• Medicaid and Medicare Advantage payments for the Island of Puerto Rico; Fee-for-Service calculations for the Island of Puerto Rico; health care funding for the Island of Puerto Rico

Duration: September 1, 2012 to April 1, 2016

General Issues: Health Issues, Medicare/Medicaid

Spending: about $505,000 (But it's complicated. Here's why.)

It can be tricky to figure out how much an organization spent on a particular lobbying engagement. The law only requires lobbyists to report the amount they were paid for federal lobbying each quarter rounded to the nearest $10,000—and if it's less than $3,000 in a given quarter (or less than $13,000 for organizations with in-house lobbyists), they don't have to disclose it at all. Plus, some organizations include spending that doesn’t belong in the report—for instance, money spent lobbying state governments or other legal work.

Agencies lobbied since 2012: U.S. Senate, House of Representatives, Centers For Medicare and Medicaid Services (CMS), Health & Human Services - Dept of (HHS)

Affiliated organizations: MCS (Medical Card Systems, Inc.); MMM (Medicare y Mucho Mas); American Health Medicare; Humana Puerto Rico; Triple-S Salud (SSS)