Soundtrack for today’s RoundUp pessimist readers- http://bit.ly/2aeAX7r OR http://bit.ly/2aeAGBD
Or you can click the one for optimist readers – http://bit.ly/2aeB57a OR http://bit.ly/2aBPHRo
SUCH A HISTORIC WEEK – Unless you have been under a rock (or perhaps engrossed in your Pokemon Go! adventure), you know this week saw a very historic milestone for our nation. Yes, dear readers, I am of course referencing the fact that a single healthcare fraud topped $1B for the first time ever.
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. Philip Esformes of Miami has set the world record with his $1B fraud robbing taxpayers who fund Medicaid. Esformes used his 30 nursing homes to bill for unnecessary procedures for Medicaid bennies. $1B people- $1B!! That’s 15,384 teachers (at an average annual salary of $65k). Heck, that might even cover 1 month of ACA premium increases. Staying in Miami for a moment, Fernando Mendez-Villamil was sentenced for 12 years for defrauding Medicare and Medicaid out of $50M. How did he get caught? At some point, he got on Chuck Grassley’s radar who noticed Mendez-Villamil wrote 96,685 scripts over 2 years for Medicaid bennies alone. Let’s head northeast to Chicago, where Gregory Toran was convicted of stealing $4.7M from Illinois Medicaid using his transportation company to bill for rides for dead people and for live people who never actually took rides. Now lets’ go way northeast on up to Anchorage, AK, where Mee Chong Collins stole $320,336 from Medicaid using false personal care services claims filed under her “Sunshine Care Services” company. Let’s move back towards the heartland, where Wendi Baker of Tiffin, OH was indicted for stealing up to $300k from Medicaid while working as a nurse at Blanchard Valley Health System. Hop on over to Oregon with me, as we watch Anthony Neal plead guilty to stealing $1.7M from Medicaid by using his clinic to order unnecessary tests. Total RoundUp reported fraud tab this week (not including the historic $1B from Mr. Esformes): $57M. Of course, Mr. Esformes, you win this week’s award!
WOW, JUST WOW- So much happened in the fraud space last week (much of it likely tied to another one of those coordinated drag nets we’ve seen the past few years), its almost difficult to think of much else. In the spirit of innovation, I will leave you with the rest of this week’s Medicaid news, in traditional haiku form (5-7-5):
News Item 1
Supplemental rule
Leaves OMB, goes to Prez
Cash this way rising
News Item 2
Bad times for Alere
Investigation slows buy
Kickbacks, fraud – oh my!
News Item 3
BlueGrass state looks back
Before leap, before Beshear
Plays chicken with feds
News Item 3
Public option lives!
Policy wonks remember
Prez gave C-P-R
News Item 4
Wolverine State plans
In the money, man oh man!
ACA cap rates high?
News Item 5
Brandstad marches on
Tells Dems and press to stuff it
Growing pains, he says
News Item 6
Anthem beats forecast
CIGNA deal still taking time
But rolls grew half-mill
News Item 7
UHC, Aetna
New Cal-forn-ya MCOs
Congrats on the win!
News Item 8
Caid’ Rx report
Abilify, Sovaldi
And Vynase top list
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 (its time to start planting a second crop!) and keep running the race (you know who you are).
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