Clay’s Weekly Medicaid Roundup: Week of February 1st, 2016

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DÉJÀ VU?- Iowa Senate dems are promising to repeal the privatization of Mcd (fancy politico-speak for “hey we just got MCOs in our state”). House Republicans are promising the bill will be DOA. Isn’t this rich- we now have dems (albeit on a state level) making meaningless gestures about repealing a major change to the healthcare delivery system. Sound familiar (but reverse everything and make it national)?

ROLLING BACK EXPANSION, ONE LAWSUIT AT A TIME- AK anti-expansioners aren’t giving up. Reps appeared in court this week for the lawsuit to stop the unilateral expansion Guvn’r Walker did late last year. The Judge told them he will make his decision on whether the case can proceed by March. Both sides agree the case hinges on the interpretation of the word “requires” in one line of AK law (run over to the twitter feed for more detail).

CLOCK STARTS ON VA LTSS OPPORTUNITY- Our RFP Batphone has been ringing about this one for a few weeks now. The key info is that VA won’t be renewing its duals demo but will instead make most of it permanent with an 1115 waiver (submitted to CMS Jan 19). MCOs everywhere are sharpening their pencils for the RFP expected to drop in the next few weeks. For those interested, there was also an MLTSS databook released by the state mid-December.

2 DATA BREACHES- GA and LA both reported data breaches of Mcd benny PHI this week. In the Peach State, Centene lost hard drives of about 950k member’s data. In the Pelican State, someone who worked at a doctor’s office stole about 13,000 benny IDs and gave it to another provider.

HOME HEALTH UNDER INVESTIGATION IN MA– There has been an 82% surge (vs 2014) in home health spending in the Bay State. Per recent analysis, 62 companies are driving the surge (and they just so happened to have started doing business with the state during the last 2 years). Stay tuned.

IT HAD TO HAPPEN SOMETIME: A LARGE PLAN AND A “POPULATION HEALTH” COMPANY HAVE JOINED FORCES FOR MEGA MARKET SHARE PLAYS, ER – I MEAN FOR BETTER PATIENT STUFF– Passport and Evolent joined forces to take on the world this week. Expect lots of phrases like “industry-leading,” “patient-centered,” etc.

SHUMLIN’S BID FOR THE MCD MAGIC MONEY MACHINE GOES ON THE ROAD/TO THE PAPERS- Based on the pro-provider tax stories out this week, the Good Guvn’rs staff have been making calls and “suggesting” stories to their favorite journalists.

FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph. Start the ticker and let’s see who wins this week’s award. 3 Florida fraudsters are on the run (Harrel, Durden and Daly. And their other brother, Darryl). They used a licensed MH provider’s billing number without the provider’s knowledge, and stole more than $500k. Rehan Zuberi of Boonton Township, NJ is facing a $7.4M Mcd fraud settlement (we reported on this May of 2014, but we now have a more precise $ amount to use for the award ceremony). It was a slow week for fraud news, but Dr Z – you win! (Note to newer readers: we only report on frauds $50k or higher. Otherwise we would be talking about hundreds of fraud items a week).

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 (build a fire!) and keep running the race (you know who you are).


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

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