New York Times investigative reporter Hannah Dreier wanted to know what happened to the hundreds of thousands of migrant children who came to the U.S. alone in recent years through the country’s southern border. Most sought to escape extreme poverty in Guatemala, Honduras and El Salvador.

In her five-part series, “Alone and Exploited,” Dreier demonstrates how a long chain of government failures and willful ignorance allowed this “new economy of exploitation” to grow and thrive.

“This shadow work force extends across industries in every state, flouting child labor laws that have been in place for nearly a century,” she writes in the first story in the series, published in February 2023.

“Companies ignore the young faces in their back rooms and on their factory floors. Schools often decline to report apparent labor violations, believing it will hurt children more than help. And [the U.S. Department of Health and Human Services] behaves as if the migrant children who melt unseen into the country are doing just fine.”

The series also reveals:

• More than 250,000 migrant children arrived alone in the U.S. in 2021 and 2022, a sharp increase over prior years. As emergency shelters ran out of room, the federal government pressed case managers to work faster to place kids in private homes and loosened some restrictions to make vetting sponsors easier.
• The U.S. government lost track of many migrant children shortly after they left the shelters. “While H.H.S. [the Department of Health and Human Services] checks on all minors by calling them a month after they begin living with their sponsors, data obtained by The Times showed that over the last two years, the agency could not reach more than 85,000 children,” Dreier writes in the first story in the series. “Overall, the agency lost immediate contact with a third of migrant children.”
• Federal officials missed or overlooked warnings signs about child labor violations, including reports from social workers about dangerous working conditions and reports from the U.S. Department of Labor outlining evidence of child labor trafficking.
• Private audits ordered by several big companies consistently missed child labor violations. “Children were overlooked by auditors who were moving quickly, leaving early or simply not sent to the part of the supply chain where minors were working, The Times found in audits performed at 20 production facilities used by some of the nation’s most recognizable brands,” Dreier writes in the last article in the series, published in December 2023.

Federal and state officials responded quickly to Dreier’s reporting by changing laws, strengthening programs and overhauling some federal agencies. Days after the first story ran, President Joe Biden’s administration announced a crackdown on child labor exploitation. Congress and the Department of Labor launched their own investigations.

Meanwhile, many major companies, including McDonald’s, Costco and PepsiCo, announced their own reforms aimed eliminating child labor across their supply chains, Dreier reported in February 2024.

I interviewed Dreier to learn more about her series and the database she created to ground her coverage. Dreier, who is on maternity leave, answered my five questions by email.

In the short Q&A below, she discusses the database, which contains key details the federal government collected on more than 550,000 migrant children from January 2015 through May 2023, and why The New York Times chose to make it public. Dreier also offers tips to help other journalists use the anonymized data to report on migrant children and labor issues in their states and communities.

Her responses have been lightly edited to match The Journalist’s Resource’s editorial style.

Denise-Marie Ordway: Why did you create this database and how did it help you report out the series?

Hannah Dreier: This was a story that focused on people and on-the-ground reporting, but it started with data. I started out in early 2022 with a question: What happened to the hundreds of thousands of young people who were crossing the southern border by themselves?

I knew from years of immigration reporting that some of these children ended up working industrial jobs. But little was known about the startling scope of child labor throughout the United States, or the industry and governmental failures that have allowed it to thrive.

My first, and largest, hurdle was figuring out how to find children in this hidden workforce. The government provides shelter to children when they arrive, but after releasing them to sponsors, it doesn’t track them further. To find where children were working, I had to develop a new approach to analyzing federal data.

I quickly realized that children released to distant relatives and strangers were the most likely to be put to work. So I filed multiple FOIA [Freedom of Information Act] requests with the Department of Health and Human Services — and eventually sued them in federal court. I was able to obtain ZIP code-level data showing where children had been released to these nonparent sponsors. I then overlaid this data with U.S. Census population-density data to pinpoint parts of the country with especially high concentrations of children living far from their close relatives.

The resulting database guided two years of reporting across 13 states.

The data pointed to spots I never would have thought of: Flandreau, South Dakota; Parksley, Virginia; Bozeman, Montana. I started visiting these towns for weeks at a time, embedding in schools, and accompanying families to weddings and quinceañeras. I sat in factory parking lots during the midnight shift change and waited outside day labor sites before dawn. I found town after town where migrant child labor was an open secret.

Ordway: What made you decide to make this data public? Should more journalists and news outlets do this?

Dreier: Yes! And I hope more reporters use this data to dig into migrant child labor in America.

After I wrote a Times Insider piece explaining my process for mapping migrant child labor, Congressional staffers, academics, other journalists and even Department of Labor investigators requested access to our database. As part of its commitment to exposing the full scope of child labor, The Times made this data public, along with a detailed map that outlined outcomes for more than 550,000 children over a period of eight years.

We found migrant child labor in all 50 states. It’s clear there’s more to this story than what one journalist or even a team of reporters can report.

Ordway: How do you recommend other journalists use this database?

Dreier: Journalists at different outlets around the country have already picked up on some child labor stories, and this data can help them tell new stories. For local reporters, the database provides a previously unavailable level of detail about migrant children, including where kids are coming from, how long they’re staying in government-run shelters, and what kind of relationships they have with their sponsors (if they’re being released to aunts and uncles, distant cousins, strangers, etc.).

It’s been great to see reporters starting to use the database to fuel their own reporting, including at The Cincinnati Enquirer and Atlanta Journal-Constitution.

Ordway: What advice would you give other journalists who’d like to create databases for their own reporting projects?

Dreier: Though the heart of this reporting was the stories of the children themselves, I used data to add sweep and bring home to readers just how widespread this problem has become.

We found useful data everywhere. It doesn’t always take a federal lawsuit to shake it loose. We used court records from PACER [the federal Public Access to Court Electronic Records system] and state courts, as well as documents from dozens of FOIA requests to the Department of Labor and state labor agencies to hunt down outcomes the government does not track.

We built a database of migrant children killed on the job, including a 15-year-old who fell on his first day roofing and a 14-year-old who was hit by a car while delivering food.

Another database showed how rarely the government prosecuted child labor trafficking cases. I also tracked serious workplace injuries suffered by children, including crushed limbs and seared lungs.

A lot of data is sitting there for the taking, and doesn’t require submitting any requests at all. I’d encourage reporters to spend time on the websites of the agencies they’re reporting on — for me, that was OSHA [the Occupational Safety and Health Administration], DOL [the Department of Labor], HHS [the Department of Health and Human Services], SEC [the Securities and Exchange Commission], and CBP [Customs and Border Protection].

I also found it helpful to try site searches of these websites (by adding “site:hhs.gov” to Google searches for example), and to add the search term .csv or .xlsx, because some databases are posted to the site but not listed anywhere.

Ordway: When you ask government agencies for data such as this, how do you make sure you receive it in a form that you can easily use for reporting purposes?

Dreier: I always ask FOIA officers to email me records and to send data as a spreadsheet, but government offices often ignore that request.

With this project, some state agencies and police departments would send records only in hard copy or on CDs.

HHS gave us thousands of rows of data in the form of poorly rendered PDFs. We resolved this issue by scanning hundreds of pages of documents, and then using online tools to convert them to searchable text and spreadsheets.

