A federal review of health insurers operating Medicare Advantage plans shows that 35 health plans overbilled the federal Centers for Medicare & Medicaid Services, the Center for Public Integrity reported on August 29.
Fred Schulte, a CPI senior reporter, said the center obtained 37 MA plan audits through a Freedom of Information Act lawsuit. The documents indicated that 35 of those health plans were overpaid in 2007. The typical overpayment was several hundred thousand dollars.
“Among the insurers charging the government too much: five Humana, Inc. health plans, three UnitedHealth Care Group plans and four Wellpoint, Inc. plans,” Schulte wrote. None of the plans would comment for Schulte’s article. Continue reading
A Freedom of Information request that takes weeks, if not months, to receive.
Repeatedly getting “No comment” from anyone you speak to.
Encountering a spokesperson who has no interest in building a relationship but, instead, serves as a barrier.
These issues – and how to address them – were discussed at the “Access Denied: How to get the story anyway” panel Thursday at Health Journalism 2016.
Veteran journalists shared how to best navigate the many challenges that journalists face. Continue reading
The job of a journalist is to seek the truth and report it. To provide comprehensive and fair accounts of issues. This mantra is written into the codes of ethics of journalism organizations worldwide.
However, when government officials throw up roadblocks, refuse to answer basic questions, and rely on excuses to thwart legitimate investigations into policy, presenting the whole truth to the public is nearly impossible. When requests for documents under the Freedom of Information Act are ignored, or responses delayed indefinitely, then it may be time to start filing legal challenges.
Such was the case with the Center for Public Integrity’s investigation into Medicare Advantage plans. Reporters tried for months to speak on the record with officials at CMS about the program’s financial probes and other oversight issues. CPI eventually filed Freedom of Information Act requests to get supporting documentation.
When CMS failed to respond after a year, CPI sued. Is this the only way to get government and other public organizations to open up their records? According to this tip sheet from Fred Schulte, it depends.
A key issue in King v. Burwell, the health care reform case argued before the Supreme Court in early March, is whether Congress intended to make certain subsidies available to eligible people across the country or only to those living in states that created their own health insurance exchange.
Sam Stein and colleagues at the Huffington Post filed public record requests with several key states, including some in which prominent GOP governors did not establish exchanges. The reporters also reviewed records from the U.S. Department of Health and Human Services and more than 50,000 previously released emails from the Oklahoma governor’s office. The requests covered a period between the March 2010 passage of the Patient Protection and Affordable Care Act and August 2011, when the IRS ruled that the subsidies should be available in all states.
How much discussion did Stein find about the risk of losing subsidies? Continue reading
In a victory for advocates of government transparency, a federal appeals court on Tuesday rejected the government’s arguments for withholding data on how much money individual retailers earn from food stamps.
Acting in a case brought by a South Dakota newspaper, the U.S. Court of Appeals for the 8th Circuit unanimously ruled against the U.S. Department of Agriculture’s claim that a federal law bars disclosure of retailers’ earning from food stamps.
The Argus Leader in Sioux Falls filed suit after the USDA rejected the newspaper’s Freedom of Information Act request for data on annual payments to individual retailers from 2005 to 2010. The USDA argued that a law protecting the privacy of retailers’ applications to participate in the Supplemental Nutrition Assistance Program or SNAP (the official name for food stamps) prohibited release of that information. A district court had earlier sided with the government, ruling that this information was exempt from FOIA, but the appeals court on Tuesday disagreed. Continue reading
A decision announced Friday would allow the public and journalists access to Medicare claims data about individual doctors.
An injunction barring release of the data had been in place for 33 years, “when a federal court in Florida sided with the American Medical Association’s contention that doctors’ right to privacy trumped the public’s interest in knowing how tax dollars were spent,” according to John Carreyrou of The Wall Street Journal.
“Dow Jones & Co., The Wall Street Journal’s parent company, challenged the injunction in 2011 after the Journal published a series of articles showing how the information could be used to expose fraud and abuse in the $549 billion health-care program for the elderly and disabled.”
Wall Street Journal reporters, who negotiated for eight years worth of data if they did not publish identities, wrote a series of stories about Medicare data, showing that the federal government isn’t taking advantage of the data it has to detect fraud. The Wall Street Journal’s articles have offered a window into the forces driving up health spending and shown that analyzing the data can reveal abuse and fraud in the Medicare system.
“The public has a right to know how much physicians are being paid by Medicare and what services they are providing patients,” said AHCJ President Charles Ornstein. “With analysis and context from journalists, the data could help patients make informed decisions and provide necessary oversight of billions of dollars in federal spending.”
Carreyrou reports the American Medical Association “is considering its options on how best to continue to defend the personal privacy interests of all physicians.”
“The Crushing Cost of Care,” by the WSJ’s Janet Adamy and Tom McGinty, won first place in the Health Policy (large) category of the 2012 Awards for Excellence in Health Care Journalism.
Read more about the Medicare data and the fight to open it to the public: