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Medicaid Who’s Who Interview: Pam Tyranski

1. Which segment of the industry are you currently involved?

A:  Medicaid and Medicare: clinical and quality program development (including value based purchasing components); drafting MCO bids; supporting program implementations; readiness reviews and accreditation evidence preparation; program assessment and re-structure

2. How many years have you been in the Medicaid industry?

A: Do I have to answer that? I started as a youngin’….since January 1988, so that makes it 30 years. I’ve been in healthcare 35 years

3. What is your focus/passion? (Industry related or not)

A: Building provider/MCO collaboration models Non-Industry: travel

4. What is the top item on your “bucket list?”

A: Visiting the town from which my grandparents immigrated

5. What do you enjoy doing most with your personal time?

A: Spending time with my husband, friends and family at the beach-year round it is beautiful.

6. Who is your favorite historical figure and why?

A: I’m a Court of Henry the 8th junkie- Catherine of Aragon is probably my favorite in that cast of characters. Some may argue she made a few ill-advised moves and trusted people she shouldn’t have, but I view that as being human. And from all I have read about her, she exhibited strength, grace, honor, faithfulness, dignity and kindness until her death. I find the plotting, intrigue, exploitation, maneuvering fascinating in Henry the 8th’s court. As a clinician, reading about the remedies they used (in that era and) to treat the King’s maladies and his own concoctions is also interesting to me.

7. What is your favorite junk food?

A: Water Ice (pronounced- “wooter ice”, yes I’m from Philly)

8. Of what accomplishment are you most proud?

A: Two things professionally: My appointment to the Delaware Board of Nursing, on which I’ve been serving by appointment of the Governors since 2011 and leading a Medicaid MCO start-up that went live in 45 days, passed readiness review, and EQRO.

9. For what one thing do you wish you could get a mulligan?

A: I can’t think of one thing I’d like to do over professionally that I wish I could re-wind for another swing at it. I view every experience as a brick in the wall -they all have their place, and upon each I’ve tried to build on what I learned, the successes I had and more importantly the mistakes I’ve made.

10. What are the top 1-3 issues that you think will be important in Medicaid during the next 6 months?

A: 1) The copayment/cost share and buy-in models in the works or proposed in several states-that will be challenging to providers, and intuitively, I worry that members won’t access care soon enough if they have to pay when they are used to not having any out-of-pocket (initially it may save $, but in the long run, I’m skeptical). 2) The work requirements on the table in a few states-how will that impact the rolls? 3) And my biggie is the national push toward value based purchasing models. For many reasons- a) global payments in various permutations have come and gone in the decades I’ve been in managed care- what is going to make them succeed now, and are we going to invest in those resources? b) in the markets I’ve been supporting, there are very few providers equipped to meet the requirements to support the more sophisticated VBP models, and who is going to fund the resources to prepare them for those models? c) I worry that it is too ambitious, and unrealistic to set goals of converting all/vast majority of providers to VBP contracts in the next few years. Will it push the smaller providers who often are the only ones in underserved areas out of the Medicaid programs because they can’t participate or compete? Will that create access issues?

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Clay’s Weekly Medicaid RoundUp: Week of June 18th 2018

Soundtrack for today’s RoundUp pessimist readers- http://bit.ly/2Ib98vV

For optimist readers- http://bit.ly/2Mdn62N

 WELL YOU SAID IF THE LEGISLATURE FUNDED IT… If you’ve been following LePage vs Expansioners, you know that the Good Guvn’r of Maine has sworn to not submit an expansion request to the federalis unless the legislature came up with the money to pay for it (seems logical, but I know desire/emotion trumps logic in our world…). On Wednesday a judge upheld LaPage’s right to not be forced to submit an expansion plan against his will. Then (also on Wednesday) the ME Senate and House approved $60M to expand the state’s program. Your move, Mr. Governor.

 NEW REPEAL / REPLACE EFFORT VIA APPROPRIATIONS? The House GOP budget teed-up on Tuesday includes $1.5T in cuts to Medicaid and “other healthcare programs.” There may also be hooks in the bill to allow for repealing ObamaCare without the Dem votes normally needed (I think this is the “reconciliation” maneuvering but not sure yet). GOP leaders are sounding the alarm over mounting debt and related fiscal crises if we don’t reduce spending. Where are my Medicaid #Resistance Fighters? Shouldn’t you be freaking out / yelling right now? By the way, the new legislation is called “A Brighter American Future.”