For me, the most important thing is to get the records. From there, it’s almost always possible to find some way to make them useable … even if it ends up being a time-consuming process.

Read the stories

Alone and Exploited, Migrant Children Work Brutal Jobs Across the U.S.

As Migrant Children Were Put to Work, U.S. Ignored Warnings

The Kids on the Night Shift

Children Risk Their Lives Building America’s Roofs

They’re Paid Billions to Root Out Child Labor in the U.S. Why Do They Fail?

The post How they did it: The New York Times exposes migrant child labor exploitation across 50 states appeared first on The Journalist's Resource.

“For over 20 years, Supreme Court Justice Clarence Thomas has been treated to luxury vacations by billionaire Republican donor Harlan Crow.

He goes on cruises in far-flung locales on Crow’s yacht, flies on his private jet and keeps company with Crow’s powerful friends at the billionaire’s private resort.

The extent of Crow’s largesse has never been revealed. Until now.

-Lede to “Clarence Thomas and the Billionaire,” by Joshua Kaplan, Justin Elliott and Alex Mierjeski

In April 2023, ProPublica published the first story in its investigative series exposing a lack of ethics oversight for U.S. Supreme Court justices, some of whom received expensive gifts and worldwide vacations from well-heeled individuals — which meant private access to justices for those wealthy benefactors and their friends. The series provided rare, behind-the-scenes details of those interactions and prompted historic reforms on the nation’s high court.

The series begins covering the personal relationship between Justice Clarence Thomas and Harlan Crow, a real estate billionaire Thomas met three decades ago, according to ProPublica reporters Joshua Kaplan, Justin Elliott and Alex Mierjeski.

Those trips meant Thomas was in contact with powerful corporate executives, including from Verizon and PricewaterhouseCoopers, and political activists, such as “Leonard Leo, the Federalist Society leader regarded as an architect of the Supreme Court’s recent turn to the right,” the reporters write.

“By accepting the trips, Thomas has broken long-standing norms for judges’ conduct, ethics experts and four current or retired federal judges said,” the reporters write.

Crucially, those trips were not listed among Thomas’ annual financial disclosures, even though gifts worth over $415 usually must be reported, the reporters found. Despite such disclosure rules, before the ProPublica investigation the Supreme Court did not have a formal ethical code of conduct.

The private jet flights and yacht trips in particular should have been disclosed, the investigation finds. Thomas’ “failure to report the flights appears to violate a law passed after Watergate that requires justices, judges, members of Congress and federal officials to disclose most gifts,” according to two ethics experts the reporters spoke with.

Crow “has denied trying to influence the justice but has said he extended hospitality to him just as he has to other dear friends,” the reporters write.

Among other findings from the investigation:

• Crow paid for boarding school tuition running more than $6,000 a month for a boy Thomas said he was raising “as a son.” According to a former school administrator, “Crow paid Martin’s tuition the entire time he was a student here, which was about a year,” the reporters write.
• A July 2008 “luxury fishing vacation” Justice Samuel Alito took with GOP billionaire Paul Singer, ProPublica reports, who paid for Alito’s private jet and whose firm later had cases before the Supreme Court. Alito did not report the jet flight in annual disclosures, according to the investigation.
• Alito’s lodging during that trip was covered by Robin Arkley II, owner of a mortgage company who had “recently acquired the fishing lodge,” the reporters write. Alito did not report the lodging in annual disclosures, they found.
• Thomas attended two donor summits hosted by the Koch network, the political organization founded by billionaires Charles and David Koch, which put Thomas in “the extraordinary position of having helped a political network that has brought multiple cases before the Supreme Court,” the reporters write.
• Crow and wife Kathy paid for a 7-foot-tall bronze statue of Thomas’ eighth-grade teacher, unveiled at an October 2021 ceremony in a New York City suburb at which Thomas spoke.

As a result of the yearlong investigation:

• The Senate Judiciary Committee last May held a full hearing on Supreme Court ethics reform and, in November, subpoenaed Leo and Crow to obtain information.
• The Supreme Court adopted its first-ever code of conduct in November 2023.
• Nonpartisan ethics watchdogs, including the Campaign Legal Center and the Project on Government Oversight, have called on the Department of Justice to investigate Thomas for failing to disclose the trips Crow provided.
• Another 40-plus watchdog groups have called for Thomas and Alito to recuse themselves from cases relating to big-time political donors. The justices have rejected such recusal.

For Kaplan, Elliott and Mierjeski, a big takeaway from the investigation is that courts at all levels need more scrutiny from journalists.

“One of the lessons of this has been that the courts are just totally under-covered as an institution, both at the federal level all the way down to local and state [levels],” Elliott says. “One piece of advice would just be to start adding judges and courts, at whatever the relevant level is, to the mental list of things that should be covered.”

Here are seven more tips for covering courts the ProPublica reporters shared with The Journalist’s Resource.

1. Think of a public figure’s entourage as a huge source pool.

It takes a village to move a public figure from point A to point B.

“It’s not like a normal person going on a trip to Europe or something,” Elliott says.

This is especially true if the public figure travels on private planes and boats, which require specialized crew to operate. For example, Crow’s yacht, the Michaela Rose, often operates with a staff of a couple dozen, the ProPublica reporters found.

“We decided to try to talk to some of those people,” Elliott says. “So we started just sort of cold calling.”

2. Being an outsider can be an advantage, but be ready to play a ‘numbers game’ with cold calls.  

Kaplan says there are “extremely talented court reporters” with well-connected sources who focus on explaining Supreme Court decisions — but the ProPublica reporting team “did not start with any sources at all,” he says.

That wasn’t necessarily a detriment. To a reporter who regularly covers Supreme Court decisions, the staff of a yacht a Supreme Court justice had boarded might not have much to offer. But it was those seemingly tertiary sources, not directly involved with the regular functioning of the court, who were critical to telling the story of who the justices were spending time with while off the bench.

“We had to kind of start from scratch and get creative with the sort of people we were talking to,” Kaplan says. “We were talking almost exclusively to people that were very far removed from Washington, very far removed from the halls of national politics. And that brought us, over the course of the year, to some kind of relatively novel places.”

Those service workers — on the yacht, at the Adirondacks resort, at the Alaskan fishing lodge and other places — were “the absolute backbone of this,” Kaplan says. “It wasn’t a situation where any one person had the keys to the castle and were able to tell us everything that had happened, but a lot of people had some really valuable piece of the puzzle.”

Kaplan estimates that over the course of reporting the series, the team placed over a thousand phone calls.

“It really is a numbers game,” adds Elliott. “Many, many, many, many people said no to us, or just didn’t return our calls.”

3. Build trust with sources by articulating the big vision of your investigation, and by making sure they understand the concepts of “on the record,” “off the record” and “on background.”

Building trust is key when interviewing sources who don’t have experience talking with reporters. The ProPublica team found the sources they spoke with were by and large persuaded by the bigger picture of the investigation.

“Regardless of where any particular source might fall in the political spectrum, there’s, I think, a very clear public interest case that we should know who is getting access to some of the most powerful government officials — Supreme Court justices —  in the country,” Elliott says.

