Follow the Money — Resources for Uncovering Fraud Connected to the Affordable Care Act


The Affordable Care Act is a massive new government program affecting millions of Americans. Naturally, this means that unscrupulous individuals and companies will try to find and exploit weaknesses in the program.

A Specialized Reporting Institute, held June 16–18, taught journalists how to uncover fraud connected to the ACA. This resources page captures some of the highlights from the SRI and presents a wealth of resources for any journalist covering fraud connected to the ACA. You'll find contacts, story ideas, examples of others' coverage and Web resources where you can dig into this issue, enabling you to provide the context needed to make your stories complete, balanced and useful to your audience.

The workshop was hosted by the New England Center for Investigative Reporting in Boston and funded by the Robert R. McCormick Foundation.

Find an Expert

Erin Carlson, senior director of education and training, National Health Care Anti-Fraud Association, ecarlson@nhcaa.org

David Donald, data editor, The Center for Public Integrity, ddonald@publicintegrity.org

Byron Harris, investigative reporter, WFAA-TV, Dallas, bharris@wfaa.com

Fred Schulte, senior reporter, The Center for Public Integrity, fschulte@publicintegrity.org

Twitter Handles to Follow

@Atul_Gawande, surgeon and writer / researcher on health care

@nytrosenthal, Elisabeth Rosenthal, a New York Times reporter and author / curator of the "Paying Till It Hurts" series

@FredSchulte, senior reporter at The Center for Public Integrity

@Trudy_Lieberman, health journalist and press critic for the CJR

Blogs Worth Reading

The CMS Blog, the official blog for the Centers for Medicare and Medicaid Services

Health Care Fraud Blog, health care fraud legal news, resources and commentary by lawyer Robert David

What Others Are Doing

A Powerful Nursing Home Owner and a Push For Medical Review Panels in Kentucky, James McNair, KYCIR, Oct. 22, 2014

Missouri doctor in Charlotte to discuss Medicare-for-all by Karen Garloch, The Charlotte Observer, July 28, 2014

Many low-income N.C. workers are locked out of Medicaid by Karen Garloch, The Charlotte Observer, July 24, 2014

APNewsBreak: Medicaid Enrollees Strain Oregon by Gosia Wozniacka, July 23, 2014

Gov. McCrory wants to change Medicaid, but DHHS struggles to manage program by Joseph Neff, News & Observer, July 5, 2014

NC legislators battle over plans to trim Medicaid spending by Lynn Bonner, News & Observer, July 4, 2014

Key Resources

Resources from the SRI

Cracking the Codes, a presentation by David Donald of the Center for Public Integrity. The presentation introduces the data and tables you'll need to decipher to track down and expose ACA fraud.

E & M Codes, a list of codes used for tracking and billing health care services.

Fraud, Waste and Abuse and the ACA, a presentation by Erin Carlson, senior director of education and training at the National Health Care Anti-Fraud Association. The presentation provides an overview of the health care fraud problem; an excellent starting point for research on ACA fraud.

Medicare Fee-For-Service Provider Utilization & Payment Data; Physician and Other Supplier Public Use File: A Methodological Overview, a document from the Centers for Medicare and Medicaid Services that introduces a public data set with information on services and procedures provided to Medicare beneficiaries by physicians and other health-care professionals.

Outliers and Outlaws, a handout from Byron Harris, WFAA-TV providing some tips on where to start looking for fraud.

Web Resources

Centers for Medicare and Medicaid Services (CMS), a government website providing information and resources on health care for Americans, including links to resources on fraud and abuse.

The Dartmouth Atlas of Health Care, a 20-year project documenting the variations in how medical resources are distributed and used in the United States. Website has volumes of searchable data.

Health and Human Services Office of Inspector General: You can search entities and individuals who have settled fraud allegations or find out who has been barred from Medicare or Medicaid.

Healthcare Cost and Utilization Project (HCUP), a family of databases, software and tools relating to health care; be sure to visit HCUPnet, an online query system based on HCUP data.

The Medicare Advantage Money Grab, a series by The Center for Public Integrity by senior reporter Fred Schulte, that includes a Medicare Advantage glossary.

National Association of Medicaid Directors, an organization that provides best practices and technical assistance for Medicaid directors in all U.S. states and territories.

Securities and Exchange Commission: Publicly-traded companies may disclose investigations and/or reveal their views on federal health policy issues. Use the company search to dig up info on a company you are investigating.

The National Association of Medicaid Fraud Control Units is a national organization for Medicaid Fraud Control Units. The website provides links to fraud reports, model legislation and more.

National Committee for Quality Assurance, a private nonprofit dedicated to improving the quality of health care, it rates the quality of health plans.

National Health Care Anti-Fraud Association (NHCAA), an organization founded by private health insurers and federal and state government officials to fight health care fraud; the website includes several pages of resources.

Poynter and NewsU Resources

The resources page from a related SRI, Obamacare: Covering What Comes Next offers a starting point for coverage of the ACA, including advice for localizing your coverage.

Training

Webinar Replays

Follow the Money: Fraud and the Affordable Care Act, presented by Joe Bergantino, gives reporters a starting place for their investigations.

Beyond the Noise: Covering the Health Care Law. Sharpen your reporting and deepen your knowledge of the Affordable Care Act and its impact on your community. In this Webinar, presented by POLITICO health care editor Joanne Kenen, you'll learn to interpret the latest enrollment figures, analyze and fact-check claims and identify what to watch for as the ACA enters its second year. Enrollment in this important Webinar is free, thanks to support from the McCormick Foundation. Originally broadcast on April 23, 2014.

Self-Directed Courses

Covering the Affordable Care Act, a series of conversations and articles on the Affordable Care Act that will provide you with the tools you need to report on health care reform accurately and with depth and context.

On the Beat: Covering Hospitals puts you in the role of a rookie reporter on the health care beat. Hone your critical thinking skills and learn to uncover and understand the reports, statistics and sources you'll need to cover health care and hospitals effectively.