 

MEDICAID FRAUD UP 157% SINCE 2013 AND SENATE LEADERS SHOW CONCERN- A new report from the Senate Homeland Security and Governmental Affairs Committee shows Medicaid fraud skyrocketing since 2013 (and it was already ridiculously high). The report claims $36B is lost to Medicaid fraud each year. Some members are laying the blame at CMS’s feet for not “taking basic steps to fight Medicaid fraud.” It doesn’t help CMS’s case that GAO has been sounding the alarm for years. Of the 11 anti-fraud recommendations GAO has made in the last 3 years, guess how many CMS has implemented. Zero. I have been tracking and trying to bring emphasis on the disgrace that is Medicaid fraud for 15 years now.. Not getting my hopes up this report will change much.

 

DEMOCRATS OPPOSE FUNDING NEW OPIOID TREATMENTS VIA MEDICAID- The House passed a bill on Wednesday to cover new treatments for opioid addiction in Medicaid programs. The legislation will allow for funding for addiction treatment to go to facilities with more than 16 beds (this

gets at the IMD exclusion for those familiar with this part of the space). States have been asking – and receiving- waivers to allow exactly this funding. But proponents say the waiver process is taking too long and this law would speed up access to treatment. Opposing dems said it didn’t go far enough.

HOW MUCH DID YOU PAY IN STATE TAXES LAST YEAR? 17% OF THAT WAS FOR MEDICAID – Up from 13% in 2000, according to a new Pew study. All 50 states spent a higher percentage of their funds on Medicaid in 2016 compared to 2000. LA had the highest surge, going from 11% in 2000 to 24% in 2016 (they also expanded Medicaid in 2016).

 

PA AMBULANCES GET 33% MEDICAID PAY RAISE- Standard rates for Advanced Life Support went from $200/trip to $300 in the Keystone State. The Ambulance Lobby (usually its one dude in the state with most of the marketshare) is a real thing. I have seen it in multiple markets over the years.

 

MAJOR CHANGES FOR MDRP? MACPAC (the Medicaid and CHIP Payment and Access Commission) is recommending 2 changes: 1) stop letting pharma set Avg Manufacturer Price using brand and generics, and instead use the prices actually available to wholesalers. This matters because rebates set off of generic prices are lower (and using the generics in the calculation dilutes the amount states can get back). And #2) MACPAC wants HHS to be able to punish manufacturers that don’t provide good enough data to monitor compliance.

MOLINA GETS FLORIDA LOSS OVERTURNED- The MCO had lost its business in 2 regions as part of the recent procurement cycle. After a successful protest, Molina will now continue to serve members in 2 of the 11 FL regions. The new decision is important for Molina – at $550M / year in revenue, the 5-year contract now secures $55M in profits (assuming a 2% profit rate).

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 – er, not so fast. Not enough space this week. Get your fraud fix in the twitter feed (I put 20 or so fraud news items in there this week).

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 (pick tomatoes!) and keep running the race (you know who you are).

FULL, FREE newsletter@ mostlymedicaid.com . News that didn’t make it and sources for those that did: twitter @mostlymedicaid . Trystero: Pityānē putrālā jagācyā tāraṇāsāṭhī pāṭhavilē

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Medicaid Who’s Who Interview: John Corlett

1. Which segment of the industry are you currently involved?

A:  I lead a Cleveland based “think tank” called the Center for Community Solutions. Community Solutions among other things works to support cost effective Medicaid policy through non-partisan research, analysis and advocacy.

2. How many years have you been in the Medicaid industry?

I’ve worked in this space for nearly two decades, first as a researcher and policy advocate and then as President of Community Solutions, as an Ohio Medicaid Director, and as the Medicaid and governmental policy Vice President for Ohio’s largest public hospital – the MetroHealth System.

3. What is your focus/passion? (Industry related or not)

My work passion is getting more people and organizations engaged in policy advocacy. My personal passions focus on my Cleveland neighborhood and the great Cleveland food and cultural scene.

4. What is the top item on your “bucket list?”

Visit Cape Town, South Africa

5. What do you enjoy doing most with your personal time?

Spending time with my partner, friends, and family.

6. Who is your favorite historical figure and why?

Martin Luther King because of he showed how one person could change a country and because he led the fight for justice and racial equality. He was a brilliant and inspiring orator who continues to inspire new generations even 50 years after his assassination. Finally his courage and commitment to non-violence even in the face of physical attack and threats.

