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- . Trust me, its cool. Click it. You know you want to. Or you can click the one for optimist readers –

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 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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