Clay’s Weekly Medicaid RoundUp: Week of July 16th 2018

Soundtrack for today’s RoundUp pessimist readers-

For optimist readers-

GIVE A WARM WELCOME TO THE NEW IL MEDICAID DIRECTOR- Patti Bellock took the helm 7/11. Welcome!

LET’S TAKE ANOTHER LOOK AT THIS KY THING- Undeterred by the litigious slowdown from a few weeks ago, KY officials are revising and resubmitting their work requirements waiver to CMS. Keep in mind the judge did not rule work requirements to be the problem- but that CMS did not do a proper review of the impact. CMS has announced a 30-day comment period on the waiver. If you need boilerplate on how the sky will fall and the world will end if the waiver is approved, I can send you a few links to think tanks who are actively coordinating propaganda – er, I mean comments / responses “curated” to make sure the “public” opinion is heard correctly. I am sure it will be balanced.


LAST FRONTIER STATE ASKS FOR $15M BACK FOR OOPSIE PAYMENTS- Seems like the AK legislature passed a 10% cut to Medicaid (that’s called a law when its passed by the legislature), but the agency forgot to make it happen. This has been going on since October, so now the agency has paid out $15M illegally (that’s what its called when you do something in violation of a law) to providers. Now its sending out pretty-please-send-the-money-back letters to providers. More than a few providers are saying they’ve already spent it and can’t afford to pay it back. Somebody call Bernie. I know he’s been working on College-For-All and Healthcare-For-All. Surely he’s solved it by now.

DESPITE CLAIMS BY ADVOCATES THAT MOST MEDICAID BENNIES WHO COULD BE WORKING ALREADY ARE- A new report in Illinois shows that 70% of able-bodied Medicaid expansion bennies are not working.

EARLY NUMBERS IN ON BENNIES FAILING TO MEET WORK REQUIREMENTS IN THE NATURAL STATE- A little north of 7,000 members did not report enough hours in June to be compliant with the new rules in Arkansas (there are another 18,000 subject to work requirements but who don’t have to report hours due to other exemptions). About 450 members did meet the requirements. Those who missed the mark in June could lose coverage if they go 2 more months without working.


THE MOTHER OF PRESIDENTS STATE PAYS MOTHER OF ALL RX MARKUP FEES- An early look at the report looking into how much Medicaid money CVS Caremark (the pharmacy benefits manager, or PBM) kept in Ohio shows about $224M staying with the middleman (CVS) after pharmacies were paid. Not sure if that’s a big deal or not? According to the report the OH CVS markup is 3x what CVS normally gets in other markets. This kind of reminds me of 340B providers not passing on savings to poor patients, but that’s another kettle of fish…

ADD IDAHO TO THE LIST OF STATES WHERE VOTERS ARE ALL NOW MEDICAID DIRECTORS- Expansioners have certified the number of signature required to get expansion on the ballot in November.

ANOTHER TROUBLED NEMT MARKET IN THE NEWS- We covered challenges with Southeastrans service in Indiana on the show this week. Looks like Veyo continues to struggle in Connecticut. Recent reports include high profile meetings with healthcare providers and advocates who are voicing complaints over missed rides. In their defense, Veyo delivered 364,000 trips in May and only 478 complaints were filed (less than ½ of 1 percent of rides). Some of the complaints get into how long providers have to be on the phone to resolve issues, and whether drivers are showing up with appropriate vehicles (i.e. wheelchair accessible).


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. There was a huge, national Medicare/Medicaid fraud dragnet in late June and most of the stories out now are from that. I will hit the highlights from that sweep: Health Quest Systems of NY will pay $14.7M to double-dog promise they are not guilty of upcoding E&M visits paid for Medicare/Medicaid. Brent Clarke of PA will pay $360k for his role in a medically unnecessary services scam. Mayura Kanekar of Queens and 12 of their (not sure if that’s a male or female name) closest criminal buddies were charged with stealing $163M from Medicare and Medicaid this week. Looks like this scam involved 5 physicians, 3 therapists and 2 pharmacy owners (there’s a high school algebra word problem in there somewhere). “Dr” Abraham Demoz of Oceanside, NY was nabbed (along with 4 of his buds) for his role in stealing $163M in an illegal kickback scheme using referrals to their clinics. Once they got the patients to their clinics, they then billed for lots of physical and occupational therapy. That’s it for the ones from the big national sweep. The biggest one that I think was Caid’ only this week was in MA. Michael Davini of Worchester, MA will go to court over fraud charges related to a $19M scam in which he is accused of money laundering and false bills to MA Medicaid for non-emergency transport. The case says Davini billed for wheelchair van rides for members not in wheelchairs. Mr. Davini – you win (we keep the award Medicaid-specific)! Taxpayers – you lost at least $350M this week by my count.


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 (have a water balloon fight, or run in the sprinkler) and keep running the race (you know who you are).


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