7. What is your favorite junk food?

McDonald’s

8. Of what accomplishment are you most proud?

Working with the State of Ohio, CMS, Cuyahoga County, and the MetroHealth System to get an 1115 waiver approved that expanded Medicaid in Cuyahoga County a year early and provided health care coverage to over 30,000 uninsured adults.

9. For what one thing do you wish you could get a mulligan?

While I was Medicaid Director, during the Great Recession, we focused most of our attention on expansion proposals for different categories of individuals which impacted relatively small numbers. Looking back it would have been much better to have focused on simplification measures that would have affected many more people and kept more people covered longer. I also wish I could have focused more on ways to leverage Medicaid to address social determinants of health.

10. What are the top 1-3 issues that you think will be important in Medicaid during the next 6 months?

November general election results, in many cases (including Ohio), will determine future of state Medicaid expansions. If CMS changes in Medicaid eligibility (e.g. work requirements, et al) are allowed to proceed we will need to pay careful attention to how they are implemented. Expect to see some states pursue a “Medicaid for all” option via a 1332 waiver.

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Clay’s Weekly Medicaid RoundUp: Week of June 11th 2018

Soundtrack for today’s RoundUp pessimist readers- http://bit.ly/2HND9BG (from the Arsenio Hall Show – How awesome is that?!?!)

For optimist readers- http://bit.ly/2HOUdqO

 

NY BLEW $1.3B ON IMPROPER MEDICAID PAYMENTS- BUT WHO’S COUNTING?- NY State Comptroller DiNapoli (am I the only one who has long-thought “comptroller” is a very strange word?) released data this week showing $1.3B in “unnecessary” Medicaid spending since 2012. The audit pins the errors on electronic systems. State HHS officials say they are working on the issue and are trying to get the cash back. From what I can tell this could be a mix of inappropriate capitation to MCOs and TPL issues. If anyone in NY knows, please write in.

 

MR BEVIN GOES TO WASHINGTON (OR RATHER WASHINGTON LEFTIES GO TO COURT AND TRY TO DRAG MR BEVIN WITH THEM)- The lawsuit against KY’s work requirements (remember they call it “community engagement”; their opponents call it “work requirements”) is set to have its day in court this Friday. Keep in mind the long list of exemptions means no elderly or disabled person will have to meet the requirements (nor children or pregnant moms)- basically this new Medicaid innovation feature (its done under an 1115 demo waiver) will only affect a subset of the KY Medicaid expansion population. Stay tuned.

 

 NC SAYS NO TO STUDYING EXPANSION- A last minute amendment was added to a rural health bill on the floor this week, but it was promptly removed by the program evaluation committee. Committee leadership says it should be in charge of what gets evaluated, and that all efforts are focused on current efforts around bringing managed care to the state right now.

NASBO SAYS MEDICAID SPENDING TO SLOW DOWN IN NEXT FY, BUT THEN SPEED BACK UP- A NASBO report published this week shows most Medicaid program spending increasing by about 4.5% in FY 18’. When they take out their crystal balls for FY 2019, its around 1.5%. After this slow down, Medicaid hits the gas again and starts spending 5.5% more in future years. The report examines proposed Governor’s budgets each year. If the Medicaid spending adds proposed in those budgets goes through, and additional $5.3B in state funds will be added to the Medicaid industry next year. Well, a lot more than that when accounting for agencies overspending their budgets (which invariably will happen).

 NH SA PROVIDERS NEED MORE MONEY- They currently get $162.60 per patient per day for inpatient substance abuse treatment ($4,878/month). Providers say this is well below cost, and are asking for $10M per year from Medicaid.

 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.  Duke Ellington Ellis of Durham, NC will have to repay $1M (yeah, right!) for his role in fraud scheme in which he forged signatures of licensed psychologists to submit fraudulent claims. His company – gotta love the names they give these things – “Nature’s Reflections” stole $8.7M over the course of the scheme. LaGracia Burnett of Philadelphia plead guilty this week to stealing $211k for false claims for behavioral health services for autistic children. Seems she had broken the laws of physics and was delivering services at 3 different clinics at the same time. Arkady Goldin of Brooklyn stole $1.5M using a kickback scheme involving his pharmacy. He paid a local medical center employee to send expensive cancer scripts his way. Goldin also billed for drugs never delivered. And this is cool- the state figured that out by checking his Medicaid reimbursements against his orders from wholesalers. Mr. Ellis – you win this week’s award on sheer volume alone. Congratulations!

