Stories

The IRE Resource Center is a major research library containing more than 27,000 investigative stories.

Most of our stories are not available for download but can be easily ordered by contacting the Resource Center directly at 573-882-3364 or rescntr@ire.org where a researcher can help you pinpoint what you need.

Search results for "Medicare" ...

  • Calculated Care

    “Calculated Care” is The Wall Street Journal’s investigation into the hidden ways financial incentives, rather than medical need, can shape the care that patients receive in America’s health-care institutions. This project combined sophisticated data analysis with shoe-leather reporting to reveal business practices that are endemic to our health-care system—but that only became apparent through the plumbing of government data not readily available to the public. These practices cost the tax-payer-funded Medicare system billions of additional dollars without clear benefit to patients—and, as the Journal’s reporting showed, even to their detriment.
  • Cleveland Clinic cases highlight flaws in safety oversight

    A three-month Modern Healthcare analysis of hundreds of pages of federal inspection reports reveals the 1,268-bed Cleveland Clinic Hospital spent 19 months on “termination track” with Medicare between 2010 and 2013 as a result of more than a dozen inspections and follow-up visits triggered by patient complaints. The Cleveland Clinic is far from alone in facing the only sanction the CMS can apply to hospitals when serious safety problems and violations of informed consent rules are brought to light by patient complaints. An analysis of Medicare inspection data found that between 2011 and 2014 there were at least 230 validated serious incidents— dubbed “immediate jeopardy” complaints—that led the agency to threaten hospitals with losing their ability to serve Medicare patients unless they immediately fixed the problems. Overall, there were at least 9,505 CMS complaints lodged in that time against 1,638 hospitals, which included low-severity “standard level” violations; midlevel “condition level” violations; and the less common but most serious “immediate jeopardy” complaints. Only the most serious and condition-level complaints can lead to threats of being cut off from government funding. Only in very rarest of circumstances has the CMS followed through on the threat. The CMS’ ultimate goal with hospital inspections “is to ensure compliance with Medicare rules, not close down hospitals that are essential to local communities,” a CMS spokeswoman said.
  • Medicare Unmasked

    The Wall Street Journal forced the government in 2014 to release important Medicare data kept secret for decades, and in a sweeping investigative series analyzed it to uncover abuses that cost taxpayers. In April, the U.S. made public Medicare billing data by doctors for the first time since 1979. The government acted because of successful litigation by Journal parent Dow Jones & Co. and amid persistent reporting on Medicare by Journal reporters.
  • State Restrains Psychiatric Patients At High Rate

    Between 2001 and 2007, Connecticut hospitals have been cited by the federal government for overuse of restraints and seclusions involving psychiatric patients. When the Centers for Medicare & Medicaid Services released for the first time data on hospital restraints it was an opportunity to report on the restraint practices at Connecticut's hospitals.
  • The Medicare Advantage Money Grab

    This is the first comprehensive effort by a media organization to analyze how government pays for Medicare Advantage, which costs taxpayers some $150 billion a year as it grows explosively. We found that rather than slow health-care spending, as intended, Medicare Advantage plans for the elderly have sharply driven up treatment costs in some parts of the United States—larding on tens of billions of dollars in overcharges and other suspect billings over the past five years alone. The findings are based on an analysis of Medicare Advantage enrollment and billing data as well as thousands of pages of government audits, research papers and other documents, and scores of interviews with industry executives. Our review revealed how an obscure billing formula called a “risk score,” that is supposed to pay Medicare Advantage plans more for sicker patients and less for healthy ones, has been widely abused to inflate Medicare costs.
  • Medicare Unmasked

    The "Medicare Unmasked” series examined the $600 billion Medicare program, stemming from The Wall Street Journal’s legal and journalistic efforts to prod the government to publicly release doctor-billing data that had been kept secret for decades. A team of Journal reporters created numerous programs to analyze the government numbers, using them to spin out articles that uncovered medical abuses that cost taxpayers. The series had big impact. The CEO of a large laboratory resigned under pressure soon after the Journal revealed it used a controversial medical practice. The Journal also broke news of an FBI investigation into a medical practice the newspaper had identified as collecting far more from Medicare for a single procedure than any other medical provider. And an ousted Walgreen executive sued the drugstore giant alleging widespread Medicare-related abuses there, citing a Journal article that revealed a $1 billion forecasting error in Walgreen’s Medicare business. The Journal has been widely recognized for its Medicare efforts. Margaret Sullivan, the New York Times Public Editor, praised the Journal for its “time, expense and persistence” in pursuing the once-secret Medicare data, calling it a “cornerstone of investigative reporting."
  • Tapping into Controversial Back Surgeries

    Spinal fusion is one of the most common surgeries in America, but there are concerns that some doctors are performing it unnecessarily. The procedure joins two or more adjacent vertebrae, often with metal rods and screws, and can result in paralysis or life-threatening complications. For this six month investigation, we built a database from previously unreleased government records. It showed for the first time how many spinal fusions each surgeon in the country performed on Medicare patients, under the billing codes used most commonly for "degenerative" conditions that cause back pain. Half a dozen experts on medical billing and spine surgery told us that focusing on these codes would be the most effective way to identify abuse. We exposed that a small group of doctors performed far more of these lucrative but potentially dangerous procedures than their peers. Some of them were also banned or suspended from hospitals or settled lawsuits alleging unnecessary surgeries. Our findings were so alarming to the president of a top neurosurgery society that he called on authorities to look into these doctors. We also put the database online, made it easily searchable by patients, and provided guidance from experts on how to interpret it.
  • Overbilling

    To produce this story, we spent months finding and interviewing former employees of the company. They told us Life Care was giving patients physical, speech, and occupational therapy they did not need, and billing the government for money they were not entitled to. Helen Toomey, a former assistant manager and speech therapist, said by the time she left in 2012, 40 percent of the work she was being told to administer was not reasonable or necessary. She also shared patient notes with us that she said showed how Life Care would not let patients leave so they could continue to bill Medicare.
  • A Scooter Swindle?

    This piece uncovered Medicare fraud by The SCOOTER Store, the nation’s leading supplier of power wheelchairs. We spent months finding and interviewing former employees of the company. They told us The SCOOTER Store “bulldozed” doctors into writing prescriptions for wheelchairs, whether patients needed them or not. Relentless phone calls and in person visits wore doctors down. They also said the company ranked doctors based on whether they would prescribe chairs, and that it had a program specifically to get chairs for people that physicians had already deemed ineligible.
  • The Prescribers

    Never-before-released government prescription records shows that some doctors and other health professionals across the country prescribe large quantities of drugs known to be potentially harmful, disorienting or addictive for their patients. And officials have done little to detect or deter these hazardous prescribing patterns.