The Center for Public Integrity’s ground-breaking series, Cracking the Codes, has been named first-place winner of the 2012 Philip Meyer Journalism Award sponsored by Investigative Reporters and Editors (IRE.) The series documented how thousands of medical professionals have steadily billed Medicare for more complex and costly health care over the past decade – adding $11 billion or more to their fees – despite little evidence elderly patients required more treatment. The series also uncovered a broad range of costly billing errors and abuses that have plagued Medicare for years – from confusion over how to pick proper payment codes to apparent overcharges in medical offices and hospital emergency rooms. The findings strongly suggest these problems, known as “upcoding,” are worsening amid lax federal oversight and the government-sponsored switch from paper to electronic medical records.
This project represents a classic mix of the Center’s ability to marry traditional shoe-leather reporting with rigorous data analysis. Reporters Fred Schulte and Joe Eaton, working with project editor Gordon Witkin and database editor David Donald, analyzed 133 million Medicare records over 20 months to demonstrate how upcoding of diagnoses and procedures was steadily increasing Medicare payouts over the years.
Less than a week after the final installment of Cracking the Codes was published, Department of Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder issued a letter sternly warning five hospital and medical groups of their intent to ramp up investigative oversight, including possible criminal prosecutions, of doctors and hospitals that use electronic health records to improperly bill for more complex and costly services than they actually deliver. Following the publication of our stories, the Obama administration’s top health information technology official launched an internal review to determine if electronic health records are prompting some doctors and hospitals to overbill Medicare.
The Meyer Award honors Philip Meyer, professor emeritus and former Knight Chair of journalism at the University of North Carolina at Chapel Hill. Meyer is the author of “Precision Journalism”,‖ the seminal 1973 book that encouraged journalists to incorporate social science methods in the pursuit of better journalism.