Clay’s Weekly Medicaid RoundUp: Week of April 11th, 2016

GOLDEN STATE WANTS ITS MONEY BACK- By now I don’t even have to tell you the details. If “MMIS” is in the sentence, you can tell me the rest: overbudget, late and ugly. CA just signed the divorce papers with Xerox (old ACS for anyone returning to the space, or those – who like me- never could make the mental switch from ACS to that company that makes copiers). The implementation is far from finished, but the state has decided its better to just start over. I’m sure CMS is happy, since they paid 90% of whatever has been paid so far. Xerox has agreed to pay the state $120M, and continue operations until 2019. Ouch.

BEEHIVE STATE EXPANSION COULD BEGIN NEXT YEAR- If CMS approves it. The main hitch is that the UT plan will cover about 16,000 new members. If UT has just been a good little soldier and taken the expansion exactly as offered, about 100,000 would have been covered. The expansion will cost UT $30M each year, and hospitals have volunteered to be “taxed” to cover about half of that.

PINE TREE STATE POLITICIANS PASS SYMBOLIC EXPANSION VOTE- Dems in the Maine Senate and house passed a largely meaningless bill this week- but everyone still expects the big bad wolf, er, I mean the Good Guvn’r LePage to veto it. Don’t count it out just yet – the GOP governors have fallen one by one on expansion the last few years. LePage just needs to figure out how to make it not look like “ObamaCare” in the press release.

LONE STAR STATE CUTS GO THROUGH – TX Medicaid agency have to follow the budget as passed by the legislature (egads!), which includes $350M in cuts. Although our hero, District Judge Tim-Screw-Checks-and-Balances Sulak blocked the cuts made in accordance with the law of the land last September, the TX Health and Human Services Commission testified this week that it has to follow the legislature’s instructions and make the cuts.

UPDATE ON OUR SUPPORT VETS FUNDRAISER- Last week I asked for suggestions on a charity we (the Mostly Medicaid Motley Crew) could all donate to between now and 4th of July. All you Readers who wrote in – thank you! I got several great suggestions, and will start running links to them in the newsletter each week until 4th of July. I don’t know a really good way to calculate how much we all give combined (and that’s not the point anyway). If you do give to one of those listed, please post a note in the Mostly Medicaid LinkedIn group, or comment on one of my posts related to this. $ amount doesn’t matter – let’s just encourage and challenge our healthcare industry colleagues to show support with a focused effort the next few months.


FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph. Shifo Healthcare Services (a home health company) of Ohio is under investigation for $2M in overpayments as of this week. OH Auditor Dave Yoast is digging but not finding documentation supporting the claims. Yury Baumblit of NY runs a flophouse (had to look that up), and got charged this week with $2M in Medicaid kickbacks related to addicts living in the flophouse. Seems Yury forced tenants to attend Medicaid group therapy sessions for substance abuse, and providers paid Yury and his wife (Rimma) kickback fees. Step by Step Senior Care (another home health company) of Little Rock, AR agreed to pay back $472k this week for charges related to billing for imaginary patients. Miami fraudsters David and Cecilia Krochmal were arrested this week for $100k in Mcd payments related to services not delivered for I/DD members. Mr and Mrs Baumblit – you win! And wow. That’s some really terrible stuff.

That’s it for this week. As always, please send me a note with your thoughts to or give me a buzz at 919.727.9231. Get outside (spring planting almost done!) and keep running the race (you know who you are).


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‘arsal al’ab w alaibn li’iinqadh alealam