Clay’s Weekly Medicaid RoundUp: Week of September 16th, 2019

Soundtrack for today’s RoundUp pessimist readers-

For optimist readers-

IN CASE YOU HAVEN’T HEARD, THERE’S A DELAY IN NC- Well all you naysayers telling me you heard whispers of a delay back in August were right. It’s official, we have our first delay in the NC move to managed care. The Good Guvn’r Cooper is throwing a hissy-fit over this everyone-agrees-its-the-answer-to-all-our-problems-Medicaid-expansion thing, and he took his toys and went home when those “other” reps (voted in by some very deplorable people in a Russian-rigged election, I’m sure) were not so excited about a possible increase to the already murderous Medicaid cost trends [insert foolish, but confident economic theory here about “losing out on free federal money”]. Translation: Cooper fouled up the funding for managed care startup costs because he couldn’t get his way and score political points on Medicaid expansion. What was to be Phase 1 in November, will now be Phase 1 and 2 simultaneously in February. The Medicaid agency team is doing a great job of managing the chaos – but there’s only so much Cooper a successful transition can handle. He may end up being placated anyway- as of yesterday the house passed a gravy-train (Medicaid expansion) bill. That bill would expand under the pretense that work requirements and related premiums will be implemented. And we all know how that will turn out (just ask NH in case you have any questions).

MICHIGAN MCO MERGERS- Priority Health will gobble up Total Health Care. The gobbler has about $4B in revenue over 830k covered bennies; the gobble-ee has about $365M over 53k covered Medicaid members (96k total). To help grease the regulatory skids, Priority will be dropping $25M into a foundation to “fund a variety of non-profit initiatives” in Detroit.

FOSTER CARE IN ILLINOIS- IL DFCS is working to move 74,000 foster kids into managed care and some reps are raising concerns. The gist of the concerns are related to a rocky experience with MCOs in general. Here’s an idea you IL knuckleheads- actually pay the MCOs and it might turn out better (see previous reporting on how IL gets sued every 6 months or so and is forced to pay MCOs BILLIONS of dollars it reneged on). Here’s another idea- do a real audit of the quality of care for those foster kids now to see how well you are doing in the absence of managed care.

AL LAUNCHES ALABAMA COORDINATED HEALTH NETWORK (ACHN)- The state launches an expanded care coordination program October 1. About 750k bennies will begin to receive services designed to better manage their care. Childhood obesity, infant mortality rates and substance abuse are the top 3 targets of the new program.

AFTER THREE DECADES OF OPERATION, FEDS DECIDE TO TRY AND CONFIRM LIFELINE SUBSIDY ELIGIBILITY FOR REALS- If you are not familiar with Lifeline, it’s a $10/month subsidy for low income folks to get a cell phone. For 34 years you have been able to get one if you are eligible for Medicaid. Actually you have been able to get one if the phone carrier (who makes money if you are deemed eligible) says you are Medicaid-eligible. So now the feds decided to start verifying that with an independent system. An OIG audit found that 36% of bennies could not be verified as eligible back in 2017. Keep smiling while you pay for all this fraud, dear taxpayer.

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.  Felicia Blount of Gary, IN got 12 months in the slammer for stealing $195k Medicaid bucks. Her and her momma both falsified bills to Medicaid for transporting Medicaid patients to appointments. Dang, Felicia! Head on up (over?) to Columbus, OH where James McFadden was convicted of stealing $258,000 from Medicaid by faking PTSD and pretending he could not talk. His charade also required him to wear diapers. His co-conspirator got paid as his personal care aide to help with his bogus condition. Go west and we find 34 people in CA, AZ and OR nabbed in a $257M Medicare and Medicaid fraud scheme. The fraudsters used various means involving medically unnecessary tests and prescriptions.  And finally (there are at least a dozen more on my desk I could write about this week, I just need to land this plane)- let’s fly back to the heartland to check in on Craig Barnett of Nebraska. Barnett is a former Medicaid auditor now serving jail time for stealing $277k using his father’s power of attorney. He used that power to take SSI monies, raid mutual funds and falsely obtain nursing home coverage (which is where the Medicaid part comes in) for his father. He was head of the NE Medicaid Audit and Financial Support Division the whole time. Mr. Barnett, I hope you can come to some sense of right and wrong as you stare at those prison bars. But in the meantime, you win this week’s award!

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 (assuming you don’t find yourself suddenly living in a parched desert like I do) and keep running the race (you know who you are).

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