Weekly Medicaid RoundUp: Week of March 27th, 2017


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

For optimist readers –  http://bit.ly/2nk2ZDg


ONLY A FEW MORE DAYS UNTIL MEDICAID STAR SEARCH– A plug for our upcoming Medicaid Star Search Webinar on April 3rd. Sign up here- http://bit.ly/2ccl593


STATE SPOTLIGHT SHOW NEXT WEEK CHANGED TO “OFFICE HOURS WITH CLAY”– State Medicaid Directors are all locked in cages in basements of legislatures this time of year. Something about “budgets.” So for those of you who want to show up for the Friday 4/7 show we will keep it and I will field whatever questions you want to throw at me re: Medicaid.


BROWNBACK SAYS NO DICEKansas reps got the votes together to expand, but the Good Guvn’r said not on his watch. He said the proposal would not help the “truly vulnerable” but instead would surge state spend on the “able bodied.”


SHOW-ME-STATE SHOWED THEM- Reps in MO soundly rejected efforts at Medicaid expansion this week, with the house voting 102-41 against. Seems the Russians paid fake news bots to force representatives to vote against their will on this one.


VA IS FOR LOVERS (AND LOST CAUSES)- The Good Guvn’r McAuliffe thinks the failure of RyanCare was his cue to restart expansion efforts. His GOP colleagues in the legislature politely reminded him they rejected expansion in 2013, 2014, 2015, 2016 and once already in 2017. Seems they don’t intend to stop their streak.


ALL JOKING ASIDEConventional wisdom is that more states will expand now that RyanCare failed bigly. KS and NC are expected to be next (Brownback may have some unilateral options left?). And GA, ID, NE and SD have been on the fence for years. Here’s a fun twist- 1132 waivers. They just got turned on January of this year, and could be a legislative-free path to changing ACA so much you don’t recognize it. Remember you heard it here first. 1132 waiver. Google it.


IOWA TAKING STEPS TO MAKE MCOS WHOLE- MCOS have claimed a combined loss of about $450M, and details about the state’s plan to stop the bleeding emerged this week. Looks like the state will chip in $10M more and the federalis $225M more to help MCOs cover losses since the state moved to manage care 1 year ago.

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.  Christina and Donald Halter of St Francois County, MO were convicted this week for stealing $209k in disability payments from a developmentally disabled vet in their care. Oh yeah – they also submitted 1,000 false Medicaid claims for nursing services not provided to other residents of their facility. Isnino Mohamud, Mowllid Nur and Ayan Barsug of Minnesota were charged this week for conspiring to defraud Medicaid out of $1M. Their crime? 2 of the guys would submit false bills for transportation of patients to the other guy’s place, where he would then provide counseling services. Problem was they were billing for individual sessions, but it was really happening as group therapy. Apparently Mohamud and Nur also recruited patients who spoke little English and had Medicaid cards. “Dr” Roberto Fernandez of Miami got popped this week for taking kickbacks from local pharmacies and home health agencies as part of a Medicaid (and Medicare) controlled substance fraud scheme. Taxpayer tab on this one so far – $20M. Messiuers Mohamud, et al- you win the day (but only b/c Bob-O Fernandez’s heist spanned Care and Caid. You had a clear Caid-only assault).


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 (You still have time to move bulbs.) and keep running the race (you know who you are).


FULL, FREE newsletter: http://eepurl.com/ep81Y . News that didn’t make it and sources for those that did: twitter @mostlymedicaid . Trystero: pita ne duniya ko bachaane ke lie putr bheja