

"… o satisfy shareholders’ profit expectations created a situation in which insurance companies refused to sell coverage to people who’ve been sick in the pas …"

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 "APCO Worldwide":

"… trade group, America’s Health Insurance Plans, and one of its PR firms, APCO Worldwide. The AHIP and APCO staffers briefed us on the tactics they were recommendi …"

Dizzying array of options in Obamacare can lead to expensive mistakes

By Wendell Potter

Commentary: Health insurers offer a wide range of plans on exchanges, customers should pay attention to the details.

Excerpts from this story referencing "insurance":

"… nrollment ends on March 31, if you want to get coverage through the health insurance marketplace and avoid having to pay a penalty, you should log on sooner ra …"

"… te to do. Lawmakers who wrote the Affordable Care Act fell for the health insurance industry’s insistence that Americans want “choice and competition.” …"

"… or of the Health Care for All Colorado Foundation, knows more about health insurance than most of us. She spent quite a bit of time last fall on the Colorado e …"

"… do it over again, she would have taken the additional step of calling the insurance companies directly after reviewing the plans they were offering on the exc …"

New Fed study says health reform can reduce financial stress

By Wendell Potter

Commentary: Massachusetts law eases financial stress.

Excerpts from this story referencing "insurance":

"… mit for any health plan offered on the state and federally operated health insurance exchanges is $6,350 for an individual and $12,700 for a family. While tha …"

"… ureau — it still represents a significant improvement. Prior to the ACA, insurance companies were able to sell policies that had no out-of-pocket maximums. I …"

"… ressed concern that while the ACA will reduce the number of people without insurance, it might increase the number of people who are under-insured. That …"

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 "UnitedHealth":

"… arrying 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 "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 …"

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