Category: Amazing Free Content

For optimist readers- http://bit.ly/2uxE8Re

 

Soundtrack for today’s RoundUp pessimist readers. On second thought, let’s do 2 optimist songs this week cause ‘Murica is awesome and its her birthday week- http://bit.ly/2uxG6Rs

 

DON’T FORGET MONDAY’S SHOW ALL ABOUT THE SENATE BILL- Alex Shekhdar of MHPA will take us all to school on what BCRA means for Medicaid funding. Sign up for free- http://bit.ly/2ccl593

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

BADGER STATE HAS BUDGET SURPLUS- You’re not alone: I had to do a double take myself. Wisconsin will close out this SFY with Medicaid $325M to the good. Recipe for this fiscal success? Slower enrollment growth and more federal cash. Less spending and more “revenue” from Uncle Sam. Whooda thunkit?

 

LITTLE AMERICA ROLLS OUT 2 PROGRAMS TO FIGHT THE OPIOID SCOURGE- Maryland launched 2 new programs on July 1 aimed at getting ahead of the opioid epidemic. The first one deserves kudos because it targets how we got into this mess in the first place nationwide – Medicaid prescribing rules. The second one increases payments to residential substance abuse providers to help deal with the carnage. MCOs will be key partners, leveraging CDC opioid reduction guidelines.

 

LAND OF LINCOLN MUST PAY ITS BILL (SORT OF)- A federal judge ordered Illinois to pay its $3B Medicaid tab (the state has been stiffing providers and MCOs for quite a while). The court order has the state paying all new bills in full and on time, and establishes a payment plan of $293M in Medicaid back payments a month until its paid off. According to IL state Comptroller Mendoza, the new ruling “takes the state’s finances from horrific to catastrophic.” Don’t worry Mrs. Mendoza, I am sure the judge will point you towards the money trees so you can fix all this. (Hint – they are through that tiny little door in the back of Congress, in the small orchard in the back. The trees in the White House gardens have been out of order since November).

 

DENIZENS OF BLUEGRASS STATE MUST PAY THEIR OWN WAY (SORT OF)- The Good Guvn’r Bevin submitted a revised waiver request this week, looking to require bennies to work 20 hours a week if healthy enough to do so. This is up from the previous plan which had an increasing scale starting at 5 hours a week, walking up to 20 hours after a year of coverage. The new plan starts at 20 hours day 1 of coverage. Savings estimates mark the change at about $2.4B for KY by 2022.

 

SPELL WEARING OFF IN LAND OF ENCHANTMENT- Long-time readers may remember New Mexico cracking down on behavioral health providers accused of rampant overbilling of Medicaid (this was back around 2013, focusing on 15 facilities). Seems the state is walking back some of its claims (encouraged by a judge), and the attempted recoveries have plummeted from a total of $9.6M to $896k. Current finger pointing includes use of an extrapolated sample that did not have supporting documentation. One of the bigger issues is that Medicaid payments were stopped to these providers, causing disruption to members. Several of the organizations have been exonerated by the state AG. Good article on the details of this in the twitter feed (@mostlymedicaid).

 

NATURAL STATE ROLLING IT BACK- Arkansas submitted its request this week to modify its magical waiver (the one where they put expansion bennies on the exchange). Changes include knocking eligibility back down to 100% FPL (it was 138% to get the ACA cash), adding work requirements for those deemed healthy enough to work, and ending an employer-sponsored premium subsidy program.

   

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. TN is taking Med Management, Inc (MMI) to court for $7M in bogus claims for pain management. John H. Johnson of Hollidaysburg, PA faces 7 years in the slammer for his role in a patient-referral kickback scheme that stole $1.1M from Medicaid. Johnson sent Medicaid members to Universal Lab for tests in exchange for kickback payments. Dawn Bentley of Detroit was sentenced this week for her role in a $7.3M Care and Caid scheme. She providing billing services for bogus physician claims in exchange for a 6% cut. He biggest client- Waseem Alam- plead guilty last year to a $33M take. Anna Young of Chadron, NE must pay back $309k after admitting to billing $102k without sufficient documentation for her mental health services (she has to pay back 3 times what she stole). Mrs. Bentley – you win this week’s award! You are the first biller I have come across offering a fraud outsourcing service. Kudos!

 

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 (cook out again this weekend- celebrate the 4^th twice!) and keep running the race (you know who you are).

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FULL, FREE newsletter@ mostlymedicaid.com . News that didn’t make it and sources for those that did: twitter @mostlymedicaid . Trystero: Il Padre ha mandato il Figlio a salvare il mondo

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).

****

FULL, FREE newsletter@ mostlymedicaid.com . News that didn’t make it and sources for those that did: twitter @mostlymedicaid . Trystero: an tAthair chuir an Mac a shábháil ar fud an domhain