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Privately run Medicare plans, fresh off a lobbying victory that reversed proposed budget cuts, face new scrutiny from government investigators and whistleblowers who allege that plans have overcharged the government for years.

Federal court records show at least a half dozen whistleblower lawsuits alleging billing abuses in these Medicare Advantage plans have been filed under the False Claims Act since 2010, including two that just recently surfaced. The suits have named insurers from Columbia, S.C., to Salt Lake City to Seattle, and plans which have together enrolled millions of seniors. Lawyers predict more whistleblower cases will surface. The Justice Department also is investigating Medicare risk scores.

Though specific allegations vary, the whistleblower suits all take aim at these risk scores. Medicare uses the scores to pay higher rates for sicker patients and less for people in good health. But officials were warned as early as 2009 that some plans claim patients are sicker than they actually are to boost their payments.

Privately run Medicare Advantage plans have signed up more than 17 million members, about a third of the people eligible for Medicare, and are poised to get bigger. Earlier this month, the industry overturned proposed cuts sought by the Obama administration for a third straight year, instead winning a modest raise in payment rates for the programs.

Medicare Advantage resonates with many seniors for its low out-of-pocket costs. It's also winning favor with some health policy experts who argue these managed care plans can offer higher quality care than standard Medicare, which pays doctors and hospitals on a fee-for-service basis.

Karen Ignagni, the chief executive officer of America's Health Insurance Plans, the industry's trade group, called the government's change of heart "a notable step to provide stable funding."

"It shows the incentives provided for whistleblowers are working well, and all the other controls and detection systems are failing miserably."

- Malcolm Sparrow

But the whistleblower suits argue that it's too easy for health plans to gouge the government.

Malcolm Sparrow, a health care fraud expert at Harvard's John F. Kennedy School of Government, said the number of these cases suggests government oversight is too lax.

"It shows the incentives provided for whistleblowers are working well, and all the other controls and detection systems are failing miserably," Sparrow wrote in an email.

Ray Thorn, a spokesman for the federal Centers for Medicare and Medicaid Services, disagreed. He said CMS "is taking steps to protect taxpayers, Medicare beneficiaries and the Medicare program." Thorn cited an increase in CMS audits and said health plans have identified overpayments and given back about $1.1 billion to the government.

Still, critics want to step up accountability as the health plans bite off bigger chunks of Medicare business. Annual taxpayer costs for Medicare Advantage exceed $150 billion

"CMS could save billions of dollars by improving the accuracy of its payments to Medicare Advantage programs."

- Government Accountability Office report

"CMS could save billions of dollars by improving the accuracy of its payments to Medicare Advantage programs," the Government Accountability Office wrote in its just-released 2015 annual report.

On another front, the Justice Department is widening the scope of an investigation into whether exaggerated risk scores are jacking up costs improperly.

Humana Inc., based in Louisville, Ky., which counts more than 3 million seniors in its plans, wrote in a March Securities and Exchange Commission filing that the investigation "includes a number of Medicare Advantage plans, providers and vendors."

On April 14, DaVita Healthcare Partners Inc., headquartered In Denver, disclosed that it had received a Justice Department subpoena. Investigators sought Medicare Advantage billing data and other records.

Shots - Health News

Humana Discloses Widening Justice Dept. Probe Of Medicare Advantage Plans

In the latest lawsuit to surface, a pair of whistleblowers allege that Blue Cross of South Carolina submitted inflated claims between 2006 and 2010, then "acted to cover up and hide the false submissions so that they would be able to retain the wrongly paid reimbursements," according to an April 3 filing.

The South Carolina suit also names the Deseret Mutual Insurance Company, a Utah plan formed by the Church of Jesus Christ of Latter-day Saints, which contracted with Blue Cross to process Medicare Advantage billings.

"We deny the allegations and are vigorously defending the case," responded Blue Cross of South Carolina spokeswoman Patti Embry-Tautenhan.

Deseret Mutual could not be reached despite repeated calls and emails to the health plan's Utah office and its South Carolina attorney.

The suit was filed by Catherine Brtva, a former Blue Cross computer billing specialist, and Jerald R. Conte, a former contractor.

The case targets flaws in computer programs that Blue Cross says were used to submit to Medicare millions of health insurance claims by hundreds of thousands of members.

Shots - Health News

Fraud Case Casts Spotlight On Medicare Advantage Plans

In court filings, Blue Cross does not deny that some overcharges occurred. But it says underpayments also happened and that it worked with CMS to correct the problems.

