Clay’s Weekly Medicaid RoundUp: Week of July 1st, 2019

Soundtrack for today’s RoundUp pessimist readers-

For optimist readers-

HAPPY BIRTHDAY TO YOU- Happy birthday to you. Happy birthday, dear America- Happy birthday to you!

RATES? WE DON’T NEED NO STINKIN’ RATES- On July 1, MCOs in Iowa began another fiscal year without official capitation rates (the same thing happened last year- it was 2 months before rates got locked down then). Last time this happened it didn’t turn out too bad for MCOs, though: They got an 8.4% bump.

CMS FUNDING NEW OPIOID TREATMENT GRANTS- CMS announced new $50M grants available for states to improve substance abuse treatment and recovery efforts. The feds are looking for proposals that would fund 18-month pilots. Applications due August 9th.

PRAIRIE STATE OWES FEDS LOTS OF DOUGH- Seems Iowa did not collect rebates on about $7M worth of Medicaid drugs. Federal HHS IG sent a letter looking to collect on the $4M federal share of those rebates. HHS has been reviewing state rebate collections, with Illinois being the 36th state to have its tires kicked. NJ has been asked to pay back $8M.

SOONER STATE DOES, TOO- Oklahoma had some recent success suing Purdue Pharma. By success, I mean they got a settlement of $270M awarded (all related to Purdue’s OxyContin marketing practices, I think). Well someone at CMS saw the news and sent a letter to OK Medicaid making sure they knew the feds were entitled to some of that money. The Good Guvnr Stitt is currently saying no dice, federalis.

NH TWEAKING WORK REQUIREMENTS- Dem state reps have been trying to undo the deal they made to keep expansion going. Looks like a compromise is being struck- the requirements stay, but there are now no penalties for non-compliance.

AK TIGHTENING THE BELT- The Good Guvnr Dunleavy is cutting $444M from the overall state budget, with $50M of it coming from Medicaid. Here is a quote that will strike terror in the heart of Medicaid-industry lifers: “Cost-saving measures can be achieved in the Medicaid program through creativity, program reform, and focusing on fraud.” What the heck does he mean cost savings through creativity? Reform? Focusing on fraud? How dare he?! Has no one told him yet the way Medicaid actually works? Someone talk to this man!

FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph. The paragraph taxpayers love to hate. Let’s start the ticker and see who wins this week’s award. Brenda Copeland of Warner Robbins, GA stole near bouts $500k using her counseling business. She was charged this week with filing false claims (and I think it may have been to an MCO, but not sure. If you are, please weigh in). Move on up and over to Pulaski County, Arkansas where we meet Charline Brandon. She has to pay back $289k to AR Medicaid for tricking patients into thinking they were dying so they would sign up for hospice (that’s a particularly special kind of cruel). One victim spent 3 years in hospice. For another entry in the despicable department, head back east to Greensboro, NC. Here we meet the good people at United Care Youth Services. According to allegations made by patients, this outfit is requiring people to stay hooked on drugs so they can stay in their housing program. Plaintiffs say they were provided free or reduced housing as long as they did not have 3 clean, consecutive drug tests. The organization also provided classes and substance abuse treatment, then billed it to Medicaid. As of the time of writing all allegations were being denied but state investigators are looking into this and other similar schemes. Ann Eldridge and Angela Keith of Sumter, SC are wrapping up their court adventure over their pilfering of $13M from Medicaid. How did they do it, you ask? Using their organization (Early Autism Project) to bill false claims over a 9-year period. The two ladies ended up getting 6 months in prison… Ok enough southern-fried fraud- lets move this party up North. Crispin Abarientos of Middletown, CT plead guilty to getting $894k worth of Remicade (an injectable used for rheumatoid arthritis) using false claims to Medicaid. He then turned around and used that Remicade on commercial or Medicare members and got paid by those payers. So get some “free” Remicade (paid for by Medicaid-funding citizens), then sell it to Medicare and commercial plans. Total taxpayer tab (grin and bear it, you suckers!) for this paragraph: $14.7M. Our illustrious ladies from South Carolina (Mrs Eldridge and Mrs Keith), you win this week’s award.


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 (stare long and hard at those almost-ready tomatoes) and keep running the race (you know who you are).

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