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 …"

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 "insurance":

"… ages $288 billion in assets, isn’t alone. Most major pension funds, insurance companies and mutual funds require investments in corporate bonds, mo …"

"… ecurities based on junk subprime mortgages and sold them to pension funds, insurance companies and other Wall Street banks because they carried the golden seal …"

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 "insurance":

"… rd in a three-part series. Some of the senior citizens who called Arizona insurance agent Denise Early wondered why their Medicare Advantage health plans were …"

"… plans by nearly $3 billion a year, according to a report prepared for the insurance industry’s trade association. Health plans argue that home visits help …"

"… er than what I had already documented,” he said. Early, the independent insurance agent in Tucson who blogs on Arizona Medicare issues, said from her vantag …"

"… re Act. Starting this year, people of all ages who buy coverage off state insurance exchanges will be scored by health status to decide the amount of money he …"

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 …"

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 "insurance":

"… at. …"

"… ericans, her cousin included, regularly postpone needed care because their insurance plans require paying several thousand dollars out of their own pockets bef …"

"… g several years back that they had become “uninsurable” in the eyes of insurance companies after a major illness. Dr. Fry, the Liberal Party’s lead exper …"

"… NA. I told the lawmakers and others how my colleagues and I in the health insurance industry worked over several decades to scare Americans about the Canadian …"

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 "Illinois":

"… ifle Association, was also active in 2002 state attorneys general races in Illinois and Kansas. It’s unknown whether the Chamber supported the LEAA’s spen …"

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 "insurance":

"… dly, not at all shocked. It was just the most recent example of how health insurance bureaucrats insert themselves between patients and their doctors, all too …"

"… a health-care nightmare. His case is an example of what can happen when an insurance company decided to question the administration of care provided by doctors …"

"… d to be denied coverage. He assumed that because he paid the premiums, his insurance company would be there for him if he ever had an emergency. Faraci filed …"

"… ” adding that Faraci would be responsible only for his deductible and co-insurance. As a former insurance company PR guy who used to deal with reporters whe …"

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 "insurance":

"… judge who corrected her mistake. She ruled on a 2010 case in favor of an insurance company represented by her then-husband’s law firm, Sutherland Asbill &a …"

"… he same conclusion, affirming the lower court’s decision in favor of the insurance company represented by her now ex-husband’s firm. Ruling in the gray zo …"

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 "insurance":

"… ce major costs because of the change: securities and investment firms, and insurance companies. In the process, Wagner has distinguished herself as a fundraise …"

"… office. Among the major donors: Goldman Sachs, Oppenheimer Funds and three insurance trade groups. The consumer bureau is particularly reviled by banks and ot …"

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 "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 …"

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 "insurance":

"… ge,” the alternative to traditional Medicare that is operated by private insurance companies. The real sponsor of the ads is the real tenant of 601 Pennsylv …"

"… g and PR outfits in the nation’s capital. As I noted last week, several insurance companies make a boatload of money by participating in the Medicare Advant …"

"… And there was this thinly veiled threat in the POLITICO story from “an insurance industry source familiar with the campaign:” “If CMS doesn’t keep M …"

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 …"

Obamacare and emergency rooms: a bit of perspective needed

By Wendell Potter

Commentary: Oregon study cited by critics requires perspective.

Excerpts from this story referencing "insurance":

"… t even more crowded. And that’s because more Americans will finally have insurance.  Reform advocates have long suggested that getting folks out of the …"

"… costly care from hospitals’ emergency rooms. ‘Those of us with health insurance are also paying a hidden and growing tax for those without it — about $1 …"

"… a bit of twisted logic in that paragraph. It is true that those of us with insurance pay considerably more for it because those who don’t have it often can …"

"… e” to its insured customers. Researchers have estimated that people with insurance pay $1,000 more a year for it than they would if this cost shifting didn …"

Shining a light on ALEC's power to shape policy

By Wendell Potter

Conservative group's power has been under-covered.

Excerpts from this story referencing "insurance":

"… programs to private insurers to letting them market highly profitable junk insurance. While ALEC-member legislators hail from every state, the organization ha …"

"… s model bills were introduced in Virginia alone last year. In addition to insurance companies like State Farm and UnitedHealthcare, ALEC’s corporate members …"

Sorting out why insurers cancel policies

By Wendell Potter

Commentary: blaming Obamacare masks real motives.