The whistleblowers argue that the plans set out to repay only about $2 million in overpayments — just 10 percent of what they actually owed. CMS officials declined to discuss the matter.

Several attorneys said in interviews they expect more cases to surface, particularly as Medicare Advantage grows. Risk scoring fraud "has popped up on our radar," said Joseph E.B. White, a Philadelphia lawyer specializing in whistleblower cases.

One suit, which the Center for Public Integrity only recently discovered, was filed in 2012 by Lisa Parker, a former clinic supervisor at The Polyclinic in Seattle, who sued the clinic and Essence Healthcare, a Medicare Advantage plan.

Parker cited a 2010 memo that asked doctors' staff to talk hundreds of elderly people into coming in for a medical visit. The clinic was to receive about $250,000 to $500,000 in 2011 from increased risk scores from the visits.

Shots - Health News

Feds Knew About Medicare Advantage Overcharges Years Ago

The lawsuit alleges the visits "were not dictated by patient concern, nor for the treatment or diagnosis of specific illnesses, symptoms, complaints or injuries, but were designed and performed to maximize the opportunity to bill Medicare."

Joel Andersen, vice president of marketing for Essence Healthcare, said in an email statement: "The government did not find any wrongdoing or any cause to intervene and thus the case was quickly dismissed. We consider the matter closed and have no additional commentary to add. We strongly advise that this matter not be characterized in any other fashion than a frivolous lawsuit based on unfounded claims."

Tracy Corgiat, vice president of marketing and development at The Polyclinic, said that CMS requires that a patient's "clinical history and medical diagnoses be newly documented each year during an in-person visit." The Polyclinic has a "rigorous process for validating the diagnoses of our patients and we are fully confident in that process," she said.

At least one doctor was taken aback.

"Let me see if I've got this right. In order to get more $$$ for the Polyclinic, we have to bring patients in for a visit they didn't need or initiate?" the doctor, Scott Stevens, wrote in an email that's part of the court file.

"They would get more from a movie and popcorn!" Stevens wrote.

This piece comes from the Center for Public Integrity, a nonpartisan, nonprofit investigative news organization. To follow CPI's investigations into Medicare and Medicare Advantage waste, fraud and abuse, go here. Or follow the organization on Twitter.

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In Fox's television show The Last Man on Earth, Saturday Night Live alum Will Forte plays a man who survives a deadly virus that has decimated the human population. In the show, Forte's character, Phil, despairs when he thinks he is the last human on earth. He drives around a lonely landscape, creating billboards that announce "Alive in Tucson" on the off-chance that someone will see them.

But when Phil meets and marries a woman whom he believes to be the last living woman on Earth, he realizes that maybe being alone wasn't so bad. This is especially true when Phil meets a second woman, whom he likes better than his new wife. Things don't get better for Phil as even more survivors start showing up in Tuscon.

If all of this makes Phil a bit of a cad, the actor says that's by design. Forte explains to Fresh Air's Ann Marie Baldonado that while his character may be the last man on earth, Phil is not meant to be the best person on earth.

"Automatically in the first episode you want your character to be likable, you want people to find him to be sympathetic," Forte says. "We thought it would be interesting to move away from there and create this character who isn't the perfect person. In this show I feel like if you continue to watch, your allegiances will kind of constantly be shifting."

Many people know Forte from SNL, where he was a cast member from 2002 until 2010. He also gained attention for his role opposite Bruce Dern in the 2013 Alexander Payne film Nebraska. Forte's other television credits include a recurring role on 30 Rock and writing credits for the Late Show with David Letterman and That '70s Show.

Interview Highlights

On the beard he grew for Last Man On Earth

I had been living with this beard for about nine months and I had a real love/hate relationship with it. There are a lot of very tricky things when you have a beard of that size. Eating is horrible, personal interactions are tricky ... people are nervous around a person with a beard that size. But I also kind of missed it [when it was gone]. It was like a little security blanket, so it was interesting, I was just completely a different person.

On working with Dern on the set of Nebraska

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Forte says he was "nervous the whole way through" while working on Nebraska with Dern and Payne. Merie W. Wallace/Paramount hide caption

itoggle caption Merie W. Wallace/Paramount

Forte says he was "nervous the whole way through" while working on Nebraska with Dern and Payne.

