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Archive Monthly Archives: June 2016

Clay’s Weekly Medicaid RoundUp: Week of June 6th, 2016

Soundtrack for today’s RoundUp pessimist readers- http://bit.ly/1UGzggU

Or you can click the one for optimist readers – http://bit.ly/1UGznci

BEAVER STATE 1115 ON SCHEDULE- Oregon will be submitting more of a continuation waiver than major changes for its Care Coordination Organization (CCO) model. The first major report on the CCOs for the state will be July 1 this year, with the waiver renewal application timed for late summer. According to the Good Guvn’r Brown, she wants to get it approved before the White House changes hands. Maybe she knows something we don’t?

BUCKEYE STATE GETS NOD FROM THE BIG HOUSE- Ohio just got CMS approval for their plan to move nursing home residents back into the community. OH has been doing this already, with 8,000 residents driving away in a U-Haul with crying nursing administrators staring at tail lights.

NATURAL STATE ADDS 25,000 TO THE ROLLS SINCE FEB- Despite all the legislative brinksmanship this spring, AR still found a way to grow the expansion rolls to 290,000.

SOONER STATE DOCS DODGE A BULLET- It was dire and desperate in OK up until last week. Medicaid providers faced a 25% rate cut. But somehow, magically – no miraculously – state legislators were able to give Medicaid $99M more this year compared to last. Amidst a $1.3B state budget shortfall. I truly am in the right line of business. Medicaid, you need way more money every year? Sure thing! Education, roads, everybody else – sorry!

PEACH STATE WARMS UP TO THE SUGAR MONEY- State Senator Renee Unterman shot down ACA expansion cash, but is now suggesting (on the state senate floor) that GA should consider doing an 1115-style expansion instead.

HOOSIER STATE CLAIMS “THE TEACHER DOESN’T LIKE ME”- IN got an emergency approval of its “conservative” (reads – not nearly as far left as the administration likes) Medicaid expansion plan this April. Now CMS is surveying members to see how they like the “conservative” approach, and IN says the surveys are biased against their model. And it sort of matters beyond IN – states like AZ, KY and OH would like to get them one of those new-fangled “conservative” Medicaid expansions, too. Who knew Medicaid could be so political? I thought it was just healthcare, right? The main Hoosier complaint is that there are plenty of questions about why you might be dissatisfied with the plan, but none asking why you are satisfied with it. Apparently question #17 had some rattled. The survey question reads: “Are you now, or have you ever been, a member of the Republican party?”

FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph. Let’s start the ticker and see who wins this week’s award. Barbara Sadler and Sedric Blakes of “Extraordinary Care Network” were convicted on a $1.2M Medicaid fraud charge this week in Baton Rouge, LA. Their crimes? Billing for one on one therapy that didn’t happen, forging signatures and fabricating client progress notes. Jennifer Green and Andria Jones of Jackson, MS got popped this week for a $1M fraud in which they got paid for bogus counseling claims. Candia Tolbert, who operated “No Child Left Behind Behavioral Health Services,” was convicted this week on $100k for false claims. Congratulations Barb and Sedric – you win by a hair, just barely beating out Jennifer and Andria.

REMINDER – NO STATE SPOTLIGHT SHOW THIS MONTH, BUT STILL DOING THE NEWS ROUNDTABLE SHOW– I know people plan their weddings and other things around those, so just trying to get the word out.

That’s it for this week. As always, please send me a note with your thoughts to clay@mostlymedicaid.com or give me a buzz at 919.727.9231. Get outside (the sun is up earlier now!) and keep running the race (you know who you are).

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FULL, FREE newsletter: http://eepurl.com/ep81Y

News that didn’t make it and sources for those that did: twitter @mostlymedicaid

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Clay’s Weekly Medicaid RoundUp: Week of May 31st, 2016

Back from one of my infamous breaks. One of the interns told me that CMS passed some sort of “Mega Rule” while I was out. That doesn’t sound too terribly important, so we’ll skip it for today.

Soundtrack for today’s RoundUp pessimist readers- http://bit.ly/1ZiOmgC . Trust me, its cool. Click it. You know you want to. Or you can click the one for optimist readers – http://bit.ly/1ZiOwEI

As is our custom here in RoundUp Land, when returning back from a break, let’s start with the red meat.

FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph. Let’s start the ticker and see who wins this week’s award. Florence and Michael Bikundi of D.C. just got sentenced for the largest ever Medicaid fraud against the District – a whopping $80M over 5 years. They used their home health company – Global Health Care Services – to enrich themselves and relatives by paying Medicaid bennies kickbacks for lying about claims for services not provided. Edward and Contina Foxx of Bedford, VA got sentenced this week for bennie fraud. They received $80k of Medicaid benefits but failed to report $500k in income they got from their scrap metal business. Mary Ann Stewart (such a wholesome sounding name, amiright?) of Pittsburgh is going to the Big House (not CMS, the other one) for operating a bogus hospice. She nabbed $500k from Medicare and Medicaid by admitting members who weren’t actually terminally ill. But doesn’t hospice require a doctor saying you need it? Yep – “Dr” Oliver Herndon helped Mary Ann out there with bogus claims. He got 3 years for his part of the fraud. “Dr” Naimetulla Syed of Newtown, CT got popped for $400k in upcoding Medicaid psychiatric claims. Seems he liked to bill for 45 minutes of therapy but only deliver 30 minutes. A housing and assistance company that serves DD members in Middletown, CT has to fork over $1.5M for falsified cost reports. Mobile Pharmacy Solutions of Buffalo, NY has to pay Medicaid $442k for filling scripts for a barred doc (“Dr” Mikhail Strutsovskiy). Still in the Empire State – Andrew Barrett, a pharmacist from Queens, pled guilty this week for $2.7M in bogus HIV meds scripts. And finally, “Dr” John P. Moore the 3rd (I imagine him with a monocle and cigar, much like Thurston Howell the 3rd on Gilligan’s Island) was sentenced to 20 months in the slammer for $80k worth of Medicaid fraud. His rap sheet now also includes drug trafficking, theft and permitting drug abuse. Phew! A lot happens in a few weeks’ time. So many to choose from… This week’s award goes to the 2 lovebirds in D.C.-  Mr and Mrs Bikundi – enjoy your stay in the jailhouse. Maybe you can get the Honeymoon Suite?

OFF ™ SALES TO SKYROCKET AFTER MEDICAID COVERAGE- Zika is our latest microscopic enemy, and the federalis just approved Medicaid cash for Mosquito repellant.

THE LEVEE BREAKS- The Hep C rx spending tsunami is set to obliterate already anemic state budgets after a string of lawsuits (and threatened lawsuits) felled any remaining speed bumps in several states last week. FL and WA both announced less restrictive coverage policies, and PA is on the brink of falling in line.

IF ONLY I KNEW A WELL-CONNECTED MEDICAID ENTREPRENEUR- The Big House (CMS, not the other one) knows it needs some innovation from the private sector and is reaching out. Its doing a road-show with tech firms (Slavitt went to Silicon Valley this week) trying to gin up some techie brain power. They also have a sort-of job posting for a “well-connected entrepreneur” to serve as a “Sherpa” to help tech companies get to know Medicaid. Anyone ever met one of those?

That’s it for this week. As always, please send me a note with your thoughts to clay@mostlymedicaid.com or give me a buzz at 919.727.9231. Get outside (the sun is up earlier now!) and keep running the race (you know who you are).

—-

FULL, FREE newsletter: http://eepurl.com/ep81Y

News that didn’t make it and sources for those that did: twitter @mostlymedicaid

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