He adds “it would have been the same case that we were making if we were writing about Elana Kagan or Sonia Sotomayor,” referring to two justices usually regarded as being more ideologically liberal than conservative.

Likewise, being patient and explaining journalistic concepts that define how the information they share will be used — on the record, on background, or off the record, for example — is a great way to get sources to open up.

“Most people, when they get a call, they’ve never spoken to a reporter before,” Kaplan says. “They don’t understand the seriousness with which one takes protecting anonymity. And so, just taking the time to get to know people and to earn that trust, I think it’s critical.”

4. Take advantage of teamwork by divvying the labor.

When embarking on an investigation that will involve hundreds of phone calls and reading reams of records, dividing the work among a small group can save time and allow for collaborative strategizing along the way.  

“The benefit of the dynamic was that while these guys were making calls, I had time to kind of noodle around,” Mierjeski says. “Some of the findings in those stories just came from the ability to spend time searching and fishing.”

With Elliott and Kaplan focusing on contacting sources, Mierjeski was able to track down, for example, coverage in Catholic Cemetery magazine of the statue of Thomas’ teacher, which Crow and his wife paid for, the reporters found. 

There can also be mental health benefits to teamwork, in terms of reporters encouraging each other to press ahead in the face of obstacles.

“For me it would be difficult, as a psychological proposition, to not be sort of paralyzed by the crushing disappointment of failure if you’re just sitting at home alone having seven people in a row ask you how you got their number and then hang up on you,” Elliott says. “It’s sort of like going to the gym — it works better if you have a partner.”

Elliott, Kaplan and Mierjeski were continually communicating, Kaplan says, which was hugely helpful for real-time brainstorming. One example: The realization that polo shirts with the logo for Crow’s yacht could lead to more information about when and where Thomas was on the yacht.

“I remember it was like Friday night at 10 p.m. that one of us realized the Michaela Rose, the yacht logo on the shirts, could be a way to find other potential trips,” Mierjeski says. “The Signal chat was just blown up.”

Elliott adds, “We started looking for every single picture we could find of Justice Thomas wearing a polo shirt to see if there was a logo on it.”

5. Seek visual evidence, especially if a key source won’t talk.

The photos the reporters obtained of Thomas on trips with Crow and Alito holding a fish in Alaska were “very helpful in establishing things, but also, I think, really resonated with people and helped these stories get a wider reach,” Kaplan says.

The photographs were “more powerful than probably any prose we could come up with,” Elliott adds. The reporters found some of them on social media sites, like Instagram and Facebook. The pictures were not just illustrative but were important evidence of places the justices had been.

Alito responded to questions from the ProPublica reporters indirectly — in a Wall Street Journal op-ed.

Thomas, however, was silent until the first story in the series published.

“It wasn’t like Justice Thomas was going through our very detailed questions that we sent and saying, ‘You have this right, you have this wrong,’” Elliott says. “It was just like, ‘No comment.’ Which can be a sensitive position to be in as a reporter because if you’re getting no engagement, you just have to be right.”

6. Tap into university archives.

The ProPublica team examined numerous archival documents while reporting the series, including from congressional and judiciary archives.

Also among them: university archives, which are often collections of documents and pictures by and about public figures produced throughout their careers. The team early in reporting the series visited the collection of former Justice Antonin Scalia, donated to the Harvard Law School Library after Scalia died in 2016. Many parts of the Scalia archive remain sealed — but photographs weren’t sealed, Kaplan says.

“From the chicken scratch scrawl on the back of some of these photos, we started learning about some of the people that had taken Scalia to an Alaska trip — reporting those out brought us to Alito,” he says.

Kaplan adds: “Figuring out what past or present officials have archives that are at least partially in a university, there’s a pretty good chance you’ll be the first reporter to have ever looked at them. And they might have some gold in there.”

Start by looking for archives from universities a public figure has attended or has some other longstanding affiliation with, such as a professorship.

7. Search court documents, which are likely to be public record, for evidence.

When covering a story that deals with private interactions or a government entity not subject to public records laws, look for court cases. Unless a judge seals a case or portions of it, such records often are subject to public inspection.

That’s how the ProPublica team was able to show in their reporting that Crow had paid tuition on behalf of the boy Thomas was raising. The private school had been involved in a bankruptcy and later dissolved, but for a time was required to file financial statements to a federal court. The reporters found those statements through the Public Access to Court Electronic Records system, or PACER, an online federal courts document repository.

“Whoever was filing those statements seems to get sloppier and sloppier about redacting them as the case was going on,” Elliot says. “We came across a financial statement from the school that actually showed a wire of money from one of Crow’s companies to the school.”

In July 2009, the company “wired $6,200 to the school that month, the exact cost of the month’s tuition,” the reporters write.

Read the stories

Clarence Thomas and the Billionaire

Clarence Thomas Had a Child in Private School. Harlan Crow Paid the Tuition.

Justice Samuel Alito Took Luxury Fishing Vacation With GOP Billionaire Who Later Had Cases Before the Court

Clarence Thomas Secretly Participated in Koch Network Donor Events

A ‘Delicate Matter’: Clarence Thomas’ Private Complaints About Money Sparked Fears He Would Resign

The Judiciary Has Policed Itself for Decades. It Doesn’t Work.

The post How they did it: ProPublica investigation unveils ethics scandals at the Supreme Court appeared first on The Journalist's Resource.

In the summer of 2022, Michael Sallah, the deputy managing editor of investigations at the Pittsburgh Post-Gazette, received an email from a source who encouraged him to look at personal injury lawsuits filed in federal court in Pittsburgh. The lawsuits involved Phillips Respironics, one of the leading makers of breathing machines, including ventilators and sleep apnea machines.

The source also sent him a Food and Drug Administration inspection report of one of the Philips factories that made the breathing machines, located on the outskirts of Pittsburgh.

“As we started to dig in and look, it was pretty horrifying stuff that we were coming up with,” Sallah says.

The reporting also revealed that Philips had known about the defective machines since 2010 and didn’t alert the public. Neither did the FDA, which had received warnings about contaminants in the machines.

And in 2021, when the company recalled its popular DreamStation breathing machines, it sent out replacement parts that continued to release cancer-causing chemicals, the investigation revealed.

The reporters also found:

• Philips continued to aggressively market the machines while its own experts warned of the dangers the devices were posing to patients.
• Philips failed to turn over more than 3,700 complaints about the eventually-recalled machines, sometimes waiting years before submitting them to the FDA. The FDA requires companies to disclose patient complaints to the agency within 30 days.
• Other leading device makers also submitted late reports about patient complaints involving flawed pacemakers, prosthetics, dialysis machines and screws and plates for bones. In 2023, 1 in 8 reports from medical device companies, including more than 232,000 complaints, were submitted to the FDA past the 30-day deadline.

As a result of the investigation:

• The Government Accountability Office is launching an investigation of the FDA’s oversight of medical devices. It’s the first in a decade. Sens. Richard Blumenthal (D-CT) and Dick Durbin (D-IL) asked the GAO to investigate how the FDA tracks warnings about dangerous devices, oversees recalls and takes actions against companies.
• Rep. Jan Schakowsky (D-IL), the ranking member of the House Energy and Commerce subcommittee that oversees consumer product safety, also called for investigations.
• Connecticut’s Attorney General William Tong called for third-party experts to conduct safety tests on recalled machines.
• Philips Respironics announced in January that it was going to stop manufacturing and selling all CPAP machines in the United States.

