What’s particularly impressive is that the CPI team showed, in several instances, how Medicare made little effort to recoup the amounts the managed care plans overbilled and how it backed off of other rules the Centers for Medicare & Medicaid Services (CMS) had proposed for fixing the payment problems. (There’s usually little press interest when Medicare backs away from a proposal.) The Center described one tactic managed care plans use for boosting Medicare income: They make visits to their members’ homes looking for undiagnosed illnesses that may result in more reimbursment. The Center reported that there’s a “paucity of evidence showing that home visits make people any healthier,” and Medicare had proposed a rule to restrict such visits. In April, after objections from insurers, Medicare announced it was not finalizing the rule.
Notably, the Center got zero help from the CMS, a problem other reporters are having with government health agencies. Schulte told me “unless they completely manipulate the news flow, they are not interested in talking.” In the old days, he said, you could get the top agency people on the phone pretty readily. Last time the CPI did a big investigation involving CMS, in 2012, the agency accepted written questions. “This time we got no interviews, no written questions, stonewalling and it was basically screw you,” he added. The Center has filed an FOIA lawsuit in federal court to shake loose more data. “CMS owns the data on overpayments. They don’t tell you who gets the money and what efforts they’ve made to get it back,” Schulte says. “We want to see the audits and who has been overpaid. The program is like a black box.”
What can reporters do in the meantime to better cover the Great Medicare Give Away? Schulte and I collaborated on some suggestions.
Move beyond the Medicare cuts scare story. That election year canard from the GOP that the president is cutting Medicare benefits to the tune of $500 billion (the 2010 claim) and $700 billion (the 2012 claim)? Drop it. Look into where elected representatives stood and now stand on this government waste story, like CPI did with Sen. Franken.
Realize you don’t always need people or patients to make a story compelling. Patient anecdotes were not an option for CPI’s story, since the payment manipulation and risk scoring chronicled in the series go on behind the scenes and policyholders see only low premiums and gym memberships. Schulte used the Q & A technique to explain why all this matters to beneficiaries in MA plans, to all Medicare beneficiaries, and to all taxpayers. Overpayments can ultimately weaken the whole program.
Make friends in the industry. Seek out consultants, actuaries, and others who know what’s going on and who can explain the nitty-gritty. Use social media like LinkedIn to find insiders and look at industry list servs and what people are saying.
Look at investor and analyst calls available on company websites. See what questions financial analysts are asking. After a while, when they stop asking questions about certain issues, that may be a signal they are no longer worried about something. Then you need to find out if a “fix” is in—from a regulator, for instance.
When an announced rule is pulled back or taken off the table, look into it. This is usually a red flag that something’s going on and reporters should take a closer look. Some of the best stories may be found here. (See more on this theme here.)
Finally, Schulte says, reporters should have a sense of consumerism. There’s a whole side to medicine that deals with dollars and cents. It’s not just cures. And you need a little police reporter in you as well to spot the scams and realize when a company or an official is lying to you, he advises. This is critical for people assigned to the health beat. Too often reporters “don’t have a sense of the past,” Schulte says. That’s particularly important with Medicare. “Medicare managed care was a complete disaster, and then they opened the flood gates. It’s annoying that you don’t see government learning from previous mistakes.” And that’s where we reporters come in—to chronicle the efforts of well-heeled stake holders to milk the program for financial gain.
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