Clay’s Weekly Medicaid RoundUp: Week of October 7th, 2019

Soundtrack for today’s RoundUp pessimist readers- (this video from 1973 is amazing; and these guys are still touring)

For optimist readers-

SUE TO GET RATES YOU WANT (WHERE DO I SIGN UP FOR THIS DEAL?)- Alaska “providers” (hospitals and nursing homes, for those fooled by this label. It ain’t Doc Brown making house calls) successfully used the judiciary to keep their pay rates above the law. The law being the process used to govern budgets in the state, including cuts. See, The Good Guvn’r Dunleavy vetoed (that’s a legal power executives have) about $50M in state Medicaid spending. So, the agency has to enact those cuts. Well, “providers” whose revenue streams depend on those Medicaid funds didn’t like it and got a judge to undo the legal process. I think I’ve seen this movie before, but in a different theater…

IOWA STILL LOOKING FOR 3RD MCO- In case you missed it United submitted its Dear John letter earlier this year. The Medicaid Director commented this week on plans to issue an RFP for a replacement MCO, but no timetable is in place yet.

NH AND FEDS AT ODDS OVER SCHOOL BASED MEDICAID PROGRAM- The Good Guvn’r of The Granite State sent a re-assuring letter to school superintendents late September. Why? Because new CMS guidance looks to make sure only services covered under the state Medicaid plan can be paid for by Medicaid in schools. Someone tell me what I am missing, but can’t this just be fixed with a state plan amendment adding any outlier services into the covered mix? And does anyone have an estimate of how much Medicaid has paid for non-covered services in schools over the years?

GOOD GUVN’R CUOMO TAKING BRIBES IN UKRAINE? SORRY, IN NY– At first I thought this was just a slimy attack from one of those (clutching pearls as I say/type this) right-wing news organizations, but turns out its in the very trusted, totally-not-fake-news NYT. Seems Mr. Cuomo was asking for big donations from the state Hospital Association during his tough campaign last year. And once those payments came through, voila– higher Medicaid rates for hospitals! (and other providers, but in keeping with modern “journalism” I chose to emphasize the implication I wanted make vs the broader context).

CONGRATS TO OUR FRIENDS AT i2i- Big news late last week that i2i and Cerner are teaming up to integrate the power of their platforms. If you’re not familiar with i2i Population Health, they are now in 2,600 systems in 36 states providing various population health management solutions.

IDAHO JOINS THE GROWING RANKS OF WORK REQUIREMENTS STATES- The public comment period on Idaho’s work requirements plan (paired up with its Medicaid expansion rollout) is now open. Get ready to be called lots of names, Gem State friends.

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.  San Juan EMS will pay $350k for stealing from Puerto Medicaid with 400 medically unnecessary flights. Pamela Van Drie and hubby Lorin G. Van Drie of Springfield, MO will serve 5 to 10 years for stealing $885k. Their crimes? Providing dental patients with mouthpieces that cost $50, and then billing Medicaid $700 for “speech aid” prosthetics. The lovebirds also (successfully) billed Medicaid for dentures for patients who were not even on Medicaid (extra points!). Kathleen Service (actual last name- great name for a social worker if you ask me) of Hartford, CT stole $151k using other providers’ billing info. CT stopped allowing social workers to bill in 2017, but Ms. Service disagreed and decided to bill anyway (just with other people’s IDs who were still allowed to bill). Paul Peterson of Phoenix, AZ was indicted this week on charges of human trafficking and Medicaid fraud. His crime? He used his position as an elected official to traffic 28 pregnant women from the Marshall Islands to come to the US and sell their babies via an adoption scheme. The Medicaid connection- he also helped them get $814k in Medicaid benefits. Fly back east to Norfolk, VA to check in on Houman Motti. Mr. Motti will go to federal prison for using his ambulance company to steal $63k in Medicaid bucks. There is a lot of strong competition for this week’s award- what’s that? This just in from the judges booth: Mr. Peterson wins this week’s award! His total dollar impact was slightly less than the Van Drie’s, but he gets extra points for abusing his elected office to commit heinous crimes.

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 (it finally rained here!) and keep running the race (you know who you are).

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Trystero: ‘ursil alab alaibn li’iinqadh alealam