Clay’s Weekly Medicaid RoundUp: Week of July 4th, 2016

Clay’s Weekly Medicaid RoundUp: Week of July 4th, 2016

Soundtrack for today’s RoundUp pessimist readers-

Or you can click the one for optimist readers –

Hope everyone had a great 4th of July. For all you folks educated in the public school system in the last 20 years, let me help you out with a clear telling of what happened 240 years ago. The 4th of July is when we celebrate some of the best men ever to have lived declaring that we would be ruled by laws, not corrupt tyrants. It is not about hot dogs or fireworks – but you do get to enjoy those things because awesome men called “the Founders” started something called “America.”

VOLUNTEER STATE ROLLING OUT HEALTH HOMES IN 4 MONTHS- TN’s Health Link program will serve behavioral health members by coordinating their primary care and behavioral health care (that whole integrated care thing). Providers will get a monthly cap for the coordination service between $70 and $140.

NO DICE FOR NO-SHOW FEE IN SHOW ME STATE- Doctors in MO are taking a hit with a high missed appointment rate for Medicaid bennies. So they wanted to have a fee imposed to members- $5 for the second missed visit, $10 for the third, and $20 for every visit missed after that. The Good Guvn’r Nixon vetoed the bill, saying it would be “gouging the poor.”

BUDGET WATCH- KS hospitals are phoning-a-friend (the federalis) to try and stop cuts enacted to deal with the budget deficit. In an open letter to CMS, the KS Hospital Association pleads with the feds to stop the $54M in cuts that would hit hospital pockets. AL docs will see the primary care payments boost come to an end starting this month. As part of AL’s $85M budget shortfall, the Medicaid agency decided to stop enhanced payments enacted originally using ACA one-time monies.

EXPANSION WATCH- AR shot its revised expansion plan over the bow this week, complete with a list of evil, access-killing requirements. If approved, the new gig will send unemployed bennies to work training programs, end 90 day retro eligibility, provide dental for bennies who pay their premiums and require bennies between 100 and 130% FPL to pay a premium that’s no more than 2% of their income (what % of your income is your premium, dear reader?). Move over west just a little, and the Good Guvn’r Bevin (KY) and CMS are now in talks over his plan to change expansion in the state. Bevin has rolled out new rules related to work requirements (including an allowance for community service) and encouraging transitioning from Medicaid to commercial insurance. According to Bevin’s team, the changes will save the state about $331M over five years. Bevin wants approval by September; CMS is saying there’s no rush in reviewing the request. If you read between the lines, Bevin is sort of saying to CMS – accept these changes or we un-expand. I like it.

FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph. Seven DE DHHS case workers were indicted for stealing $959k in food stamp benefits. “Drs” Chethan V. Byadgi and Rajaa Nebbari of Scranton, PA got their plea deals rejected last week- their crime? Allowing non-licensed staff to write scripts for narcotics and filing $159k in false claims to Care’ and Caid’. “Dr” Monaco of Haverford, PA operated A Foot Above Podiatry and stole $5M via false claims (services not provided). Misty Baker of Brandon, VT stole $77k using faked time sheets for the VT Children’s Personal Care Services program. Wow, what a diverse week we had for fraud! We even had a nearly $9M foodstamp fraud in our lil’ ole Medicaid column. That being said, you can only win if your fraud is for Medicaid (and at least $50,000 – to weed out the amateurs). “Dr” Monaco – you win this week’s award!

A WORD ON OUR WEBSITE- To all those who visited our site the last few weeks, you may have experienced downtimes and malware warnings. We have just completed a relaunch with a new hosting provider, and should be good to go. I apologize for the inconvenience. I promise we are not Estonian hackers trying to get your SSNs. Although there probably are some of those doing just that right this moment- in order to file false Medicaid claims, of course.

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 (the tomatoes are coming in!) and keep running the race (you know who you are).


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News that didn’t make it and sources for those that did: twitter @mostlymedicaid

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