Excerpts from this story referencing "insurance":

"… fordable Care Act. …"

"… her insurers will take him up on the offer. The answer: it depends. Some insurance executives will view the offer as one they can’t turn down. Even though …"

"… od to say about Obama’s proposal, keep in mind that she doesn’t run an insurance company.  While industry executives look to her to comment on what po …"

"… them are having to switch plans not because of Obamacare but because their insurance companies want to move them into policies with higher profit margins. Ins …"

Separating myth from reality on Obamacare

By Wendell Potter

Commentary: media scare stories, website snafus obscure opportunities to save.

Excerpts from this story referencing "insurance":

"… s among the many Americans who in recent weeks received letters from their insurance companies saying that their policies won’t be available next year. Insu …"

"… . It turns out Robert wasn’t willing to just wait. He decided to call an insurance agent and talk to a real live human being about his options for next year. …"

"… icker shock he had been expecting, he will save $1,400 next year on health insurance. The plan he is leaning toward — a top-of-the line “platinum” plan …"

"… it’s likely that more people will get more for their insurance buck next year than less. In addition, most of the people who buy coverag …"

What Congress didn't say: Obamacare outlaws policies that are essentially worthless

By Wendell Potter

Commentary: Obamacare outlaws worthless policies that insurers loved to sell.

Excerpts from this story referencing "insurance":

"… g materials. Insurers have made billions in profits from selling such junk insurance, and people like Blackburn clearly want to get rid of the law that makes j …"

"… d people like Blackburn clearly want to get rid of the law that makes junk insurance illegal. As I wrote in Deadly Spin, a years-long industry strategy has be …"

"… and more medical expenses to patients. As part of that strategy, big insurance firms bought smaller companies that specialize in limited-benefit plans, w …"

"… limited-benefit plans, which often provide such skimpy coverage that some insurance brokers have refused to sell them. Cigna, for example, marketed a limited …"

Beginning of the end for major health insurers

By Wendell Potter

Kickoff of new law will expose irrelevance of big insurers.

Excerpts from this story referencing "insurance":

"… business, like data management.  …"

"… ober 1, 2014, that law will signify the beginning of the end of the health insurance industry as we know it. As I’ve noted previously, my former CEO at Cign …"

"… ership retreat that what kept him up at night was the fear that big health insurance corporations might someday be viewed as unnecessary middlemen, that their …"

"… lue proposition” would come under scrutiny and found to be wanting. That insurance companies would, to use his term, be disintermediated. That day has arriv …"

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 "insurance":

"… bsp;  …"

"… ealth care reform. Potter spent 15 years helping one of the biggest health insurance companies in the U.S. spin and craft its message, but since 2009, he’s i …"

"… y a public plan like Medicare or Medicaid must buy coverage from a private insurance company. The second provision: establishment of state health insurance mar …"

"… ate insurance company. The second provision: establishment of state health insurance marketplaces (called exchanges in the law) where private insurers compete …"

Unions chafing at Obamacare provisions

By Wendell Potter

Labor leaders say big business was mollified at their expense.

Excerpts from this story referencing "insurance":

"… ng for that sooner rather than later. …"

"… en unionized workers the same consideration they gave business leaders and insurance company executives when the Affordable Care Act was being drafted. As ful …"

"… ore time addressing the concerns of the business community, especially the insurance and pharmaceutical industries, than their friends and reliable allies in t …"

"… ear were lobbyists for doctors and hospitals, drug makers and, of course, insurance companies. Perhaps that shouldn’t have surprised us, given the politica …"

The fiction of Obamacare 'rate shock'

By Wendell Potter

Scare tactics aside, Obamacare rates will be lower for many.

Excerpts from this story referencing "insurance":

"… stituents in a Congressional hearing. …"

"… ‘Rate Shock’ as Some insurance Premiums to Double in 2014.” Health insurance executives were hoping we’d swallow their scare campaign on rates, and t …"

"… was really the blame or if, possibly, and more likely, those businesses’ insurance carriers were just gouging them. Five and a half months later, I’m still …"

"… shock” allegations were based on anything other than assertions made by insurance company CEOs and lobbyists and their buddies on Capitol Hill. ----------- …"

Fear-mongering won't scuttle Obamacare

By Wendell Potter

Opponents want to scuttle health reform, but time is running out.

Excerpts from this story referencing "insurance":

"… it has been about winning elections. …"

"… reds of millions of dollars already — with much of that cash coming from insurance companies and their business pals worried about shrinking profit margins …"

"… actually think the law doesn’t go far enough to protect us from abusive insurance companies and money-hungry doctors and hospitals. This means that those wh …"

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