Merie W. Wallace/Paramount

We spent a ton of time together. It was pretty amazing to watch him make the transformation [into Woody] because for anybody who doesn't know him, he's the most vibrant, feisty in a fun way — he's just awesome and full of life and then the moment the cameras would start rolling he just morphed into the Woody character. It's about as drastically different as you can get. ... The moments we would be done shooting or between takes, we wouldn't be in character we would just be talking like friends. That was such a big part of this experience because I was really nervous the whole way through. I didn't want to mess up Alexander Payne's movie and Bruce Dern's movie. Here are all these legendary people and he was so good about putting me at ease and that friendship that we developed helped me get out of my head and, I think, do a better job in the movie.

On filming the road trip scenes for Nebraska

The very end, after we completed all the dialogue stuff from the movie we actually went to Billings, Mont., and made the trip all the way to northern Nebraska and Alexander Payne followed us in this big RV. He actually had bought the RV that Jack Nicholson drives around in About Schmidt so he had had this RV and they mounted a camera to the front of it and would just drive behind us and pull up to the side of us and get all these amazing shots of that drive. But the whole time, Bruce and I are in this car just for days and days, just talking about life and I could listen to his stories forever. He's a fascinating, wonderful man.

On Dern's acting advice

Bruce Dern was really great about giving me advice the whole way through, and he would always be talking about "find the truth of the scene" and just play that. It just seemed like actor mumbo jumbo for a while, and then after a couple of weeks, it really registered — I started understanding what he was talking about. It's just the same thing as comedy, like you're just trying to figure out the reality of the scene and play it as truthfully as you can. Obviously in an absurd sketch there's going to be a different reality and truth than in the movie Nebraska, so it was just about figuring out that truth and committing to it fully. It's all about commitment, I guess.

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On landing his job at Saturday Night Live

I just lucked out and Lorne Michaels came to one of the shows. I already had a job so I didn't even think that it was possible to go over to SNL. I was under contract with ... That '70s Show, so I was nice and loose because I was very happy as a comedy writer, too, so I just didn't even think that it was an option. Then I ended up having a good night, probably because I was so loose, and he invited me for an audition. I was terrified, I had to really get talked into auditioning. I went out, auditioned, and got the job and then turned it down, for the same reasons I just said — just terrified that I wouldn't be good at it and I would be giving up this amazing job at That '70s Show, which was such a fun job, great people. I liked the show so much, and I turned [SNL] down. I regretted it for the entire year that I had to wait until Lorne, thank God, came back the next year and asked me if I would change my mind, but I decided I had to go for it because I would never forgive myself if I didn't at least see what it would be like.

We told you earlier this week about the anger in Poland over remarks made by the head of the FBI linking that country to the Holocaust. Hungary, which James Comey also mentioned in his speech, has now joined in the protests against the comments.

"The words of the FBI director bear witness to astounding insensitivity and impermissible superficiality," the Hungarian Foreign Ministry said in a statement. "We do not accept from anyone the formulation of such a generalization and defamation."

In a speech last week at the Holocaust Memorial Museum in Washington, a version of which was published in The Washington Post, Comey called the Holocaust "the most significant event in world history." But it was his remarks about who participated in the killing of Jews that drew most of the attention. Comey said:

"In their minds, the murderers and accomplices of Germany, and Poland, and Hungary, and so many, many other places didn't do something evil. They convinced themselves it was the right thing to do, the thing they had to do. That's what people do. And that should truly frighten us."

Poland summoned Stephen Mull, the U.S. ambassador to Warsaw, to the Foreign Ministry on Sunday to demand an apology.

Mull later told reporters that suggesting any country other than Nazi Germany was responsible for the Holocaust "is harmful and offensive." But he added: "Director Comey certainly did not mean to suggest that Poland was in any way responsible for those crimes."

Comey himself addressed the controversy on Tuesday when he was asked by Tennessee's WATE-TV if he had an apology to those offended by his remarks.

"I don't," he said. "Except I didn't say Poland was responsible for the Holocaust. In a way I wish very much that I hadn't mentioned any countries because it's distracted some folks from my point.

"I worry a little bit in some countries that point has gotten lost. There is no doubt that people in Poland heroically resisted the Nazis, and some people heroically protected the Jews, but there's also no doubt that in every country occupied by the Nazis, there were people collaborating with the Nazis."

The issue is a sensitive one in Poland, which was angered by President Obama's remarks in 2012 when he referred to a "Polish death camp." The White House called that a "misstatement" that it regretted.

