Clay’s Weekly Medicaid RoundUp: Week of July 30th 2018

Soundtrack for today’s RoundUp pessimist readers-

For optimist readers-


THIS IS NEW- As part of an investigation into a plane crash in AK, Medicaid Director Brodie has had to clarify that Medicaid does not pay for flying groceries and building materials when you happen to be going to a Medicaid visit. Basically the $90M AK NET program uses planes, and a Medicaid bennie en route (with some extra baggage, apparently) was on a plane that crashed recently. She and her 2 year old are ok; the pilot died.

UPDATES ON 2 FL CONTRACT PROTESTS- The AIDS Healthcare Foundation is still ticked about losing its contract in the latest round of FL MCO awards. Protests were planned for Thursday to blame the Good Guvn’r Scott. Scott says the plan is just a private sector business that is mad their revenues were awarded to another plan. Also in FL- Argus Dental and UHC both withdrew their protests of the latest MCO awards. Their protests were related to the new scope of dental services in FL Medicaid, touted as the “broadest dental package ever available to Florida Medicaid recipients.” Congrats to our friends at Liberty Dental, DentaQuest and MCNA Dental who all won in the recent awards!

GOOD NEWS OUT OF OHIO RE OPIOIDS- CareSource announced this week that opioids scripts to its members have decreased 40% in the past year and a half. The MCO is working to reduce it 50% by the end of 2018.

KAISER DROPS RURAL COLORADO MEMBERS TO INCREASE ACO SUCCESS ODDS- About 2,500 members in the northern, southern and mountain areas of CO were dropped by Kaiser Permanente this week. Kaiser will continue getting cap for the 670,000 members in easier-to-serve areas of CO, however.

 NH SCHOOL-BASED SERVICES PROGRAM TOUCH AND GO- NH lawmakers passed a funding bill last year to provide speech therapy and other services in schools to all Medicaid-eligible (not just those enrolled) kids in schools. Recent changes in federal funding rules allowed for an additional bump of $28M to the program. Latest news out of Concord suggests program officials are running behind on implementation work, and school starts in just a few weeks.

 NATIONAL EVV REQUIREMENTS DELAYED-  President Trump signed a law this week that delays the much-anticipated electronic visit verification (EVV) components of the 21st Century Cures Act. Major requirements to include EVV were set to begin Jan 2019 (new dates are in 2020). Disability advocates have opposed requirements related to GPS tracking of homecare workers and celebrate the delay. Overall, this is a loss for those of us concerned with reducing the egregious fraud in homecare services.


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. Salwa Albayati of St. Louis was charged for her role in a personal care services scheme. She and her caregiver billed Medicaid $700 every 2 weeks, including times when Ms. Albayati was in Europe and the Middle East. Salwa took a $420 cut out of every payment. Total bill since 2011 is $241k. Compassionate Homecare operators Carol Anders and Ryan Santiago of Raleigh, NC were ordered to payback the $585k they stole from Medicaid (and another $2.5M in penalties). Pretty much a typical services-not-rendered, not allowed per policy scheme. Wossen Ambaye and Haimid “Mookie” Thompson of Buffalo, NY stole $1.2M using an NET scheme. Lots of billings for trips that never happened or were not in accordance with Medicaid policy. Gena Randolph of SC can make the dead speak, at least according to her Medicaid claims. Randolph was convicted this week for stealing $2M using bogus speech therapy claims (including services for members who were dead). Bonus – She was also convicted of Medicaid fraud in 2012. (Special thanks to Mark for sending this one in). Mustak Vaid of Brooklyn was sentenced to 18 months in the slammer for serving as the face of a 6-clinic fraud scheme operating on Medicaid cash. Vaid and Aleksander Burman ran clinics that stole about $30M from Medicare and NY Medicaid. Features of the scheme include falsifying medical records to get around pesky medical necessity requirements, hiring corrupt doctors to pose as owners of clinics and billings for supplies and services never provided. Ms. Randolph, you win this week’s award! Your perseverance and can-do attitude as evidenced by 2 Medicaid fraud convictions in 6 years put you over the top. Taxpayers, you lost $32M on the schemes uncovered this week.


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 (do some weeding) and keep running the race (you know who you are).

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