Weekly Medicaid RoundUp: Week of June 26th, 2017

Soundtrack for today’s RoundUp pessimist readers- http://bit.ly/2u5LKtU

For optimist readers- http://bit.ly/2u2PRXL (a poppy bit for your vacation trip)


SHAMELESS PLUG FOR OUR NEW ONLINE TRAINING COURSE: Check it out. We released it after years in the making. Here’s the video ad for it- http://bit.ly/2twQCeF

I WILL BE AT MHPA 2017, WILL YOU? Chairing a Medicaid Director’s panel. Would love to see you there. You can check it out here – http://bit.ly/2twCi5L

DETAILS OF THE SENATE BILL THAT WILL KILL EVERYONE 4 TIMES OVER AND ALSO INCREASES CLIMATE CHANGE AND ALSO EVERY OTHER BAD THING WE CAN TACK ON TO THIS BILL THAT STOPS THE SPENDING ORGY WE HAVE ALL ENJOYED FOR DECADES, UNINTERRUPTED (BUT WE LOOKED NOBLE DOING IT, AND ALWAYS CLAIMED MORAL SUPERIORITY, SO WE’RE TOTES GOOD, RIGHT?) – Long headline, short link to good analysis on the timeline for the BCRA funding changes: http://bit.ly/2u1CDKM  Here is another one that compares the House and Senate bills in case you are into that sort of thing: http://bit.ly/2twMXxs


YEAH, BUT HOW DID WE GET HERE? As part of the frenzy to show what all problems Medicaid can solve, DJs have put the “Caid can solve the opioid crisis” EP back into the rotation. My suspicion is if you look at a chart oxycontin, et al volume over the last 20 years and slapped a category for payer on it that Medicaid funded the current opioid crisis. Am I crazy to think this? Write in and do tell.


IT’S THE BIG ONE, ELIZABETH! Please tell me you get the reference. Assuming you do, I am suddenly struck by the richness of what we all share via pop culture. Anyways… OR Caid has studies out now showing a 17% drop in cardiac arrests after expansion. Once patients got an insurance card in their pockets, they delayed care less and had that chest pain checked out.


MCOS IN ILLINOIS: MAY NEED TO WRITE THIS ONE OFF ON YOUR TAXES- IL State Attorney Stratton told a judge this week that the state simply does not have the cash to pay its Medicaid costs (as was asked by a recent Medicaid member lawsuit in response to the state not paying providers and MCOs). The lawsuit asked IL to pony up $500M more a month to get caught up. Stratton says the state may be able to come up with $150M a month for the pay-your-freaking-tab effort. Fortunately, healthcare superheroes from CA and NV flew in and paid for it out of their own pocket (they had a ton left over once their single-payer bills failed last week). Just kidding, we all know Bernie wrote the check.


SHOW ME STATE WANTS TO UN-SHOW EXPANSION- MO reps voted to freeze Medicaid enrollment in the expansion group to try and help deal with their budget crisis. All analysts expect this to trigger a fight with the Good Guvn’r Kasich.
CENTENE GOES ON PROBATION IN THE CORNHUSKER STATE- Seems the state is unhappy with the plan’s troubles getting behavioral health and home health providers paid.

FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph. Rabbi Zalmen Sorotzkin of Lakewood, NJ was popped this week for leading a $1M fraud bilking Medicaid and other benefit programs. Cheryl Mcgrath of Guysville, OH plead guilty this week to using her home health care company steal $2M from Medicaid via false claims, including for dead people or people in nursing homes at the time she claimed to be providing home health services. Anthony Handal and his fiancé Sandra Mora of Orlando, FL billed Medicaid for $160k of intensive family case management services they never provided. They would conduct an initial meeting with the Medicaid-enrolled families to get their member numbers, then never do anything else to help them (but billing FL Medicaid for 3 sessions a week for the family). Collins Anyanwu-Miller of Bridgeport, CT was arraigned this week for stealing $390k from Medicaid by falsifying home care claims. Mr. Anyanwu-Miller even managed to get paid for home care services that occurred while he vacationed in Europe. Mrs. Mcgrath- you win! (Taxpayers, you lose! Total tab this week: $3.6M).


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 (when the rain stops) and keep running the race (you know who you are).


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