But as Abraham Foxman, a Holocaust survivor from Poland who now heads the Anti-Defamation League, notes the issue is more complicated. In an essay on MSNBC, Foxman notes that a Polish Catholic woman saved his life when he was a boy. He adds:

"Poles have a right to set the record straight about their history when it is distorted or conflated with that of the Nazis and Germany. But Mr. Comey was not wrong in what was his essential message: As evil as the Nazis were, their phantasmagoric mission to destroy the Jewish people was made much easier because the public in most European countries, Poland included, too often acted as bystanders and sometimes even as accomplices."

Writing in The Post, Laurence Weinbaum, director of the Israel Council on Foreign Relations, called Comey's remarks "carelessly drafted, though presumably well-intentioned." But he says:

"Thanks to the efforts of Polish researchers, we now know that more Poles participated in the destruction and despoliation of their Jewish neighbors than was previously believed. Many Poles saw the removal of the Jews from Poland as the one beneficial byproduct of an otherwise grievous occupation. For the least scrupulous local people, the Holocaust was also an El Dorado-like opportunity for self-enrichment and gratification. For some, this temptation was irresistible, and they did not recoil from committing acts of murder, rape and larceny — not always orchestrated by the Germans."

The Associated Press reports that Frank Spula, head of the Polish American Congress , an organization that represents at least 10 million Americans of Polish descent, said he would expect Comey to resign over his remarks.

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The fighting in Georgia can be hard to follow from afar, but it traces a theme that has been recurring ever since the Soviet Union shattered into 15 countries in 1991. Georgia was one of those lands that gained independence, but it soon degenerated into a war in the northern region of Abkhazia, where Russian-backed separatists carved out a piece of territory they claim and hold until this day.

The conflict feels eerily familiar now in the context of the current turmoil in Ukraine, and has haunted much of recent Georgian cinema (or, to be fair, the limited scope of Georgian cinema that reaches North American audiences). In 2012's The Machine Which Makes Everything Disappear and 2013's In Bloom, the war is never directly seen but its ravaging effect on Georgian society—the thousands of dead, the broken families that resulted—is evident. Zaza Urushadze's Tangerines, meanwhile, is actually set during the war, but the movie examines the conflict so circumspectly that it actually feels more distant than in either of the other films.

Urushadze's movie, a surprise Oscar nominee earlier this year for Best Foreign Language Film, centers on Ivo (Lembit Ulfsak), an Estonian living in what is now a Georgian war zone. While the majority of his fellow Estonians have returned home to escape the conflict—according to an opening title card, Estonian communities in Georgia date back 100 years—Ivo has stayed to help his neighbor, Margus (Elmo Nganen), harvest his tangerine crop, for which Ivo makes the crates.

Ivo and Margus seem relatively protected from the front lines of the war, but the conflict comes to them when two Abkhazian mercenaries arrive looking for food and proceed to get in a gunfight with Georgian soldiers outside Margus's home. Two wounded men emerge—the first, Ahmed (Giorgi Nakashidze), an Abkhazian; the second, Niko (Misha Meskhi), a Georgian—and Ivo brings them both back to his house to help them recover.

The set-up—two enemies living under the same roof, both owing their lives to a gracious, neutral party—is already more allegorical than realist, and Urushadze's script never pushes much further. The arguments between Ahmed and Niko—who both promise Ivo they won't kill each other in Ivo's house—are simplistic: One says the land they're on is Abkhazian, the other that it's Georgian; Ahmed emasculates Niko; Niko calls Ahmed uneducated. It's not, to say the least, a deep or particularly insightful examination of the roots of war.

Instead, it's evident pretty early that Urushadze is pushing not toward an examination of war but to an appreciation of our common humanity. (Margus's tangerines—superfluous and at risk of neglect during such a violent conflict—are overused as a symbol in this respect.) Some might reject the message outright, but even if it appeals, here it's too far removed from reality to be effective. For one, the event that catalyzes the inevitable reconciliation of differences between Niko and Ahmed is nearly unbelievable in its contrivance. But most of all, because the conflict between Abkhazians and Georgians is so sketchily drawn, the ultimate heartwarming tone of the film seems not so much unearned as unspectacular.

There might be, to be fair, a problem of cultural translation. American films need only scantily explain the horrors and importance of the Vietnam War because they're a matter of common knowledge at this point. The same may be true of the Abkhazian War in Georgia. But there's still a difference between Tangerines and the more successful In Bloom or Machine. The latter two don't explain much about the war either, but you can see its effects on the faces of its characters and subjects. In Tangerines, that same work is left entirely to our imaginations.