Fred Schulte - KFF Health News
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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.
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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.
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The Centers for Medicare and Medicaid Services has a backlog of some 3,000 FOIA requests and says it may need 10 years or more to dig out from under some large cases.
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An unpublished government study from 2009 sounded alarm bells about the risk formula used to pay privately run Medicare insurance plans. Since then billions of dollars in waste have been documented.
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Bills concerning health care exchanges are pending in at least 16 states. The measures are split pretty evenly between ones that seek to bolster the exchanges and those that would impede or bar them.
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Privately run Medicare Advantage plans offer seniors an alternative to standard Medicare. The plans are paid monthly fees based on complex risk formulas that are drawing federal scrutiny.
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An indictment in Florida is likely to draw heightened scrutiny to potential billing fraud in privately run Medicare plans. It also raises questions about the effectiveness of government oversight.
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State legislatures are the new battlegrounds for the Affordable Care Act. Lawmakers across the country are at odds over hundreds of bills that would either cripple or prop up the sweeping health law.
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The Health and Human Services Office of Inspector General said it would review Medicare Advantage billing practices with an eye toward curbing overcharges.