Clay discusses the Medicaid news with Jerry Dubberly of Myers and Stauffer, Alex Shekhdar of Medicaid Health Plans of America, and Mark Washington of Social Solutions.
Medicaid News Roundtable: June 2016
Category: Amazing Free Content
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).
—-
FULL, FREE newsletter: http://eepurl.com/ep81Y
News that didn’t make it and sources for those that did: twitter @mostlymedicaid
Otets prati Sina , za da spasi sveta
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
Otac je poslao Sina da spasi svijet
Medicaid News Roundtable: May 2016
Clay discusses the Medicaid news with Ray Hanley of the Arkansas Foundation for Medical Care, Cathy Huff of Fetch Multimedia and Kris Vilamaa of Germane Health Solutions.
Medicaid State Spotlight: New York
We spoke with Jason Helgerson, the New York Medicaid Director. He covered lots of topics with the group, including the Medicaid Redesign initiative, New York’s Delivery System Reform (DSRIP) program, and the Payment Reform project.
Medicaid Industry Who’s Who Series: Ray Hanley
Ray Hanley is a featured panelist for the upcoming Medicaid News Roundtable Webinar on May 27th. RESERVE your seat today at bit.ly/1S4sns9!
Medicaid Who’s Who: Ray Hanley – CEO of Arkansas Foundation for Medical Care
- What is your current position and with what organization?
A: The CEO of Arkansas Foundation for Medical Care, a 240-employee organization that sprang from the old PROs of the 1970s, but which today does a wide variety of work for Medicaid, Medicare and others.
- How many years have you been in the Medicaid industry?
A: I began as an Medicaid eligibility caseworker in 1974, went on to managed Medicaid UR, and then Medicaid Director for Arkansas for 16 years, then to EDS/HP as client executive working with Medicaid agencies.
3. What is your focus/passion? (Industry related or not)
A: Improving access to health care and improving the quality of that care which is one of the reasons I led the 35 organization “AR Health, AR Jobs Coalition” that worked to pass expanded Medicaid coverage in Arkansas.
- What is the top item on your “bucket list?”
A: Help move Arkansas substantially up in health rankings among states.
- What do you enjoy doing most with your personal time?
A: Biking around the world since I had to give up running marathons 4 years ago with bad knees, so far I have biked on four continents. Otherwise spending time with my family at a log cabin near the Buffalo National River in the rugged Arkansas Mountains.
I’ve also put into print 20 Arkansas history books.
- Who is your favorite historical figure and why?
A: Teddy Roosevelt who created the conservation movement from his “bully pulpit”
- What is your favorite junk food?
A: Pizza
- Of what accomplishment are you most proud?
A: Two daughters who, while raising 4 young children between them, turned out to be outstanding people and health care professionals in their own right.
- For what one thing do you wish you could get a mulligan?
A: Since I’ve never played golf, I have no idea how to answer that.
10. What are the top 1-3 issues that you think will be important in Medicaid during the next 6 months?
- Access … too many states have not expanded coverage, especially in the South.
- Access … in that too many providers won’t see Medicaid patients in part because the rates are too low … coverage without access is self-defeating.
- Quality improvement … driven by wider use of outcome-based payment metrics and refinement of the patient-centered medical home concept.
Clay’s Weekly Medicaid RoundUp: Week of May 2nd, 2016
BUCKEYE STATE ON FOOLS ERRAND- Ohio has the laudable, but laughable, goal of implementing a requirement that Mcd bennies chip in $99 bucks (or about 1.5 cartons of Marlboro Reds in Ohio) a year. The member contribution would go to a health savings account. There would also be new copay requirements (the state would dump a grand into the HSA to help with those). I give this less than a 5% chance of passing given the “your-evil-for-even-suggesting-there-be-the-slightest-cost-to-the-member” mentality of most of those in our Mcd world.
EMPIRE STATE CONSIDERING MCD COVERAGE FOR EX-CONS- The Good Guvn’r Cuomo is horse-trading with CMS as we speak to get Mcd funding for the plan. His plan appears to be a limited scope benefit, designed to help with substance abuse and a defined set of medical conditions.
UPDATE ON AL MCD USING BP OIL MONEY FOR FIX- It didn’t happen. Seems that some state senators wanted to use the money AL got to deal with the coastal disaster on roads instead of Medicaid. Officials are now foreshadowing the areas to be cut the most. It’s getting hot down here, and its not even June.
SUNFLOWER STATE SLOWS DOWN ON WAIVER INTEGRATION PLAN- The Good Guvn’r Brownback of KS will not veto a legislative directive to stop efforts on the integrated waiver services for Kansans with disabilities. The planned waiver was aimed at increasing HCBS services for members, but advocates were concerned of the speed and ambiguity of the plan.
WE DID NOT THINK OF THE IMPACT OF THE MINIMUM WAGE HIKE ON MEDICAID COSTS, COMRADE- When NY decided to raise its minimum wage from $9 to $15 by 2018, seems no one did the fiscal impact analysis on Mcd costs. As we in our insulated, behind-a-computer-or-on-a-plane-each-week jobs often forget, the healthcare industry employs many minimum wage workers. This provider increase (the wage hike) will add $13M to this year’s NY Mcd costs and $88M to next year’s. And the year after that, and the year after that . . . No worries. Close your eyes and remember the money trees in Washington, D.C. They’re so pretty this time of year.