 

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 (build a nice fence) and keep running the race (you know who you are).

FULL, FREE newsletter@ mostlymedicaid.com . News that didn’t make it and sources for those that did: twitter @mostlymedicaid . Trystero: ua tono mai te Metua i te Tamaiti ia faaora i te ao nei

 

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Medicaid Who’s Who Interview: Jon Hamdorf, Kansas Medicaid Director

1. Which segment of the industry are you currently involved?

A: Public Insurance – Medicaid

2. How many years have you been in the Medicaid industry?

A: 1 year

3. What is your focus/passion? (Industry related or not)

A: I have a passion for serving others. Throughout my life I have always gravitated toward service orientated positions. In my college years, I was a deputy sheriff. Post-college, I worked in healthcare IT for multiple companies in leadership roles that either supported a sales organization or customer organizations and now I am serving as Kansas Medicaid director and Director of the Division of Health Care Finance serving the individuals on our Medicaid program and in our State Employee Health Plan.

4. What is the top item on your “bucket list?”

A: To finish my PhD. I am currently a PhD candidate at University of Kansas Medical School in the Health Policy and Management Department.

5. What do you enjoy doing most with your personal time?

A: With serving as a Medicaid Director and trying to finish a dissertation, personal time is rare. When I do have it, I enjoy riding in my Jeep Wrangler with the top down, driving across the Kansas countryside with my wife Angela and my dog Samantha.

6. Who is your favorite historical figure and why?

A: Dwight D. Eisenhower. Eisenhower was a leader and a hero, but also a down-to-earth personable man who united the nation. I love that when he decided to run for president, he was courted by both the Republican and Democratic party. I often walk over to the Kansas capitol building and look up at the statue of Eisenhower and imagine what it would be like to have a conversation with him and learn from his experiences.

7. What is your favorite junk food?

A: Giordano’s Pizza. If anyone from Giordano’s corporate office sees my answer, please strongly consider opening a restaurant in Kansas City. It would make me very happy.

8. Of what accomplishment are you most proud?

A: I am most proud of the culture changes we have been able to make in Kansas Medicaid. My staff is amazing and they have done a fantastic job engaging with stakeholders, legislators and individuals in our program to develop solutions and better serve the individuals in the Kansas Medicaid program.

9. For what one thing do you wish you could get a mulligan?

A: My mother made my older brother, my younger sister and I play the piano when we were young. We all were able to stop when we went to junior high and started participating in athletics. If I had a mulligan, I wouldn’t have stopped playing the piano. I have a keyboard that I still play on when I have time, but I would love to be proficient at it.

10. What are the top 1-3 issues that you think will be important in Medicaid during the next 6 months

A:

1) Integrating social determinants of health to provide whole person care
2) Establishing individualized plans of service to understand members life goals and develop tailored solutions
3) Figuring out early, targeted interventions to change the life trajectory of young people in Medicaid to give them the skills to live independent, fulfilling lives. This will provide financial solvency to the Medicaid program and help end the cycle of poverty.

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Medicaid Industry Who’s Who Series: David Brueggeman

Medicaid Who’s Who: David Brueggeman – Medical Economist and Manager of Actuarial Science @ Caresource

  1.  Which segment of the industry are you currently involved?

A:   I work at CareSource, an Ohio-based nonprofit health plan that serves nearly 2 million members spread across Ohio, Kentucky, Indiana, West Virginia and Georgia. Our membership is supported by a workforce of 4,000 employees.

2. How many years have you been in the Medicaid industry?

A:  I have been in the Medicaid industry for seven years, concentrating on FP&A, Medical Economics, and Actuarial areas. Prior to joining the payer side, I spent three years on the provider side, which I think gives a healthy perspective of the challenges on both sides of the table – challenges magnified by the fact that Medicaid is often the lowest payer in the portfolio.

 3.  What is your focus/passion? (Industry related or not)

A: I try to understand the needs and motivations of others. In Medicaid, we are challenged with helping policymakers and sometimes our own staff in understanding the motivations of the populations we serve who may lead vastly different lives than our own. At CareSource, we have a Poverty simulation that our staff goes through to understand the mindset and day-to-day experience of our members, including those with chronic health conditions. I am a firm believer that you have to walk a mile in someone’s shoes if you want to truly understand them, and I apply that to both work and in my personal life.

