Medicare

Documents Reveal Secret Legal Battle Over Medicare Overbilling

11:46am June 19, 2015

by Fred Schulte

The federal government overpaid for nearly half of the patients of a Medicare Advantage plan, a Medicare audit found. At issue is whether insurers "upcode" diagnoses to reap bigger payments.

Health & Safety

How Medicare Advantage Investors Profited From Loose Government Lips

1:00pm May 20, 2015

by Fred Schulte

When the Centers for Medicare and Medicaid Services sent a memo to insurers saying government audit policies could be relaxed, investors privy to the news pounced, sending shares upward.

Health & Safety

Brand-Name Medicines Dominate Medicare's $103 Billion Drug Bill

8:18am May 04, 2015

by Jordan Rau

Federal officials released prescription histories of hundreds of thousands of doctors and identified the most common and costly drugs. Medicare spent the most on a purple pill for heartburn.

Northeast Baptist Hospital, one of five hospitals within the Baptist Health System in San Antonio.

Health & Safety

Health System Took Control To Make Joint Replacement More Profitable

2:13pm May 01, 2015

by Jay Hancock

Baptist Health System in San Antonio made money doing what used to be industry heresy: reducing patients' use of medical care.

More Whistleblowers Say Health Plans Are Gouging Medicare

12:29pm April 24, 2015

by Fred Schulte

Federal authorities are investigating claims that some Medicare Advantage health plans have overcharged the government for years by claiming that patients are sicker than they are.

Congress Approves Longer-Term Fix For Medicare Reimbursements

7:49pm April 15, 2015

by Christopher Dean Hopkins

Eight senators, all Republicans, voted against the bill because funding has not been fully allocated for its $214 billion cost. President Obama says he will sign it.

Patient perceptions have been tough to change at Rowan Regional Medical Center in Salisbury, N.C.

With Medicare Pay On The Line, Hospitals Push Harder To Please Patients

7:33am March 11, 2015

by Jordan Rau

The federal government now factors patient satisfaction ratings into the rates Medicare pays hospitals. Some hospitals with lower ratings are finding it's difficult to change patients' perceptions.

Queue Listen Now

Health & Safety

More Scrutiny Coming For Medicare Advantage, Obamacare

4:17pm February 12, 2015

by Fred Schulte

The Health and Human Services Office of Inspector General said it would review Medicare Advantage billing practices with an eye toward curbing overcharges.

Aetna made big changes to its pharmacy networks for 2015.

Health & Safety

Medicare Offers Relief To 400,000 Caught In Drug Plan Mix-Ups

11:19am February 03, 2015

by Michelle Andrews

Aetna beneficiaries can reconsider their Part D choices after the insurer incorrectly identified some pharmacies as being in-network, dropped others and removed some from the preferred network.

Cleveland Clinic pharmacist Katie Greenlee talks with Morgan Clay about how he should take his prescriptions when he leaves the hospital.

Cleveland Hospitals Grapple With Readmission Fines

11:44am January 29, 2015

by Sarah Jane Tribble

The Cleveland Clinic has seen its Medicare penalties go down, while those paid by hospitals that serve many of Cleveland's poorer residents have gone up.