The reporting team included Sallah, Michael Korsh and Evan Robinson-Johnson from Post-Gazette; Cenziper from ProPublica; and Monica Sager from Northwestern University.

In an interview, Sallah and Cenziper, both Pulitzer Prize winners, share these 11 reporting tips for journalists.

1. To strengthen a reporting project, collaborate with other newsrooms.

After Sallah began looking into the lawsuits in federal court, he reached out to long-time reporting colleague Cenziper to pitch a collaboration. The two had worked together at the Miami Herald and later at The Washington Post and had been wanting to find a collaborative project. This seemed to be the one.

Pittsburgh was ground zero for Philips because it’s where the company manufactured the breathing machines. Meanwhile, ProPublica journalists had a lot of experience writing about the FDA.

“We all bring different strengths, skills and resources to the table,” says Cenziper.

They also collaborated with Mediahuis NRC in Amsterdam, which helped provide sources there at the headquarters for Philips’ parent company, Royal Phillips. They also worked with Northwestern University’s Medill Investigative Lab, where student journalists helped comb through more than 100,000 patient complaints involving Philips breathing machines, filed in FDA’s tracking system since 2010.

2. Collaborate with student journalists.

Cenziper is also a professor at the Medill School of Journalism at Northwestern University and the director of the Medill Investigative Lab. Sallah is a media fellow at the lab.

Cenziper had been working with Medill student journalists for several years on different investigative projects at The Washington Post and ProPublica.

“And both organizations have embraced their work because young journalists bring fresh eyes, fresh perspective, passion and grit to the table,” Cenziper says.

In this case, students helped dig into the data and documents and sit down with families across the country, willing to share their experiences with the breathing machines.

The students were also savvy at mining social media, which helped in finding patients affected by the defective devices.

3. Share information to gain patients’ trust.

The reporters wanted to humanize the stories and they had to get the patients to trust them.

“We’re asking people to basically lead us to their bedrooms, where these breathing machines are set up,” Cenziper says.

So they shared with patients some of the information they had discovered in the FDA reports.

“These folks were living in a vacuum,” Sallah says.

There was very little information available to them to know and understand what the crisis involved. Some had been kept the dark by the company and the FDA for years.

“Debbie and I were able to approach them and offer them a bit more [information] and give them a little sense of guidance so they can navigate things, and in return, some of them were very grateful and seemed to open up more, the more we could share with them,” Sallah says.

“I also think it was in some ways therapeutic for some of the people to share their stories with us,” Cenziper adds. “We sat in so many living rooms — I don’t mean for a quick hour interview; I mean half a day or more — just talking to people and listening to people and looking at their family photos and reading their medical records.”

4. Take the time to gain the trust of internal sources.

It took the reporters many months to get the company scientists to talk. The scientists were hesitant because talking to the press could risk their jobs and reputations and potentially made them vulnerable to libel or defamation lawsuits.

But the reporting team kept calling until one day one scientist agreed to talk, explaining the complexity of the science behind the defective machines and how dangerous the chemicals were to humans.

“I’ve been doing this for 30 years and I still believe that people at the end of the day want to do the right thing,” says Cenziper. “And at the end of the day, our sources believed this company kept a very dangerous secret and that someone needed to provide answers. Someone needed to have to provide transparency.”

The reporters consulted with their editors and lawyers and agreed to protect the identities of their internal sources.

5. Understand the science. Really.

Mastering the data and understanding the science helps you write with authority, Sallah says.

It took the reporters months to understand the complicated science behind volatile organic compounds released from the defective sleep apnea machines.

“It’s really up to you to understand everything. Everything,” Sallah says. “And that meant science, it meant the mechanics as much as we could so that there were no gaps.”

They were meticulous in understanding the toxicology.

“We were primed and briefed over and over about these concepts until we finally absorbed them and understood them,” Sallah says.

When they were talking to experts, they’d ask the basic questions.

“We’d say, ‘Look, this is going to sound like a dumb question, but…’” Sallah says. “And they never took it that way. They were so appreciative of us taking the time to learn this that they made it as basic, as comprehensive, as accurate as they could be.”

6. Find several experts to guide you.

It took many phone calls to find the scientists who were willing to read the FDA reports, take the time to interpret them and weigh in on something that they hadn’t been a part of.

But getting experts was a necessary part of the reporting process.

“When you’re writing about science, always find a guru who can guide you through it,” Cenziper advises.

And rely on more than one expert.

“We didn’t want just one toxicologist. We had three to five,” she says.

When Philips tried to downplay the toxicity of various chemicals, the reporters kept talking with scientists to understand the science and how the machines worked. They eventually realized that there was one thing the company couldn’t reconcile: The chemical cocktail released by the breathing machines triggered what’s known as genotoxicity, which means it can mutate human cells and lead to cancer.

“We reached that point through a lot of our own inquiry into where this finally ends and that’s something [the company] couldn’t dispute,” Sallah says. “You don’t want a ‘he said, she said’ [story]. You want to be able to give the reader some finality and that was one of our quests.”

7. You’ve heard it before, but here it is again: Avoid acronyms and jargon.

Sleep apnea machines are also known as CPAP machines, which stands for continuous positive airway pressure machines. They use mild air pressure to keep breathing airways open while patients sleep.

The reporters didn’t introduce the word CPAP until several paragraphs into their first story. At the beginning and throughout they mostly used “breathing machines” and “sleep apnea machines.”

“We worked very hard at trying to make [the stories] as conversational as we could,” Sallah says. “You’re not writing some sort of a dissertation on the ways in which these machines work. You have to make it interesting. So the ways in which these machines operate have to kind of be woven into the story in a way where it’s still a narrative.”

“I always tell young journalists it doesn’t matter how great your findings are. It doesn’t matter if you’re going to bring down a president,” Cenziper adds. “None of that matters if people stop reading what you wrote.”

8. Don’t settle for long wait periods for your public records (FOIA) requests.

The reporters asked the FDA for documents related to the 2021 Philips breathing machines recall and the health hazards posed by the machines, including internal emails and Philips monthly status reports. When the FDA said it would need more than two years to provide the records, lawyers for ProPublica and Post-Gazette sued the FDA in federal court in New York. Their lawsuit was successful.

“Transparency in this case is a matter of significant and urgent public concern,” Sarah Matthews, ProPublica’s deputy general counsel, said in a statement shared by the news organizations in their Goldsmith application. “These records will shed light on the recall of Philips ventilators and other breathing devices that have put the health of millions of Americans in jeopardy.”

The FDA agreed to turn over the records in batches, which continues to date.

“Our very last story was based entirely on records that we received through FOIA,” Cenziper says.

9. Read the documents. Don’t settle for numbers.

The reporters had a massive data challenge because they were looking at thousands of complaints in an FDA database that was difficult to navigate and manipulate. They eventually paid for a subscription to a proprietary database of the reports, which was more manageable.

