Clay’s Weekly Medicaid RoundUp: Week of September 3rd 2018

Soundtrack for today’s RoundUp pessimist readers- (1989)

For optimist readers- (1976)


POISON PILL IN MAINE- LePage’s administration finally submitted an expansion waiver request this week to CMS. But the Good Guvn’r asked CMS to deny it. LePage sent Veerma a letter, with the gist being – “Hey, a lefty judge forced us to submit this waiver app, but we ain’t got no cash for it. So best to just shoot it down. Wink-wink. Nod-nod.”

SD BALLOT EXPANSION INITIATIVE LOSES KEY BACKER- State Rep David Moore was a proponent of expansion in SD when it included a sunset provision / escape clause if it put SD on a runaway, break-the-bank spending path (like it has in most states that took the “free” money). Now that activists have put full-on, no-way-out expansion on the ballot in November (I-185; not an interstate but rather how they name their resolutions they vote on come election day), Moore has come out against it in a pretty high-profile op-ed. Seems like some other op-ed in the NYT overshadowed this one. I missed the NYT one. Can someone tell me the name of the person that wrote that one?

ASTRAZENECA TO PAY TX $110M TO DOUBLE-DOG PROMISE IT DID NOTHING WRONG- The Lonestar state should have held-out for triple-dog level money. AstraZeneca got caught marketing Seroquel and Crestor off-label. For Seroquel, they worked to get docs to feed it to teenagers, before it was approved for the hip kids. For Crestor they downplayed diabetes risks.

WHY CAN’T COUNTIES IN NY JUST CONTINUE TO PAY BALLOONING MEDICAID COSTS AND SMILE LIKE EVERYBODY ELSE? Well for one reason there’s a new report out reminding county managers how much they must chip in and how big the NY Medicaid behemoth has become. Its now a $70B budget – just for Medicaid; bigger than some state’s entire budgets- and counties have to pay $7.6B of that. And it used to be worse before Pataki and Cuomo put in hard caps on what counties pay.

RELATED TO THAT LAST STORY– NY Medicaid enrollment has grown 57% over the last 10 years. There are now 7M enrollees, which translates into about 36% of all state denizens.

CONGRATULATIONS TO CAROL, BUT MORE SO TO KY– Carol Steckel will take the helm as KY Medicaid Commissioner. She’s one of the absolute best Directors our little world has seen, and I have lost count of how many states she has headed up.  Carol, Congrats! KY team – you made a great choice!

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. John Durmon of Warren, AR was charged with stealing $185k in Medicaid dental bucks. Some good nuggets in this one – he billed for 2,557 x-rays for 85 patients over a 1 year period. That’s 30 x-rays each! Margaret Williams of Anchorage stole an estimated $7M using her nursing homes. Flamingo Eye (that’s the name of the nursing home chain- maybe it made you think of warm places while you were in her crappy nursing home in Alaska?) was used as a rev-max scheme for elderly and disabled members. Waveny Blackman of National Harbor, MD plead to stealing $9M Medicaid bucks using fake patient IDs to bill for bogus medical supply products. Vincent Njong of Silver Spring, MD plead guilty to stealing $66k for bogus billings as a personal care aide (with $66k you just barely made the floor to get included in the RoundUp, Vincent – try harder when you get your billing ID back. Which we all know you will in a few years). Margaret, you win hands down! Taxpayers- you lost $16.3M this week just in these stories that made it the news. You better work hard and smile just thinking how you are helping pay for all this fraud. Somebody’s gotta pay for it.


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 (start chopping firewood. I predict a real winter this year) and keep running the race (you know who you are).

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