Clay’s Weekly Medicaid RoundUp: Week of February 18th, 2019

Soundtrack for today’s RoundUp pessimist readers-

For optimist readers-

NEW ONLINE TRAINING COURSE IS OUTWant to understand the opioid crisis? Our newest online course will help. Check it out here-

YES, DOROTHY, WE ARE STILL IN KANSAS AND WE ARE STILL WAITING ON OUR MEDICAID APP TO BE PROCESSED AFTER STANDING IN LINE FOR 2 YEARS- A lot of the eligibility processing backlog has been handled, but there are still issues. New stories out this week give more depth to the issue, and it does look like Maximus (the eligibility processing vendor) doesn’t share all the time. But they are in over their heads. The SNAFU seems to have started when the vendor took on a new (to them) type of eligibility determination, related to long term care members. They had done the much more simple apps for kids and families for 20 years. There’s a really good article on this in this week’s News Curator, btw.

REASON #472 TO EXPAND MEDICAID: IT MAKES HOSPITALS EVEN RICHER- TransUnion Healthcare (a credit reporting agency trying to grow up into a broader info services role) released a report this week showing that Medicaid expansion can help add millions to hospital bottom lines (see this week’s soundtrack for a related song). The researchers reviewed thousands of cost reports to identify self-pay bad debts that could be covered by Medicaid if a state expanded.

QUESTION TO ALL THOSE #RESISTERS AGAINST WORK REQUIREMENTS- You keep talking about how hard it is for members to comply with reporting. Are you thus volunteering to make it easier in some way? Or are you really just continuing to beat your gums about how you think work requirements are just bad? Say what you mean, footsoldiers. Multiple regurgitated stories this week about how hard it is to call in, log on or in various other ways report that you tried to work if you were able to in Arkansas. I think Resisters know they lose the argument on whether its fair to ask those that can work to work, so they incessantly talk about challenges with reporting compliance. Yes, its hard. So roll up your sleeves and help out. Here’s an idea – ACA had gabillions in funding for “navigators” to help people sign up for coverage. Maybe repurpose those same staff to help people prove they are eligible to keep it?

TARHEEL GOOD GUVN’R TEASES EXPANSION- Cooper is now doing townhalls / expansion “roundtables” as of this week.

PINE TREE STATE EXPANSION TICKING AWAY NOW THAT LEPAGE IS OUT OF THE WAY- 6,000 bennies added to the Maine rolls since January.

FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph. Anita Ramiriz-Ambriz of McAllen, TX was convicted of stealing $4M Medicaid bucks almost 2 years ago, but yet again was able to delay sentencing this week (pro-tip for convicted fraudsters in here somewhere). Her crime? Getting paid for DME not provided. Head on up to Plattsburgh, NY for our next caper, in which Arshad Nazir and Muhammad Jahangir were convicted of Medicaid taxi-cab fraud (isn’t it great that this is a thing? Its become its own category in recent years). Messieurs Nazir and Jahangir pilfered a combined total of $567k by operating a kickback scheme. Medicaid patients were paid (often times with a bag of tobacco) to say they needed to get somewhere related to their health condition. The taxi companies then would get $230 (or so) for a “non emergency medical transportation ride.” Taxpayers, we truly are gullible fools. Skip on down to Durham, NC to check out Tamara McCaffity’s scheme. She was sentenced this week for stealing $900k using her mental health provider companies (one of them DBA “Dreamworks II,” which frankly is a great name. We should maybe start a new award category for best named bogus mental health provider companies. There have been some doozies over the years). McCaffity bought stolen Medicaid member IDs so she could submit bogus claims to Medicaid. And you, dear taxpayer, paid them (if you live in NC, you only paid about 30%. If you are outside of NC, you paid about 70% through the FMAP. See that whole “but its free federal money” silly argument goes both ways). Mrs. Ramiriz-Ambriz- you win this week’s award on technique alone. I am truly impressed that you have avoided sentencing for 2 years despite being convicted of Medicaid fraud. (Why do we even try to fight this stuff?)

Need even more Medicaid fraud stories? – You can get your fix in the FWA Curator archives.

Want to read the articles summarized here, highlighted for your reading pleasure? Check out the News Curator archives.


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 (plant asparagus – did you know it takes 2 years?) and keep running the race (you know who you are).

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Trystero: Ntate o rometse Mora ho pholosa lefats’e.