But, in addition to getting a sense of the scope of the problem, they began to read the complaints.

“Numbers are just numbers,” Cenziper says. “You need to understand what goes into the data.”

By reading the complaints, the reporters spotted patterns of failure by the FDA.

“If I had a recommendation for other journalists, it would be, look at what’s going into the data. Take the time to read documents,” Cenziper says. “Don’t just publish summary numbers.”

10. When covering medical devices, understand the role of regulators.

The FDA has made a lot of progress in overseeing pharmaceuticals, but its process is different for medical devices. The FDA mostly leaves it up to the medical device industry to regulate itself, the reporters explain.

“And that can be dangerous because the guinea pigs are the patients, the people, who are out there, who need these devices and it can take years of deaths and injuries before they finally figure out this device is hurting people,” Sallah says.

Take the time to understand the role of government regulators and the history of gaps and weaknesses in their oversight, he advises.

“It’s not just going to be the devices themselves that break down, but it’s also how long it takes for the government to respond and to take action despite all the enforcement tools it has at its disposal,” Sallah says.

11. Keep a timeline.

One of the reporters’ organizing tips is to create a timeline, especially for large investigative projects.

“We did a very big 40-some page timeline with hyperlinks,” Cenziper says. “That not only helped us get our thoughts together and our lede and nutgraf, but also helped us organize the stories.”

“That was the single most important document that we created,” Sallah says of the shared document.

They also published a timeline of the events, starting from when the breathing machines arrived in the market. 

Read the stories

With Every Breath: Millions of breathing machines, one dangerous defect

Portraits of Pain

A Failure to Protect: Millions of people used tainted breathing machines. The FDA failed to use its power to shield them.

Millions of People Used Tainted Breathing Machines. The FDA Failed to Use Its Power to Protect Them.

Senators call for probe into FDA’s oversight of medical devices, citing series on Philips CPAP recall

Philips Recalled Breathing Machines in 2021. Chemicals of “Concern” Found in Replacement Machines Raised New Alarm.

Video: “With Every Breath” Captures the Human Toll of Philips’ Failure to Disclose Dangerous Defects of Its CPAP Devices

Timeline: Inside Philips, an unfolding crisis

Follow the latest news.

The post How they did it: A reporting team led by Pittsburgh Post-Gazette and ProPublica exposes dangerous defect in popular breathing machine appeared first on The Journalist's Resource.

It was no surprise to Jerry Mitchell to learn high-ranking law enforcement officials had been accused of behaving badly in parts of Mississippi where journalists had not kept a watchful eye.

But the details he and his colleagues at Mississippi Today and The New York Times uncovered during a yearlong investigation shocked even this veteran journalist, who has been exposing corruption in the state’s criminal justice system for more than 30 years.

The project uncovered decades of allegations of sex abuse, torture, bribery, retaliation and other abuses of power at sheriff’s offices across the state. When Mitchell and a fellow journalist at Mississippi Today, Ilyssa Daly, started looking into claims made about one sheriff in 2022, residents came forward with what seemed like unbelievable stories about other sheriffs as well as detectives and patrol deputies in different parts of the state.

The combined efforts of these journalists and journalism organizations produced the seven-story series, “Unfettered Power: Mississippi Sheriffs.” It revealed that:

• A sheriff in Noxubee County, located on the Mississippi-Alabama border, allegedly demanded that a woman being held in the county jail send him sexually explicit photos and videos and ignored her complaint that she had been coerced into having sex with two deputies.
• Multiple women accused a sheriff in Clay County, in northeastern Mississippi, of sexually harassing or coercing them. For example, an incarcerated woman accused the sheriff of arranging for her and another prisoner to be brought to his house, where they had to change into boxer shorts and pose for photos. A Clay County Sheriff’s Office employee told journalists she picked up two female prisoners from the sheriff’s house and returned them to the jail.
• A sheriff in Rankin County, in the middle of the state, allegedly lied to get grand jury subpoenas to spy on his married girlfriend.
• Rankin County narcotics detectives and patrol officers, some of whom referred to themselves as the “Goon Squad,” allegedly used Tasers and waterboarding to torture people into confessing to drug crimes or providing information. Of the drug raids the journalists examined, the biggest involved a $420 sale of heroin. The series identified 20 of the deputies present during those incidents.

“All of this reporting has just been beyond the pale,” Mitchell says. “A lot of this has been totally shocking to me.”

A lack of oversight in Mississippi

The series also documents how the three sheriffs operated largely without oversight and avoided being investigated for a range of serious allegations.

For example, a district attorney compiled a report of evidence collected against Rankin County Sheriff Bryan Bailey in 2016 but stopped investigating, in part because he was friends with Bailey. Although he shared details with two local judges and forwarded the investigation to the state’s attorney general, the case ended there, Daly and Mitchell reported in September.

When a former deputy called Bailey to warn him about the Goon Squad, Bailey called him “a dirty cop and accused him of secretly recording the call,” Howey and Rosenfield write in a November article.

The impact

The series jarred public leaders. Earlier this year, state legislators introduced a bill that would allow the Mississippi Board on Law Enforcement Officer Standards and Training to investigate law enforcement misconduct. The measured passed the Mississippi House unanimously last week and was sent to the senate.

The series also spurred federal action. Several weeks after journalists asked about the U.S. Attorney’s Office’s languishing investigation of former Noxubee County Sheriff Terry Grassaree, he was indicted on bribery charges. After the story about him ran in April, he was indicted on additional charges.

Immediately after the two news outlets published the piece on Rankin County’s Goon Squad, attorneys for the U.S. Department of Justice’s Civil Rights Division flew to the state capital to meet with the president of the local chapter of the NAACP. Days later, the U.S. Attorney’s Office put out a press release urging victims to come forward.

Federal officials put up billboards, too, urging residents to report police brutality to the FBI.

Meanwhile, on March 19, two members of Rankin’s Goon Squad were sentenced to prison for torturing two Black men last year using Tasers, a sex toy and other objects. One of the victims was shot in the mouth. On March 20, two other former deputies were sentenced for their part in the torture, one of whom received a 40-year federal prison sentence.

We asked the reporting team for advice to help other journalists take on similar projects. Below, we highlight four of the tips they shared.  

1. If you report on law enforcement agencies, get their Taser log data.

Data collected from deputies’ Tasers played a key role in Howey and Rosenfield’s reporting on Rankin County deputies’ use of force. It allowed them to confirm victim statements and demonstrate when, where, how, and how long deputies fired their Tasers while on the job.

“One running theme we kept hearing again and again is people being tased and Tasers being used as torture weapons,” Rosenfield says.

Many Tasers keep detailed digital records of their use. The Rankin County Sheriff’s Office gathers that data to compile departmentwide logs. Mississippi Today and The New York Times examined 24 years of the agency’s Taser data.

The journalists determined, for example, that three deputies triggered their Tasers a combined 14 times during a 2018 home raid over an $80 sale of methamphetamine. The four men at the home that night said deputies beat them and used Tasers and a blowtorch while interrogating them.

