A Center for Public Integrity investigation detailing questionable spending by private Medicare plans has been awarded the prestigious Philip Meyer Journalism Award for social science reporting.
The series, Medicare Advantage Money Grab, documented how Medicare Advantage plans, created more than a decade ago to control health care spending on the elderly, have instead wasted $70 billion dollars through manipulation of a tool called “risk scores” from 2008 through 2013. The formula is supposed to pay health plans more for sicker patients and less for healthy people — but it often pays too much. Medicare Advantage plans now cover nearly 16 million seniors at an estimated cost to taxpayers of more than $150 billion last year.
The series also explained how the federal government has for years missed opportunities to corral overcharges and other billing errors tied to the abuse of risk scores. It painted a picture of the growing power of the Medicare Advantage industry and its sway over members of Congress. The series also foreshadows possible problems with the Affordable Care Act as it uses the risk score system.
The project was built from the reporting efforts of senior health care reporter Fred Schulte, an analysis of Medicare Advantage risk score data by former Center data editor David Donald and intern Erin Durkin, and interactives and visualizations by news developer Chris Zubak-Skees, who were individually cited as part of the award. The series was edited by executive editor Gordon Witkin.
The Center team spent months searching public records, including federal and state court records, and interviewing experts, health lawyers and data companies.
Judges called the series “superb” and noted that despite numerous obstacles, the Center's journalists “aptly dissected the shocking shortcomings” of the Medicare Advantage program. They noted that the explanation of the risk score system and the analysis of how it is manipulated was “particularly lucid.”