 4.  What is the top item on your “bucket list?”

A: There are several people I would like to meet, including former President Barack Obama, Atul Gawande (surgeon and author of the Checklist Manifesto), and Richard Thaler (father of behavioral economics). I did most of the other items (skydiving, rock climbing, motorcycle riding, backpacking in Europe) before I had children in case something went terribly wrong.

 5.  What do you enjoy doing most with your personal time?

A: I enjoy spending time with my wife and two young children. A recent favorite moment involved laying in the grass explaining the vastness of space and all the interesting discoveries humanity is making about black holes and exoplanets to my intensely curious 6 year old. I am also a voracious reader of science, technology, business, and political magazines and blogs.

 6. Who is your favorite historical figure and why? 

A: Leonardo Da Vinci. His incredible breadth and depth of knowledge and ability to connect disparate concepts to create innovation are the same capabilities I strive for every day.

7.  What is your favorite junk food?

A:  Here in Dayton we have something called Killer Brownies from Dorothy Lane Market. They are incredible slices of heaven – brownies with chocolate and caramel and optional nuts – but not so good for the waistline.

 8.  Of what accomplishment are you most proud?

A:  Early in my career at CareSource, I was assigned to an internal think tank that was tasked with figuring out how we could get past certain roadblocks in our member experience. Why was health so low on our member’s priority list? We really dug into the social determinates of health both from an academic and applied perspective. We also sat down with real members and asked them some important questions and gained key insights that led to the creation of our Life Services division, which is focused on assisting members with several aspects of the social determinants model. We are actively trying to help people move out of Medicaid and be the best version of who they can be.

9. For what one thing do you wish you could get a mulligan?

A:  This is a difficult question. I would initially say that starting my career in banking was a mistake as I eventually realized that being a monetary lubricant was not a life goal for me; however, I learned a lot about technology and consumer-centric approaches that serve me well today. I believe the only true mistake is one you don’t learn from.

10. What are the top 1-3 issues that you think will be important in Medicaid during the next 6 months? 

A:  

One, as participants in IN, OH, and KY Medicaid programs which all have either approved or pending waivers, we are seeing firsthand both the opportunities and challenges that come with work requirements and “skin in the game” benefit designs. The jury is still out on whether these concepts will have the desired outcomes, but many states are jumping in with both feet.

Two, I think that Medicaid plans need to start collaborating more in designing value based models to minimized the burden on providers who are trying to accommodate ten or more models with differing goals and intentions from different payers.

Three, I think we as an industry need to start thinking about what health means to our populations and how we can best engage. At the TEDMED conference, I was inundated with app developers promising to move the needle. I asked a simple question: “If better health is #15 on the priority list of an individual, #1 being food, #2 being shelter… and #10 being Facebook, how does this move me above Facebook?” These are the questions we need to ask ourselves if we are going to have a real impact on our members’ lives.

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Medicaid Industry Who’s Who Series: David Newell

Medicaid Who’s Who: David Newell, President and CEO @ PromiseShip

  1.  Which segment of the industry are you currently involved?

A:  Children and family services

2. How many years have you been in the Medicaid industry?

A: Around 26 years

 3.  What is your focus/passion? (Industry related or not)

A: To transform child and family services in the United States.

 4.  What is the top item on your “bucket list?”

A: I would love to travel extensively across India and Nepal.

 5.  What do you enjoy doing most with your personal time?

A: Film photography usually of my kids and family.

 6. Who is your favorite historical figure and why? 

A: Abraham Lincoln.  I have always been fascinated by his brilliance, leadership, humor and tenacity despite many life challenges and personal failures.  I am in awe of him.

7.  What is your favorite junk food?

A: Pizza

 8.  Of what accomplishment are you most proud?

A: The work at my current agency, PromiseShip, makes me very proud of how we have been able to improve child and family outcomes in Nebraska

 9. For what one thing do you wish you could get a mulligan?

A:  Well, I wish I could start over being a husband and dad with what I know now.

10. What are the top 1-3 issues that you think will be important in Medicaid during the next 6 months? 

 

A: I am very interested in the intersection of the Family First Prevention Services Act and Medicaid services for kids and families.

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Clay’s Weekly Medicaid RoundUp: Week of May 25th 2018

Soundtrack for today’s RoundUp pessimist readers- http://bit.ly/2KSCG2Y

For optimist readers- http://bit.ly/2KT2aNX (A Dick Cavett reference for my friend Jeff, the Tall Irishman)

 

 ABOUT LAST WEEK- There was way too much parenthetical thought (I apologize). [I will try to do better this week]. I promise.