Howey and Rosenfield reported the Taser logs also showed that “[a]t least 32 times over the past decade, Rankin deputies fired their Tasers more than five times in under an hour, activating them for at least 30 seconds in total — double the recommended limit. Experts in Taser use who reviewed the logs called these incidents highly suspicious.”

Rosenfield recommends asking industry experts and academic researchers for help understanding Taser log data and identifying potentially problematic patterns.

“We talked to lots of use of force experts to find out what we could actually glean from the logs and how to read them correctly to contextualize them,” he adds.

2. Be kind and transparent. Sources may be more willing to help if you’ve treated them well.

Daly, the lead reporter on the project, spent hours driving across the state with Mitchell, interviewing sources, tracking down court files and transcripts, and digging through stacks of paper records in various government offices and facilities.

When she’s  out reporting, she says she tries to treat everyone she encounters with kindness. She also aims for transparency, so sources know what she plans to do with the information they share with her.

She calls this approach “walking in the sunshine.”

“Always walk in the sunshine with whatever you’re doing and be friendly and polite and make source connections with everyone around you — because you don’t know who’s going to help you with the thing you need most,” she says.

It paid big dividends for her last year, when an assistant records clerk she saw often at a local courthouse went out of her way to find a case file. Details from the case, filed in 2012 by a former prisoner accusing Clay County Sheriff Eddie Scott of sex abuse, were crucial to the story about Scott.

Initially, no one could locate the file, which Daly later learned probably had been missing for years.

“The woman comes back and can’t find it and she’s freaking out and she’s saying, ‘This has never happened before,’” Daly says.

Daly helped search the office’s paper files but also came up emptyhanded.

A couple weeks later, she and Mitchell returned to the courthouse with a different strategy for gathering bits of information from court filings, to try to figure out what information the missing file contained. When the head clerk spotted the two journalists, she told them the assistant clerk found the file they wanted.

The assistant clerk had spent days looking for the file and found it misplaced in another part of the clerk’s office. What it contained: The only public record of a local woman’s allegations that Scott, when he was the county’s chief deputy, had coerced her into a sexual relationship after her arrest. He had promised to use his influence to help her, she writes in the court filing. She says they had sex in his patrol car, parked on a hog farm, on at least five occasions.

The file also contained hand-written, suggestive letters that Scott sent to her in prison in 2011, months before he became sheriff. Mississippi Today and The New York Times published one of those letters.

“You never know which source might go that extra mile,” Daly says.

3. Understand that the way you present yourself through your words, actions and appearance can create or break down barriers between you and members of the public.

For Howey, one of toughest parts of the series was getting people to open up, especially those living in communities that have been regularly targeted by law enforcement.

He discovered that being himself, which meant not hiding his tattoos and piercings, helped him connect with residents in the rural and lower-income communities he visited. Sometimes, he wore a T-shirt to interviews — for his own comfort and so people he approached might be less apprehensive or suspicious of him.

“Usually, the people with the big vocabularies and nice wardrobes are the people who put them in the positions they’re in,” Howey says.

He notes that most people can “sniff out insincerity.”

“I just approach people as myself instead of a stuffy, professional reporter,” he says. “It’s about finding that line that allows you to stay professional and allows you to be personable enough for people to see you’re a real human being.”

If someone starts confiding in you, they might tell others you’re trustworthy.

“I’ve had situations where I’m talking to people and they’ll make a phone call [to a potential source] and say, ‘He’s actually cool,’” Howey says. “That has gotten me interviews.”

4. Use digital tools such as Pinpoint and Descript to make your job easier.

Two of the investigative team’s favorite digital tools are Descript and Google’s Pinpoint.

Descript is a video editing app. You can use it to record, edit and transcribe videos as well as collaborate on videos and podcasts. Rosenfield and Howey use it for transcribing audio files.

There is a free version, but they recommend investing in the paid version, which starts at $12 a month. The free version comes with one hour of transcription per month while the entry-level paid plan provides 10 hours a month.

Pinpoint is a free research tool that lets you examine and search large collections of documents quickly. You can also use it to transcribe audio and video files and sort documents according to key words and phrases, including locations and people’s names.

“It’s a great resource when you’re grappling with reams of court and police records and it’s a mixture of digital and paper,” Howey explains. “This tool allows you to compile everything into one folder and makes it all text searchable so it’s easy to extract information. It’s extremely useful. We used it constantly to look for patterns in police reports, to pull certain records out without spending 20 minutes looking for them in folders.”

Read the stories

Sex Abuse, Beatings and an Untouchable Mississippi Sheriff

Where the sheriff is king, these women say he coerced them into sex

The Sheriff, His Girlfriend and His Illegal Subpoenas

How a ‘Goon Squad’ of Deputies Got Away With Years of Brutality

Who Investigates the Sheriff? In Mississippi, Often No One.

The post How they did it: Mississippi Today and The New York Times reveal sex abuse, torture allegations at sheriff’s offices appeared first on The Journalist's Resource.

“In some respects, there was nothing unusual about the killing of Walter Gonzalez.

Eighty-six pedestrians had already died in car crashes in New York City last year by October 23, when a driver slammed a pick-up truck into Gonzalez in Brooklyn. It was not out of the ordinary that the driver was speeding, nor that his license had been revoked months prior.

But there was one thing that stood out about the crash: the paper license plate hanging from the back of the truck.”

-The lede to “Ghost Tags: Inside New York City’s Black Market for Temporary License Plates,” by Jesse Coburn

In April 2023, online news outlet Streetsblog NYC published the first story in a four-part investigation exposing a vast black market for temporary license plate tags, the massive scale of which was not publicly known.

Temporary tags are legal when someone buys a car. In New Jersey, for example, a dealer issues the buyer weatherized paper tags to display until metal plates come in the mail.

But it is illegal for dealers to issue temporary tags absent a car sale. It is also remarkably easy for dealers to sell those tags on the black market. And when dealers were caught, the penalties were small — before the series from Streetsblog investigative reporter Jesse Coburn.

Further, “Drivers were using them to mask their identities while evading tolls and traffic cameras, or while committing more serious crimes, authorities said,” Coburn writes.

At the time the Streetsblog investigation was published, auto dealers fraudulently selling authentic tags could fetch $100 to $200 apiece, while the maximum violation for a first-time offense in New Jersey was $500, Coburn found. One dealer in New Jersey issued tens of thousands of tags in 2021, and “could have made millions of dollars,” if all those were sold on the black market, Coburn writes.

Coburn’s seven-month investigation was built upon nearly 50 public records requests he filed, particularly from motor vehicle authorities in New Jersey and Georgia, for information on dealers illegally issuing temporary tags. Those tags, Coburn found, were being issued by dealers who appeared by and large not to be engaged in any legitimate business.

“The data really tells the story because it’s like, here’s this dealership that has no online presence, none whatever, no listing on Google Maps — none of the trappings of a successful car dealership — issuing tens of thousands of temp tags every year,” Coburn says.

Since the Streetsblog series, New Jersey has imposed tougher restrictions on temporary tags, including potential prison time and fines up to $10,000 for violators. A lawmaker in Georgia has also introduced legislation aimed at curtailing the market for fraudulent temporary tags there.

