Clay’s Weekly Medicaid RoundUp: Week of December 31st, 2018

Soundtrack for today’s RoundUp pessimist readers-


For optimist readers-


READY FOR MEDICAID INNOVATIONS 2019- I will be there again this year (my 9th time), chairing one of the very best Medicaid events you can go to. Also, its sunny Florida in February (I’m looking at you, Michigan). If you decide to go, let me know and we can meet up. Check it out here –


PREVIEW OF MONDAY’S MEDICAID NEWS SHOW- We will cover the Texas ruling, state budgets and about a million other things. Not signed up yet? Sign up here for free-


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. Since we’re punting news to the Monday show, lets do a butt-ton of fraud this week. Darrel Bryant and Gifty Kusi of Hillard, Ohio were convicted of stealing $3M from Medicaid for bogus drug cream claims. They were assisted by Jornell Rivera, who is a “doctor” listed as a co-conspirator in the case. Abdi Ali Gure of Bloomington, MN was charged for stealing $260k with a services-not-provided scheme. Laird Richmond and Jason Lowery of Seattle, WA were ordered to pay back $928k they stole by not paying employees the full “sleeping” rate. In WA, if you require staff to stay overnight in a residential facility, you have to pay them a certain rate while they sleep. These 2 yahoos billed the state for the full rate but didn’t pass it onto the staff. Christiana Care (Delaware’s largest hospital system) is back on the radar for yet another fraud scheme. A few years ago the health system settled for $3.3M with the state to make allegations related to shady billing practices in its neonate unit go away.  Now an auditor has surfaced new issues in the past few weeks. Lisa Raymond and Robert Maglicic of Florence, SC were charged with stealing $2M from Medicaid for behavioral health services not provided. Toshirea Jackson of Bridgeport, CT was ordered to pay back the $2.5M she stole using her 2 social services businesses. Seems Mrs. Jackson was stealing the Medicaid IDs of people she was counseling for substance abuse, and then using them to submit false claims. Luis Omar Vargas of Roselle, NJ was convicted for stealing $2M with a dental patient kickback scheme. He paid patients $25 to do a visit (wish I got paid for visits- doesn’t it normally work the other way around? Are we to believe the patients innocent in this? Were they tried? If not, why not? $2M!!!), and then billed Medicaid for boucoup more on bogus claims. Haytham “Tom” Fakih of Deerborn, MI stole $1.2M from Medicaid and Medicare (not eligible for this week’s award, Tom) by billing for expensive meds to dead patients. Mobolaji Stewart of Maryland stole $434k from D.C. Medicaid with bogus personal care aide claims. She even billed for more than 24 hours in a day (now that’s commitment). Fly clear across the country to Alaska to meet Sirje Kulakevich, who stole “more than $50,000” as a personal care aide in the The Last Frontier. Margaret Fisher of the Music City fled to North Dakota, but her $1M Care and Caid behavioral health fraud caught up with her this week. She (and her staff at her direction) forged signatures on counseling session documentation. George Louis Moreno of McAllen, TX plead guilty to a $1.5M DME fraud this week. His crime, lots and lots of bogus claims for incontinence supplies. Messieurs Bryant and Kusi, you win! Something about the $3M worth of cream spoke to me. Taxpayers, you lost at least $18M in that last paragraph ($36,437 per word).


Check out the Fraud Curator for the original articles for the adventures above. Also lots of member fraud nuggets in it, too.

Medicaid FWA Curator- Vol 5

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 (if it ever stops raining) and keep running the race (you know who you are).

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