 MINNESOTA ASKS FOR WAIVER TO ALLOW RESIDENTIAL SA TREATMENT- Now that views on residential treatment in places with more than 16 beds are changing (under the weight of the opioid epidemic), states are looking to relax rules meant to defund those horror-story mental health facilities from back in the day. If approved, MN will join 11 other states who have recently received the exemption to allow drug addiction treatment in facilities with more than 16 beds.

 NC ADDS WORK REQUIREMENTS TO MUCH-WATCHED WAIVER REQUEST- Journalists now see this as a poison pill to the NC effort based on 1 comment Verma made a few weeks ago about concerns over non-expansion states and work requirements.

GEM STATE REACHES VOTER CRITICAL MASS- The evolving nature of U.S. Government- in which the Constitution is but a piece of junk mail sent to us from those crusty, silly, old (add in still-socially acceptable slur here) guys back in the day from some place in the Northeast I think- now includes voters taking over the power of appropriations from Congress. Seems voters in Idaho are joining the mob of MoveOn-ers who think they can ballot anything they want into existence. Idaho activists confirmed they reached the necessary 58,000 signatures to put Medicaid expansion on the ballot in November. If they had to pay for what they are voting for, they would swipe their card for $3,206 (each, annually) to cover the costs (state and federal) for the 62,000 members their vote will add to the Medicaid rolls. But we all know its silly to expect voters to consider costs of their decisions. That’s someone else’s problem, right?

LEPAGE MAY GET OVERRULED- A Maine judge is deciding whether to order the state DHS to file a waiver request for expansion as chosen by voters. Roundup readers will remember that the Good Guvn’r LePage said he ain’t doing nothin’ to move it forward unless the legislature funds it.

SD WORK REQUIREMENTS PLAN GIVES SECOND CHANCES- SD policy makers have added another step before getting booted off if you don’t meet work requirements. Under the new proposal, bennies would get on a corrective action plan after not working 80 hours in a given month. Then if the CAP doesn’t fix it, they would get booted. The new feature is designed to avoid getting shot down by CMS as “too harsh” in a non-expansion state.

EVERGREEN STATE ANNOUNCES MCO WINNERS- The latest round of MCO awards in Washington concluded this week. Congrats to Amerigroup, Molina, UHC, CHPW and Coordinated Care. Special congrats to Molina and Amerigroup who nabbed statewide contracts for integrated care in all 9 regions.

VA LETS EVERYBODY DOWN-  Everybody hoping for expansion this week, anyway. Virginia Dems were expected to push through an expansion vote on Tuesday, but needed 1 Republican to defect to the SpendMore side. Without getting to much into the weeds of VA legislative procedure, basically this bill needs to get out of committee and it didn’t do that just yet. The majority leader in the VA senate announced this week that he expects it to pass, even if it does take a minute to work out the details. Be patient my dear Dems – you will be able to implode the VA state budget soon enough.

IOWA ON THE REBOUND WITH CENTENE – After a nasty breakup with Amerihealth, Iowa announced Centene is its new love interest this week. Announced this week, will start July 2019. Congratulations to all our Centene colleagues!

 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. Khurram Gondal of Ticonderoga, NY (and 11 other co-conspirators) were arrested this week for defrauding Medicaid out of at least $8M using their bogus transportation business. This scheme includes trips that never happened and kickbacks to complicit bennies. Roshanak Khadem (and 4 others) of Los Angeles were arrested on Tuesday for their part in a $20M scheme. Khadem (aided by a former Anthem investigator, who knew the ropes) and team would bill MCOs for things not provided using the billing numbers from bennies who were happy to get “discounts” on cosmetic procedures. Seems an allergy-related lab test CPT code was a hole about the size of a Mac truck in the MCO edits system. Keisha Demas of Brooklyn was arraigned this week for stealing about $500k, of which $60k was from NY Medicaid via a false claims scam related to her role as a nurse at Interfaith Medical Center.  Congrats, Roshanak- using a former MCO investigator as a fraud consultant gives you the style points needed to win this week!

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 (take some cutting, and propagate something already doing well on your property) and keep running the race (you know who you are).

FULL, FREE newsletter@ mostlymedicaid.com . News that didn’t make it and sources for those that did: twitter @mostlymedicaid . Trystero: il-Missier bagħat lill-Iben biex isalva d-dinja.