“New Jersey and Georgia have also shut down dozens of dealers for temp tag fraud since the series came out and proposed $150,000 in fines,” Coburn says. “Seven of the dealers that I sort of flagged to these states as possible temp tag violators are now under criminal investigation.”

Keep reading for four tips from Coburn based on his investigation, including how it came about, how he got people buying and selling temporary tags to talk to him, and the types of sources he thinks are most compelling.

1. Stay alert — is there something weird in your neighborhood?

Being an investigative reporter isn’t necessarily about having deep government sources or getting your hands on an incendiary tip, Coburn says. Sometimes, a strong investigation can come from staying alert to changes in the places you frequent.

“During the pandemic, in my neighborhood in Brooklyn, I started seeing tons of these paper license plates on cars from out of state — Texas, New Jersey, Georgia, Virginia, Maryland,” Coburn says. “And, you know, I’m sort of wondering what this is about.”

Coburn says he saw some local news coverage of illicit temporary tags in New York City, but those stories were driven mostly by police reports and press conferences.

“It just seemed inconceivable to me that so many people had just bought cars in Texas or Georgia,” he adds.

So, he began filing public records requests for data on temporary tags issued by auto dealers in New Jersey.

“What I saw was that there were these dealerships that were issuing massive numbers of tags — 10, 20,000 tags in a single year,” Coburn says. “Which should mean that that dealership is selling that many cars.”

He started digging into one dealer, F&J Auto Mall in Bridgeton, New Jersey, and learned it “issued 36,000 temporary license plates in 2021 — more than any other dealership in the state, including the used-car juggernauts Carvana and CarMax combined,” Coburn writes in Part 1 of the series.

Coburn recalls that when he looked up the publicly available address for F&J, Google Maps images showed a “warehouse in the middle of nowhere, with no big sign out front. A giant parking lot that was totally empty. That was the moment I was like, ‘There’s something really crazy going on here.’”

2. To ‘find your Virgil,’ try old-fashioned cold calling.

Cold calling may not feel like the most natural thing in the world, but if you don’t otherwise have good sources for your story, a few dozen unsolicited calls can work.

That’s what Coburn did when he realized he needed reputable auto dealers to walk him through what the data indicated about F&J. He searched for dealerships in northern New Jersey, close enough to his home base to potentially visit in person.

Initially, the response from auto dealers was “chilly” and “people were very skittish,” Coburn says. But before long, he struck journalistic gold.

“It took me about a dozen dealerships,” he says. “But, eventually, I got this guy on the phone named Abdul Cummings.”

As an émigré from Palestine running a legitimate used auto dealership, Cummings was troubled by the illegal activity happening in his industry, Coburn says. Cummings immediately began describing to Coburn how the paper tag fraud worked. Coburn recalls that Cummings was “very candid, and smart” with “a lot of integrity.”

“Find your Virgil,” Coburn advises, referring to the ancient Roman poet, a fictional version of whom shepherds Dante through hell in the Divine Comedy. “Someone who can kind of guide you through.”

Coburn found many other key sources through cold calls, such as Jose Cordero, who told Coburn he made $18,200 selling temporary tags before New Jersey authorities caught him.

3. Use court calendars to find sources involved in active cases.

Coburn identified temporary tag buyers through cold calls, but also by looking at WebCriminal, the online criminal court portal for New York.

“It’s extremely Web 1.0 — it’s very hard to use,” Coburn says. “But there is a wealth of information if you kind of know how to find it. And so eventually, I figured out how to search the court calendars for every day, and to search by violation.”

The violation for possessing illegal temporary tags is called “criminal possession of a forged instrument.” Coburn would search for people being arraigned on that charge and potentially related charges, such as driving with a suspended license.

“I would just sit in court and wait for their hearing to be called,” he says. “You know, I just had this list of names. And then after they were arraigned, I approached them and tried to talk to them — and was once again amazed at how candid people were.”

That’s how Coburn got the story of Adrian Mocha, who had his license suspended. In the span of one year, Mocha went through “eight or nine” temporary tags, according to Part 3 of the investigation. Coburn simply approached Mocha and interviewed him following one of Mocha’s court dates.

4. Seek sources outside the spotlight for interesting anecdotes.

Politicians and other high-profile officials are often used to interacting with members of the news media. They may be guarded and self-aware in what they publicly convey. But people who have less or no experience talking with reporters provided some of the more interesting details in Coburn’s story — such as Ali Ahmed, manager at Zack Auto Sales, which is registered in New Jersey, according to Coburn’s reporting.

Coburn visited Zack Auto Sales and asked Ahmed about the 999 temporary tags the dealership issued in 2022, despite having no presence online. Ahmed said, “If you’re going to go deep, and I find it, and you go to ask about my company in Trenton and New Jersey, you’re going to get trouble with it, believe me,” Coburn writes in Part 2 of the series. Ahmed said they “retail and wholesale [cars] online, like a broker,” according to Coburn’s reporting.

“Streetsblog did not find evidence that Zack Auto Sales illegally sells temporary license plates,” Coburn writes. “But one car wholesaler and one car broker based in New Jersey told Streetsblog that wholesalers and brokers have no reason to issue large numbers of temp tags.”

Coburn also recalls the compelling story of how Kareem Ulloa-Alvarado discovered he had been unknowingly delivering temporary tags for a dealership for a few weeks in December 2022 and January 2023, after finding the gig on Craigslist.

In Part 4 of the series, Coburn reports that Ulloa-Alvarado didn’t realize he was doing anything illegal until he was attacked at knifepoint during a delivery in the Bronx. When he went to police, a detective told Ulloa-Alvarado that he could be arrested for delivering fake tags if he filed a report about the assault. “Kareem was shocked,” Coburn writes.

“They were very interesting, original people,” he says. “I like stories where I’m not just speaking to media-trained government officials.”

Read the stories

Part 1: The Dealers

Part 2: The Landlords

Part 3: The Buyers

‘Duped’: A Harlem 20-Something Blows the Whistle on an Illegal Temporary License Plate Business

The post How they did it: Streetsblog exposes underground sales of illicit temporary license plates in New York City appeared first on The Journalist's Resource.

In a call with a long-time source, what stood out most to STAT reporters Bob Herman and Casey Ross was just how viscerally frustrated and angry the source was about an algorithm used by insurance companies to decide how long patients should stay in a nursing home or rehab facility before being sent home.­

The STAT stories had a far-reaching impact:

• The U.S. Senate Committee on Homeland Security and Government Affairs took a rare step of launching a formal investigation into the use of algorithms by the country’s three largest Medicare Advantage insurers.
• Thirty-two House members urged the Centers for Medicare and Medicaid Services to increase the oversight of algorithms that health insurers use to make coverage decisions.
• In a rare step, CMS launched its own investigation into UnitedHealth. It also stiffened its regulations on the use of proprietary algorithms and introduced plans to audit denials across Medicare Advantage plans in 2024.
• Based on STAT’s reporting, Medicare Advantage beneficiaries filed two class-action lawsuits against UnitedHealth and its NaviHealth subsidiary, the maker of the algorithm, and against Humana, another major health insurance company that was also using the algorithm. 
• Amid scrutiny, UnitedHealth renamed NaviHealth.

The companies never allowed an on-the-record interview with their executives, but they acknowledged that STAT’s reporting was true, according to the news organization.

