Weekly Medicaid RoundUp: Week of June 12th, 2017

Soundtrack for today’s RoundUp pessimist readers- http://bit.ly/2szI2LI (Pray for our nation. Even if you don’t believe in prayer. Or our nation. We gotta make as much noise as we can in the desperate hopes that He will hear us.)

For optimist readers- http://bit.ly/2szB7Sr



SHOUTOUT TO MY SOA PEEPS- Great time with my actuary friends at the SOA Health Meeting in FL this week. Thanks again to everyone for making it another great experience!



I’LL TAKE MINE WITH SPRINKLES- In case you haven’t heard, a rep from NV has thought of something none of us have in the 50+ years of the program: Medicaid for All! This is such a great idea, but why stop there? Why not Medicare for All (paging Dr. Sanders)? Or TriCare for All? Or BlueCross Blue Shield for All? If I would have known I can just append the magic words “For All” to something and get stuff without worrying about pesky things like costs, actual eligibility requirements and, oh, I don’t know, general freakin’ stability- I would have been namin’ and claimin’ it years ago (paging Dr. Osteen). Ferraris for All…Checklist of questions before you get starry-eyed on this one: What will be the FMAP (will there be FMAP)? Will provider rates stay at Medicaid rates? Will this be done with a State Plan Amendment, or an 1115 Waiver? Do you think CMS will approve either? Or, are you thinking NV is so serious about this, it will do it all with state-only dollars? What percent of individuals (now that the individual mandate is likely gone) do you think will choose to “buy” Medicaid on the exchange (would you buy Medicaid if you had a choice)? How will the subsidies for this one work? Will anyone buy it without a subsidy? If the state is selling coverage (Mike Sprinkle’s plan) and calling it Medicaid, is that actually Medicaid? Is the state now an MCO and subject to MLR rules, MCO taxes, etc? Hashtag: ImportantQuestions.


GOING, GOING, GONE! Any hopes that expansion costs would ever flatten out, that is. New data shows state expansion costs in 2018 will be $8.5B- more than a 100% increase over 2016. Some of this is that the tab is finally come due (states started paying a % of costs this year), but a lot of it is states’s eyes were bigger than their stomachs and expansion costs a LOT more than dreamers ever dreamed.


MEDICAID IN THE GOLDEN STATE FOR EVERYBODY? NOT SO FAST- CA reps dropped plans to give Medicaid to all undocumented persons in the state. There were plans to use tobacco taxes to cover the initiative, but seems those $s will instead go to increase Medicaid provider rates.


SOONER STATE WILL PAY DOCS LATER RATHER THAN SOONER- OK Caid officials have proposed to float payments to providers by a month in order to not decrease rates. Not sure I understand the overall logic, so write in if you know more. Scarily similar to what we wrote about last time re: IL being $2B behind in Caid payments.


BEAVER STATE GETS NEW TAXES TO FUND CAID HOLE- OR reps passed a new $550M tax on hospitals and health plans to avoid Medicaid cuts. The state faces a $1.4B budget hole (not just Caid).


HEALTH HOME PROVIDERS BEG FOR MORE BREAD IN THE BEEHIVE STATE- Home health aides now have better employment options with the upturning economy, and Utah home health agencies are asking for more Medicaid funding to be able to pay employees more than their other options.



FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph. Alan Nisselson of the Bronx plead guilty this week for his role in a $27M false claims Medicaid fraud conducted by his company Narco Freedom. Elizabeth Powell of Helena, MT plead guilty for her role in a $450k Medicaid fraud involving physical therapy claims. She got her family to say they were getting PT and then diverted the payments out of the physical therapist’s bank account. Kester Atumonyogo of New York was indicted for stealing $1M with a nutritional formula fraud. Mr. A used a stolen SSN to enroll his DME company (Monack Medical Supply) and then started billing MCOs like mad. Robert and Kristina Corrado (father and daughter) of Nesconset, NY stole $2M from Caid using a kickback scheme that provided housing to homeless people only if they agreed to get treatment at their substance abuse treatment center. Wilbert Veasey, Jr. of Dallas, TX was sentenced to 17 years for his role in a $400M home health fraud ($500k was Caid, $22M was MediCare). Kathleen Tuorila of Del Rio, TX was sentenced this week for her role in a $3.5M DME Medicaid fraud. She helped submit false claims for power wheelchairs. Total taxpayer tab this week: roughly $57M. Congratulations, Alan- You win!



That’s it for this week. As always, please send me a note with your thoughts to clay@mostlymedicaid.com or give me a buzz at 919.727.9231. Get outside (Weeds everywhere!) and keep running the race (you know who you are).


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