Welcome to the latest edition of Investigative Roundup, highlighting some of the best investigative reporting on healthcare each week.
Growing Scrutiny of Medicare Advantage
Teresa Ross, a longtime manager at the Seattle health plan Group Health, filed a sealed whistleblower suit against the company years ago, alleging there were problems with the way it billed Medicare, Bloomberg reported. She and other whistleblowers coming forward claim that insurers are scamming Medicare out of billions of dollars.
After years of investigating, the Justice Department took up Ross's case last year, Bloomberg reported. Other whistleblowers came forward as well, accusing Kaiser Permanente, which Group Health merged with in 2017, and some of its competitors, of inflating how sick members are to get higher payments from Medicare.
"The industry vehemently contests the allegations and says that plans get paid appropriately for the risk they take on," Bloomberg wrote. "But the disputed billing practices at the heart of Ross's case have become central to the health-care business and, as baby boomers retire, to America's fiscal future."
Nearly half of people on Medicare receive their benefits through Medicare Advantage, or private plans such as the one Ross worked for, which get paid more for patients with more severe illnesses, Bloomberg reported. And cumulative extra payments, compared to what traditional Medicare would have paid, will soon top...
(The Center Square) – The federal government and the state of Illinois have filed a joint complaint alleging that a Chicago-area medical practice and billing company knowingly submitted fraudulent...