Clay’s Weekly Medicaid RoundUp: Week of March 6th, 2017

Soundtrack for today’s RoundUp pessimist readers-

Or you can click the one for optimist readers –

It’s 4am. I have had 2 cups of coffee already. Let’ see what happens.

BEFORE I DO ANYTHING ELSE – A plug for our upcoming Medicaid Star Search Webinar on April 3rd. This is your chance to hear from 3 companies trying to be innovative in the Medicaid space- without having to sit through a cheesy sales pitch (they each get 10 minutes).  Sign up here-


I GUESS I’LL TALK ABOUT ALL THIS REPEAL AND REPLACE STUFF. IF YOU WANT ME TO- The best summary I can give is that the bill introduced this week has zero chance because both sides hate it. Multiple conservatives in the Senate have spoken against it, saying its ObamaCare-lite and a failure to deliver on a critical promise to the base to repeal ACA. Lefties have cranked up the fever-pitch-crazy machine, spouting non-stop EVERYONE WILL DIE headlines. The real question is will Ryan be able to throw up his arms and say “well, I tried,” or will Paul, Cruz and others hold him to the fire to put out a bill that repeals ACA even if it has to be Pelosied (ramming it through throats with just enough votes). Another interesting little twist was the CMS CMO coming out against RyanCare. Maybe he and Sally Yates can start a consulting company once he gets bagged in the next month or so? One last note – Verma made it through the Senate yesterday, one step closer to the CMS head job. Everyone I have talked to in our world says she is awesome. I will believe them over fake newsers any day. Unless of course it comes out that she is a Russian CIA spy using my toaster to read my mind (Wikileaks Vault 7 reference for those who don’t read outside of CNN).


AMERIHEALTH AND MERCY HOSPITAL ON THE ROCKS IN HAWKEYE STATE- So far the 2 can’t reach agreements on payment rates. This is part of how the savings happens, people. You pay MCOs to negotiate with behemoth providers for you. There is a similar story happening in MN with BCBS and Children’s hospital.


LAND OF LINCOLN GETS EXPANSION BILL. SURPRISE! IT’S DOUBLE WHAT WAS PROJEKTED. Sadly no one is surprised anymore. There are now 4 things certain in life (updated since I was a child): Death, taxes, MMIS projects failing and Medicaid expansion costs being double what was promised during the sales/shaming into approving phase. IL Medicaid has now spent about $9.2B on expansion, compared to the original projections of $4.6B.


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.  4 numbskulls in Anchorage, AK got popped this week for stealing $1M in Medicaid moo-la. Their crime? Falsifying records to up payments to their nursing home business. Enny Portillo of Highland Mills, NY plead guilty this week to nabbing $75k for personal care services that were not performed. Mrs. Portillo took advantage of NY’s Consumer Directed option to pilfer the cash. Corey Werito and Rosita Toledo (both awesome, and rhyming names!) of Farmington, AZ plead guilty of stealing $2M from Medicaid using their transportation company. Kester Atumonyogo (what is it with the awesome names this week?) of Valley Stream, NY stole $1.5M from Medicaid by using false claims to get paid for enteral nutrition supplies. Mr. Automonyogo- you win, even beating out the team effort by the group in AK! This week’s Roundup Fraud total – $4.6M from taxpaying citizens. And remember – that’s just what I found in the news quickly. At 4AM.


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 (I have 100+ pepper plants already.) and keep running the race (you know who you are).


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