Ross and Herman spoke with The Journalist’s Resource about their project and shared the following eight tips.

1. Search public comments on proposed federal rules to find sources.

Herman and Ross knew that the Centers for Medicare and Medicaid Services had put out a request for public comments, asking stakeholders within the Medicare Advantage industry how the system could improve.

There are two main ways to get Medicare coverage: original Medicare, which is a fee-for-service health plan, and Medicare Advantage, which is a type of Medicare health plan offered by private insurance companies that contract with Medicare. Medicare Advantage plans have increasingly become popular in recent years.

Under the Social Security Act, the public has the opportunity to submit comments on Medicare’s proposed national coverage determinations. CMS uses public comments to inform its proposed and final decisions. It responds in detail to all public comments when issuing a final decision.

The reporters began combing through hundreds of public comments attached to a proposed Medicare Advantage rule that was undergoing federal review. NaviHealth, the UnitedHealth subsidiary and the maker of the algorithm, came up in many of the comments, which include the submitters’ information.

“These are screaming all-caps comments to federal regulators about YOU NEED TO SOMETHING ABOUT THIS BECAUSE IT’S DISGUSTING,” Ross says.

“The federal government is proposing rules and regulations all the time,” adds Herman, STAT’s business of health care reporter. “If someone’s going to take the time and effort to comment on them, they must have at least some knowledge of what’s going on. It’s just a great tool for any journalist to use to figure out more and who to contact.”

The reporters also found several attorneys who had complained in the comments. They began reaching out to them, eventually gaining access to confidential documents and intermediaries who put them in touch with patients to show the human impact of the algorithm.

2. Harness the power of the reader submission box.

At the suggestion of an editor, the reporters added a reader submission box at the bottom of their first story, asking them to share their own experiences with Medicare Advantage denials.

The floodgates opened. Hundreds of submissions arrived.

By the end of their first story, Herman and Ross had confidential records and some patients, but they had no internal sources in the companies they were investigating, including Navihealth. The submission box led them to their first internal source.

The journalists also combed through LinkedIn and reached out to former and current employees, but the response rate was much lower than what they received via the submission box.

The submission box “is just right there,” Herman says. “People who would want to reach out to us can do it right then and there after they read the story and it’s fresh in their minds.”

3. Mine podcasts relevant to your story.

The reporters weren’t sure if they could get interviews with some of the key figures in the story, including Tom Scully, the former head of the Centers for Medicare and Medicaid Services who drew up the initial plans for NaviHealth years before UnitedHealth acquired it.

But Herman and another colleague had written previously about Scully’s private equity firm and they had found a podcast where he talked about his work. So Herman went back to the podcast — where he discovered Scully had also discussed NaviHealth.

The reporters also used the podcast to get Scully on the phone for an interview.

“So we knew we had a good jumping off point there to be like, ‘OK, you’ve talked about NaviHealth on a podcast, let’s talk about this,’” Herman says. “I think that helped make him more willing to speak with us.”

4. When covering AI initiatives, proceed with caution.

“A source of mine once said to me, ‘AI is not magic,’” Ross says. “People need to just ask questions about it because AI has this aura about it that it’s objective, that it’s accurate, that it’s unquestionable, that it never fails. And that is not true.”

AI is not a neutral, objective machine, Ross says. “It’s based on data that’s fed into it and people need to ask questions about that data.”

He suggests several questions to ask about the data behind AI tools:

• Where does the data come from?
• Who does it represent?
• How is this tool being applied?
• Do the people to whom the tool is being applied match the data on which it was trained? “If racial groups or genders or age of economic situations are not adequately represented in the training set, then there can be an awful lot of bias in the output of the tool and how it’s applied,” Ross says.
• How is the tool applied within the institution? Are people being forced to forsake their judgment and their own ability to do their jobs to follow the algorithm?

5. Localize the story.

More than half of all Medicare beneficiaries have Medicare Advantage and there’s a high likelihood that there are multiple Medicare Advantage plans in every county across the nation.

“So it’s worth looking to see how Medicare Advantage plans are growing in your area,” Herman says.

Finding out about AI use will most likely rely on shoe-leather reporting of speaking with providers, nursing homes and rehab facilities, attorneys and patients in your community, he says. Another source is home health agencies, which may be caring for patients who were kicked out of nursing homes and rehab facilities too soon because of a decision by an algorithm.

The anecdote that opens their first story involves a small regional health insurer in Wisconsin, which was using NaviHealth and a contractor to manage post-acute care services, Ross says.

“It’s happening to people in small communities who have no idea that this insurer they’ve signed up with is using this tool made by this other company that operates nationally,” Ross says.

There are also plenty of other companies like NaviHealth that are being used by Medicare Advantage plans, Herman says. “So it’s understanding which Medicare Advantage plans are being sold in your area and then which post-acute management companies they’re using,” he adds.

Some regional insurers have online documents that show which contractors they use to evaluate post-acute care services.

6. Get familiar with Medicare’s appeals databases

Medicare beneficiaries can contest Medicare Advantage denials through a five-stage process, which can last months to years. The appeals can be filed via the Office of Medicare Hearings and Appeals.

“Between 2020 and 2022, the number of appeals filed to contest Medicare Advantage denials shot up 58%, with nearly 150,000 requests to review a denial filed in 2022, according to a federal database,” Ross and Herman write in their first story. “Federal records show most denials for skilled nursing care are eventually overturned, either by the plan itself or an independent body that adjudicates Medicare appeals.”

There are several sources to find appeals data. Be mindful that the cases themselves are not public to protect patient privacy, but you can find the number of appeals filed and the rationale for decisions.

CMS has two quality improvement organizations, or QIOs, Livanta and Kepro, which are required to file free, publicly-available annual reports, about the cases they handle, Ross says.

Another company, Maximus, a Quality Improvement Contractor, also files reports on prior authorization cases it adjudicates for Medicare. The free annual reports include data on raw numbers of cases and basic information about the percentage denials either overturned or upheld on appeal, Ross explains.

CMS also maintains its own database on appeals for Medicare Part C (Medicare Advantage plans) and Part D, which covers prescription drugs, although the data is not complete, Ross explains.

7. Give your editor regular updates.

“Sprinkle the breadcrumbs in front of your editors,” Ross says.

“If you wrap your editors in the process, you’re more likely to be able to get to the end of [the story] before they say, ‘That’s it! Give me your copy,’” Ross says.

8. Get that first story out.

“You don’t have to know everything before you write that first story,” Ross says. “Because with that first story, if it has credibility and it resonates with people, sources will come forward and sources will continue to come forward.”

Read the stories

Denied by AI: How Medicare Advantage plans use algorithms to cut off care for seniors in need

How UnitedHealth’s acquisition of a popular Medicare Advantage algorithm sparked internal dissent over denied care

UnitedHealth pushed employees to follow an algorithm to cut off Medicare patients’ rehab care

UnitedHealth used secret rules to restrict rehab care for seriously ill Medicare Advantage patients

The post How they did it: STAT reporters expose how ailing seniors suffer when Medicare Advantage plans use algorithms to deny care appeared first on The Journalist's Resource.