{ "id": "1996-may-pulitzer-finalist-for-beat-reporting-medicaid-hmo-game", "slug": "1996-may-pulitzer-finalist-for-beat-reporting-medicaid-hmo-game", "url": "https://dwillis.github.io/uplink/article/1996-may-pulitzer-finalist-for-beat-reporting-medicaid-hmo-game.html", "year": 1996, "month": "May", "monthNum": 5, "headline": "Pulitzer finalist for beat reporting 'Medicaid HMO Game'", "kicker": "", "author_name": "Dawn Hobbs", "author_title": "IRE staff", "affiliation": "IRE", "summary": "A Fort Lauderdale Sun-Sentinel investigation by reporters Fred Schulte and Jenni Bergal exposed widespread fraud and poor care in Florida Medicaid HMOs, revealing that executives enriched themselves while patients suffered inadequate services. The 1996 Pulitzer finalist series documented enrollment fraud, unqualified providers, and executive misconduct that cost taxpayers millions.", "keywords": [ "Medicaid", "fraud", "investigation" ], "topics": [ "Health & Environment", "Investigative Methods", "Business & Economy" ], "technologies": [ "As Easy As", "File Express", "Excel", "SPSS" ], "full_text": "Pulitzer finalist for beat reporting 'Medicaid HMO Game'\n\nBy Dawn Hobbs, IRE staff\n\nDoctor, doctor give me the news; I got a bad case of - cheating the taxpayers.\n\nA Fort Lauderdale Sun-Sentinel investigation revealed that HMOs designed to provide cost-cutting health care for the poor often fail to deliver services the state paid them to provide.\n\nThe investigation also indicated that while patients may suffer, some Medicaid HMO executives live lavishly off the taxpayers leasing luxury cars and awarding themselves generous salaries or service contracts.\n\n\"The Medicaid HMO Game: Poor Care, Big Profits\" is the Sun-Sentinel's fourth investigative series exposing quality problems in tax-funded Florida HMOs. The series, by Fred Schulte and Jenni Bergal, was a 1996 Pulitzer finalist for beat reporting. It ran Nov. 26-29, 1995. The reporters began investigating HMOs in the early 1990s.\n\nContractors see green\n\nThe investigation exposed physicians with histories of providing poor patient care, convicted felons and trash collectors-all of whom had applied for HMO contracts or had already received them. The point is to sign up as many people as possible, Schulte explained, because the state pays the HMO contractor per person.\n\n\"They were out signing people up under bridges and forging people's names on applications,\" Schulte said. \"In Miami, they'd drive up in a big van and unload a bunch of sales agents dressed up as nurses with white coats and stethoscopes. They'd knock on people's doors and tell them about this wonderful program. When the people said they were already on Medicaid, the agents told them they must sign up or lose their Medicaid benefits.\"\n\nThe enrollment fraud proved to be so outrageous, that Schulte and Bergal investigated matters further.\n\nThe team began collecting every sort of document available: the Florida Agency for Health Care Administration general correspondence files, HMO hospital and physician utilization data, disenrollment data, medical peer review reports, annual incident reports and grievance reports and administrative hearing judgments and final reports.\n\nNone of these documents came in electronic form. And even worse, Schulte and Bergal found thousands of pages of medical peer review records and other reports sitting in boxes in a closet in the Tallahassee state offices.\n\nBuilt to order\n\nAfter retrieving all the boxed data, Schulte and Bergal met with Jay Mendell, professor of public administration at Florida Atlantic University in Ft. Lauderdale. Mendell, who has taught computer systems and the Internet to graduate students for 20 years, has provided technical support to Schulte and Bergal on several assignments.\n\nMendell set up data templates with as much error rejection as possible in which Bergal then entered some 5,000 to 7,000 pages of peer reviews. As Easy As, shareware available through Trius, and File Express, another shareware put out by Expressware, were used for entering the data on an IBM clone.\n\nPick a program\n\nOnce the data was entered, Mendell explained, it went into a program that best expressed the results-sometimes Excel and sometimes SPSS.\n\n\"Sometimes simple summary statistics and ratios will do the trick, and then you use Excel,\" Mendell said. \"Other times, when the data is more complicated, you need to produce three-dimensional plots and look at them from different angles. This is when you use SPSS, a heavy-duty statistical program.\n\nAs a result of this series, key Florida legislators promised new laws to crack down on Medicaid HMO abuses during the current session, rewrote contracts for Medicaid HMOs and banned door-to-door marketing. State officials also refused to license two HMOs whose ties to state Sen. Alberto Gutman were documented by the newspaper. The series disclosed that the senator had attempted to broker the sales of HMOs for fees as high as $1 million and had gone into the HMO business outside Florida with some health industry executives with business before his committee. Gutman has resigned from the health-care committee and faces state charges.\n\nFred Schulte can be reached at (305) 356-4591, or send e-mail to freds@aol.com", "provenance": { "extracted_by": "anthropic/claude-sonnet-4-6", "extracted_at": "2026-07-05", "verified": true }, "similar": [ { "slug": "1995-june-database-uncovers-abuse", "score": 0.204 }, { "slug": "2001-marchapril-floridas-dead-heat", "score": 0.176 }, { "slug": "2004-march-bits-and-bytes", "score": 0.173 }, { "slug": "1996-may-pulitzer-finalist-for-national-reporting-military-secrets", "score": 0.169 }, { "slug": "1996-april-uplink-update", "score": 0.155 } ], "html_url": "https://dwillis.github.io/uplink/article/1996-may-pulitzer-finalist-for-beat-reporting-medicaid-hmo-game.html", "json_url": "https://dwillis.github.io/uplink/article/1996-may-pulitzer-finalist-for-beat-reporting-medicaid-hmo-game.json" }