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 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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