LOTS OF LITIGIOUS PAYDAYS FOR STATES- Lots of cash flying around this week, mostly from big pharma to states. KY got $5M from Pfizer related to drug rebates not paid on Protonix (an antacid drug – [INSERT HEARTBURN JOKE HERE]). IN got $9M from the same lawsuit. WA got $23M. Total payout to all states and federalis was $784M (ouch, Wyeth. But at least you can move on and watch the stock price rise now that the settlement is done, right?).
FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph. Wayne Wilson of Statesville, NC is headed to the big house for 18 months for stealing $210k for services he did not perform. Wayne is a doc who thinks Mcd didn’t pay him enough, so he “padded” his claims. Dwight and Charmetra Reece (man, there is a lot of husband and wife Mcd fraud) of Oklahoma City were charged this week with stealing $99k from Mcd. The couple operated a counseling agency and billed for services not delivered. Including payments for Charmetra’s mother (who is not a licensed counselor). Agape Health of Alexandria, VA has settled with Mcd this week over allegations it billed for transportation services not provided. Total bogus cab fare – $386k. Agape – you win! Follow that cab! (to jail. Do not past Go.)
I CAN’T NOT WRITE ABOUT THIS- George Clinton will release a new album this year entitled “Medicaid Fraud Dawgs.” I am not making this up.
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
Pitāra biśba sanrakṣaṇa putrakē pāṭhiẏēchilēna
Medicaid Special Topics Series: Long Term Care (May 2016)
We spoke with Camille Dobson of the National Association of States United Against Disabilities (NASUAD) and Warren Hebert of the Louisiana Homecare Association about key topics in the Medicaid industry today. Camille provided insights about new federal LTC regulations, and Warren spoke from the perspective of a family caregiver for a member with long term care needs.
Clay’s Weekly Medicaid RoundUp: Week of April 25th, 2016
BRITISH PETROLEUM TO FUND AL MEDICAID- Lawmakers struggling to scrounge up funds to fill the Mcd budget gap have come up with a way to leverage money the state is owed from the BP oil spill. It’s a little tricky for me to understand but it involves a bond issue that then gets paid off with BP money and I think somehow a new (or quicker) $85M pops out to plug Mcd. Not sure yet on the reaction from coastal residents who may see the move as snatching the funding tied to the devastation of their environment six years ago.
EMPIRE STATE TO COVER HEP C DRUGS- This follows a recent lawsuit requiring commercial plans in NY to cover drugs like Sovaldi and Harvoni. There are 25,000 new Hep-C cases in NY each year. At some point, each of those could become eligible for the drug, creating a new $2B annual spending item for Hep-C rx alone.
LA MEDICAID EXPANSION IS ROLLING OUT NOW- The state is beginning to migrate members from existing programs that already meet the Mcd expansion population requirements. Members of Take Charge Plus and New Orleans Community Health Connection were asked to update addresses this week so that they can receive their brand new Mcd cards.
AZ HOSPITALS RECEIVED MORE THAN $1/2B RETURN ON THEIR MCD “TAX”- The Medicaid Magic Money machine strikes again. St Joe’s had the biggest ROI on the “tax”, receiving more than $24M than it put in. The money trees in D.C. did look a little sickly last week, but they were watered and rebounded quickly.
MOUNTAIN STATE WILL GLADLY PAY YOU ON FRIDAY FOR A HAMBURGER TODAY- It’s never a good sign when the Mcd agency sends you a letter saying it may be a while before you get paid because state revenues are down. Yet that’s what WV did to 24,000 Mcd providers this week. At least they gave you a heads up, I guess?
MCO WINS IN THE KEYSTONE STATE- Centene and UPMC won bids in SE PA this week under a new effort to negotiate pay for outcomes MCO contracts (up to 30% of payments tied to outcomes). Congrats to our friends and colleagues in Centene and UPMC!
AH, THE MEGA RULE- As most of you by now know, the final Medicaid Managed Care Rule was released Monday. There’s simply too much to cover but 2 quick things- the already voluminous 653-page rule more than doubled itself to 1,425 pages (maybe they fed it after midnight, or got it wet?). And #2- everyone I know says it seems like CMS just ignored most of the comments. Not sure on that last one, but hope to do a show on it soon and have some good discussion on it.
FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph. Darin Cox of NY got $80k in Mcd payments for his taxi service carting bennies to appointments. Thing is, he didn’t have a taxi license. Robert Rouzaud of Cleveland, OH got charged this week for false Mcd claims for tooth fillings. Mr. Rouzad got paid $343k for fillings for teeth that had previously been pulled, or for patients with dentures. And in one of our rare (rarely detected, anyway) cases of member fraud – Jennifer Garret of Chandler, AZ got indicted this week. Mrs. Garret received more than $70k in Mcd (and other) state benefits, all while her and her husband made loads of cash on their car restoration business. Enough to buy a Nissan 350-Z and Mercedes SUV while toting a Medicaid card in her pocket. Mr. Rouzad, you win! Mr. Cox – perhaps you should consider an Uber career? Mrs. Garret – perhaps Mr. Cox could borrow your Mercedes if he gets out before you do?
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 (remember to water those seedlings!) 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
Ata dünya saxlamaq üçün Oğlunu göndərdi
Medicaid News Roundtable: April 2016
Clay discusses the Medicaid news with Joel Mengers of the Menges Group, Bruce Greenstein of Blend Health Insights and Dr. Craigan Gray of Salient Health Solutions.