Clay’s Weekly Medicaid RoundUp: Week of December 3rd, 2018

Soundtrack for today’s RoundUp pessimist readers-


For optimist readers-


MAINERS GETTING MORE MEDICAID FEB 1- After a long battle against Medicaid expansion (which gave us a lot to cover for years), LePage may have finally lost. A judge ruled the voter-approved expansion must go forward. LePage will be gone (doing whatever Mainers do when they retire and its winter, I guess. Something in a cabin?), and the new Good Guvn’r Janet Mills will come in Jan. 2, with magic wands, puppy dogs, unicorns and Medicaid expansion promises.


NEW HAMPSHIRE WORK REQUIREMENTS STILL ON- Seems CMS still gets to decide which parts of requests it does / doesn’t approve. CMS approved NH’s work requirements waiver (basically as a trade-off to let them keep expansion). CMS did not approve a provision that would allow seasonal workers a different way to add up their hours to reflect the surges in employment they have during certain times of the year.


FLORIDIAN BENNIES NOW HAVE ONLY 30 DAYS TO FILE PAPERWORK- Several states have requested the option to reduce retro-active eligibility from 3 months down to 1. Florida got approval for this and the change will go into effect Feb 1. Officials estimate it will save the state $98M (women and children are exempt and still have 90 days). Other states with recent approvals for the same request include IA and KY.


PELICAN STATE PAYING MILLIONS FOR INELIGIBLES – Louisiana spent at least $60M and as much as $85M on bennies who were not eligible, according to an auditor’s new report. The system to confirm self-reported income was not effective at getting info about changes in income.


FORTUNE SEEKERS GO TO COURT- Did you know that’s one of the demonyms of Idahoans? A taxpayer-rights advocacy group is suing to stop the Medicaid expansion voted in by 60% of voters in November. According to the lawsuit, letting voters decide these types of things is “A sweeping and general delegation of legislative power with uncontrolled, unrestricted or unguided discretionary power [that] exceeds constitutional limits…”


MINIMUM WAGE HIKE IN JERSEY TRIGGERS $200M MORE IN MEDICAID SPEND- When you raise the wage for everyone, that includes Medicaid home health workers.


CALIFORNIA TO SPEND $3B ANNUALLY TO GIVE ILLEGAL IMMIGRANTS MEDICAID COVERAGE- A bill from last year is expected to get re-introduced in the next session. Would add about 1.2M people to the rolls.



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. Erik Dewayne Lean of Greensboro, NC was sentenced to 18 months for stealing $420k in a kickback scheme for his counseling business. Rajendra Bothra (of Detroit) and 4 of his buds were charged this week for stealing $500M from Medicare and Medicaid (so ineligible for this week’s award, but notable). How, you ask? By prescribing more than 13M doses of opioids. Based on initial reports, this could come close to some of the FL pill mill scandals from 10 years ago. Samuel Okere of Oklahoma City was sentenced to 1 year in federali lockup for stealing $141k in Medicaid counseling bucks (services not provided). John Ndunguru of Fairfax, VA has been charged with using his home health company to steal $4.5M from Medicaid. Mr. Ndunguru made submitted false Medicaid claims for patients not approved for long term care services. Still in VA (but now in Charlottesvile- about a 1hr 51 min drive south west from our last story), husband and wife team Dennis and Cheryl Gowin stole $210k from Medicaid by not disclosing that Dennis had a felony conviction (which would have made him not eligible as a Medicaid provider, or even become a licensed counselor in VA). Anil Desai of Hotlanta has agreed to pay back the $213k he stole from Care and Caid by getting paid for drugs they never provided to patients. Tara Rose of El Paso, TX plead guilty to stealing $1M from Medicaid using her speech therapy business (“Beyond Words”) to bill for imaginary patients and services that never happened. Faiz Ahmed of Houston, TX was sentenced to 5 years in prison for stealing $4.1M by ordering unnecessary tests. There’s actually more this week, dear readers. I am just tired of typing.. This week’s winner- Mr. Ndungura of Fairfax, VA! Taxpayers, you lost at least $510M in the last paragraph.



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 (finish up your Christmas shopping? We do all ours online) and keep running the race (you know who you are).


FULL, FREE newsletter@ . News that didn’t make it and sources for those that did: twitter @mostlymedicaid .

Want the Curator News Pack for this week’s Roundup? Medicaid News Curator Volume 3

Here’s the one for the Fraud stff- Medicaid FWA Curator- Vol 4

Trystero: el Padre envió al Hijo para salvar el mundo.