Clay’s Weekly Medicaid RoundUp: Week of June 11th 2018

Soundtrack for today’s RoundUp pessimist readers- (from the Arsenio Hall Show – How awesome is that?!?!)

For optimist readers-


NY BLEW $1.3B ON IMPROPER MEDICAID PAYMENTS- BUT WHO’S COUNTING?- NY State Comptroller DiNapoli (am I the only one who has long-thought “comptroller” is a very strange word?) released data this week showing $1.3B in “unnecessary” Medicaid spending since 2012. The audit pins the errors on electronic systems. State HHS officials say they are working on the issue and are trying to get the cash back. From what I can tell this could be a mix of inappropriate capitation to MCOs and TPL issues. If anyone in NY knows, please write in.


MR BEVIN GOES TO WASHINGTON (OR RATHER WASHINGTON LEFTIES GO TO COURT AND TRY TO DRAG MR BEVIN WITH THEM)- The lawsuit against KY’s work requirements (remember they call it “community engagement”; their opponents call it “work requirements”) is set to have its day in court this Friday. Keep in mind the long list of exemptions means no elderly or disabled person will have to meet the requirements (nor children or pregnant moms)- basically this new Medicaid innovation feature (its done under an 1115 demo waiver) will only affect a subset of the KY Medicaid expansion population. Stay tuned.


 NC SAYS NO TO STUDYING EXPANSION- A last minute amendment was added to a rural health bill on the floor this week, but it was promptly removed by the program evaluation committee. Committee leadership says it should be in charge of what gets evaluated, and that all efforts are focused on current efforts around bringing managed care to the state right now.

NASBO SAYS MEDICAID SPENDING TO SLOW DOWN IN NEXT FY, BUT THEN SPEED BACK UP- A NASBO report published this week shows most Medicaid program spending increasing by about 4.5% in FY 18’. When they take out their crystal balls for FY 2019, its around 1.5%. After this slow down, Medicaid hits the gas again and starts spending 5.5% more in future years. The report examines proposed Governor’s budgets each year. If the Medicaid spending adds proposed in those budgets goes through, and additional $5.3B in state funds will be added to the Medicaid industry next year. Well, a lot more than that when accounting for agencies overspending their budgets (which invariably will happen).

 NH SA PROVIDERS NEED MORE MONEY- They currently get $162.60 per patient per day for inpatient substance abuse treatment ($4,878/month). Providers say this is well below cost, and are asking for $10M per year from Medicaid.

 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.  Duke Ellington Ellis of Durham, NC will have to repay $1M (yeah, right!) for his role in fraud scheme in which he forged signatures of licensed psychologists to submit fraudulent claims. His company – gotta love the names they give these things – “Nature’s Reflections” stole $8.7M over the course of the scheme. LaGracia Burnett of Philadelphia plead guilty this week to stealing $211k for false claims for behavioral health services for autistic children. Seems she had broken the laws of physics and was delivering services at 3 different clinics at the same time. Arkady Goldin of Brooklyn stole $1.5M using a kickback scheme involving his pharmacy. He paid a local medical center employee to send expensive cancer scripts his way. Goldin also billed for drugs never delivered. And this is cool- the state figured that out by checking his Medicaid reimbursements against his orders from wholesalers. Mr. Ellis – you win this week’s award on sheer volume alone. Congratulations!


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 (build a nice fence) and keep running the race (you know who you are).

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