Author: MM_ADMIN

Soundtrack for today’s RoundUp pessimist readers (technically a movie clip this week)- http://bit.ly/2rvupJk

For optimist readers – http://bit.ly/2rvJIC0

 

IS THIS THING ON? As is our custom here in Roundup-Land, after a long hiatus (client work, gardening), I make it up to you by starting off with the Fraud Follies instead of saving them until the end. But this time, there’s a catch. I translated this week’s Farrises Fantastic Fraud Follies into Russian. You have to take an extra step and use Google Translate to get it back to English (or your preferred language). Do you give up now and move on to the next quick blurb in your news feed? Are there secret messages and memos in this week’s roundup? Leaks, even? You will never know unless you head on over to Google Translate and paste this puppy in there now. NOTE: I have also reverse-translated and there are some good transliterations that happened. Some things get lost in translation. Some things get better. I am excited for you about this. Here’s the link to Google Translate: https://translate.google.com/

 

И ТЕПЕРЬ МОШЕННИКИ СЛЕДУЮТ, ТОВАРИЩИ – Ахад Лотфи из округа Ван Бурен, штат Мичиган, был на этой неделе в суде за обвинения в мошенничестве, связанные с заказными вкладышами для обуви, проданными в его клиниках хиропрактики (всего украдено- 200 тыс. Долларов). Цезарь Тавера и Андрес Айала из Черри Хилл, Нью-Джерси признают себя виновными на этой неделе в мошенничестве с Medicaid. Их преступление? Кража $ 1.5M от Medicaid с использованием их ролей в некоммерческих целях местного сообщества. Г-н Тавера хорошо провел время – в одном случае он снял 35 000 долларов с банковского счета некоммерческих организаций, находясь в казино. Огайо получит 447 000 долларов США от CareCore как часть мультигосударственного урегулирования. Кажется, CareCore платит всем, чтобы перестать приставать к ним об обвинениях, которые они планировали, чтобы автоматически одобрить радиологические тесты, которые не были необходимы с медицинской точки зрения (CareCore – это компания, предоставляющая льготы, и они должны выплатить всего 54 млн долларов). Ев-Грей из Чикаго признал себя виновным в краже 7 млн ​​долларов от Medicaid, работая с электронным заявлением о медицинской записи, которое помещало законсервированный язык в медицинские документы, чтобы удостовериться, что Medicaid заплатит (они становятся умнее, люди). Мистер Грей – Вы выигрываете награду на этой неделе! Ваши очки за инновации привлекли вас к вершине.

 

A FEW OTHER QUICK HITS-  Oregon said it may have spent hundreds of millions on members who were not eligible. Info still coming in on this one so probably smart to be patient. The California Medicaid expansion bill comes due this year, and its $1.3B in state funds for 2017. Several incumbent Illinois MCOs did not submit proposals on time for the new awards and won’t be in the race. After a ton of pressure, PA Medicaid will cover HeP C miracle drugs. BCBS and Amerigroup got hitched in NC in prep for the inevitable managed care switch there. Oklahoma is considering pulling plans to bring managed care in. And Ohio is trying to find $600M now that the federalis have said they can’t tax MCOs anymore.

 

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 (I need rain, do you need rain?) and keep running the race (you know who you are).

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FULL, FREE newsletter: http://eepurl.com/ep81Y . News that didn’t make it and sources for those that did: twitter @mostlymedicaid . Trystero: Apa elküldte a Fiút a világ Megváltójaként

Soundtrack for today’s RoundUp pessimist readers- http://bit.ly/2owUh57

For optimist readers – http://bit.ly/2ox20jq

 

 

MY KIND OF TOWN- Had a GREAT time at the HEA-RISE MMC Leadership conference this week in Chicago. Looking forward to next year. And to Balto next month with the MMC Congress. Will I see you there?

 

 

THE (EGADS!) CONSERVATIVE FEATURES IN EMERGING MEDICAID TRENDS (DOES ANYONE HAVE ANY HOLY WATER?) I have been around this Medicaid game long enough to know the war over Medicaid spending is a war of attrition and anything that even smells slightly conservative loses in the end because of lack of sustained interest on the conservatives’ part and vehement “resistance” on the liberals’ part. That being said, there are many signs if you care to read the bones: Every week a new state announces waiver plans with job requirements. Wisconsin was the latest- and it added drug testing and premiums. Maine announced similar plans (they linked food stamps to work already). Arizona is considering a 5-year lifetime enrollment max for the “able-bodied” (super slippery word all around) as well as work requirements.

 

 

OREGON MAY BE THROWING IN THE TOWEL ON EXPANSION- Dems – I repeat Dems – in OR are proposing Medicaid be un-expanded. Why? you ask? Because the state is short $1.6B.

 

BUT ON THE OTHER HAND, NC MAY BE GETTING CLOSER TO EXPANDING- Republicans – I repeat Republicans – introed HB 662 this week to start the process of funding expansion using federal dollars. GOP leadership in both the NC House and Senate remain opposed, but hey – these Repub Resisters deserve some props, right?

 

CMS WILL “REVIEW” MONTANA’S EXPANSION- This situation is sort of like when you see the cops at the precinct get a visit from Internal Audit. CMS approved MT’s expansion in 2015 and had high hopes for adding 70k under the spreading wings of Mother CMS. What is the crime that brought in Internal Audit? MT charges 2% for premiums to bennies above 50% FPL. And copays. So, CMS is sending in sleuths to “evaluate” the program (take a gander at how many other waivers ever get evaluated, vs just renewing the “demos” for decades on autopilot). The real goal is to get a ton of negative public comment to pile on to the program and insist a mandate for change has been discovered. Keep in mind the same thing happened to IN last year (a post-CMS approval PR campaign ala a surprise round of public comment-y evaluation against the “conservative” model once they saw other states following IN’s lead).

 

MISSOURI SAYS NO TO EXPANSION- While some had high hopes for the Show Me State this year, and a proposal was introduced, sources say no dice.

 

SO DOES NEBRASKA- The committee that reviewed the expansion proposal in the NE legislature politely declined this week. Would have added about 90k to the rolls.

 

CLAY GETS TIRED OF WRITING EXPANSION HEADLINES- Aren’t you tired of reading them? How about a video about Atlantic Mole Crabs instead http://bit.ly/2oxf9sL ?

 

LOW CAP RATES MAY SCARE OFF MCOS? Says the headline. What are they gonna do – go back to the exchanges? Ha! (imagine that Ha! being said by A.L.F.)

 

FARRIS’S FANTASTIC FRAUD FOLLIES– And now for everybody’s favorite paragraph… but not enough space this week, Dear Readers. Had to catch you up on a ton of news. I put lots of Follies in the twitter feed for you this morning, though. My favorite is the former NY state legislator who was charged with running a Medicaid pill mill scam. Check them out and tell me your favorite.

 

 

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 (don’t forget mulch for your baby plants!) 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: Leej Txiv tau xa Leej Tub kom txuag lub ntiaj teb no

 

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 3^rd. 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 DICE– Kansas 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 ASIDE– Conventional 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