Tag: State News

Posted on by

Expansion of Arkansas Medicaid system announced

 
 

MM Curator summary

[ MM Curator Summary]: New monies are being appropriated to clear some of the I/DD waiting list.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

LITTLE ROCK, Ark. – The developmentally disabled waiting list became a bit of a topic during the special session as part of the debate against making income tax cuts.

Gov. Asa Hutchinson said on Tuesday they have been aware of the issue for a while now.

The Arkansas Medicaid waiver provides services to those with intellectual disabilities, with the waiver covering about 500 Arkansans.  However, there is a waiting list in the thousands to get those services.

All together there are 3,204 on the list.

Over half on the list have incomes low enough to qualify them for some Medicaid services, but the rest are getting none.

 
 

Hutchinson is requesting 200 additional slots and those will be funded with existing revenue.

He is also asking the general assembly at some point to add 37.6 million dollars to create more slots so that everyone on the list can be served by 2025.

Director of Disability Services, Melissa Stone, said this will help those who need services to live more normally.

“People have waited a very long time and because of this announcement we are now able to move quickly to get them the services they need to stay in their home and in the community,” Stone said.

Hutchinson said he hopes to take that action during the fiscal session, and once that is done, DHS will submit a request to add those slots progressively over the next three years.

 
 

Clipped from: https://www.kark.com/news/state-news/expansion-of-arkansas-medicaid-system-announced/

Posted on by

Backlog of Medicaid applications spurs Arkansas lawmakers to concur with hiring contract help for $29M

 
 

MM Curator summary

[ MM Curator Summary]: Maximus will get $29M to help Arkansas with its current eligibility processing backlog.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

Arkansas lawmakers endorsed a $29 million contract Tuesday that aims to address the state’s backlog of Medicaid applications.

M

  • Morning

About 50,000 Medicaid eligibility applications were backlogged as of mid-November, according to state Department of Human Services spokeswoman Amy Webb. Webb said that number is not unprecedented, but the main causes of the backlog are the coronavirus pandemic, which has resulted in worker quarantines and temporary office closures because of positive cases, and staff turnover that has led to vacancies the department is having difficulty filling.

“We are short-staffed as most public [and] private employers are right now, and we’ve got a backlog of applications to process,” Mark White, chief of staff for the Department of Human Services, told the Review Subcommittee of the Arkansas Legislative Council.


White said the backlog is primarily affecting long-term care facilities, which means nursing homes and assisted living facilities have to operate without payment.

“The issues that most affect the beneficiaries have been our long-term care, where we have seen applications taking a little longer to process,” he said after the meeting. “We know that’s a strain on nursing homes, so we’re working to address that.”

The Department of Human Services plans to hire the Reston, Va.,-based company Maximus Human Services Inc. to help with processing Medicaid applications as well as changes related to Medicaid eligibility, White said.

The company will bring in staff to help the department work through the backlog as well as “provide some ongoing surge capacity” by allowing the state to access the company’s capacity to augment its own staff to deal with an influx of patients, he added.

Maximus will recruit, hire and train contracted eligibility specialists, according to information about the contract provided to the committee. The Department of Human Services inked a larger contract with Maximus for staffing several years ago, Webb said.

When the contract goes before the Arkansas Legislative Council for approval on Friday, the department will present its full plan, at the request of Rep. Jeff Wardlaw, R-Hermitage, White said.

Wardlaw, along with fellow Legislative Council co-chairman Sen. Terry Rice, R-Waldron, said in interviews Tuesday they are concerned about the impact of the delayed payments on rural nursing homes.

Wardlaw said his area lost two assisted living facilities two years ago as a result of Medicaid reimbursement issues and that other legislators from rural areas share those concerns.

“Every time we lose one of these facilities, we can’t get them back,” he said.

Rice said the backlog issue has been going on for some time and, at one point, reimbursements were taking four to five months when they should take 45 days or less. It’s something he has been discussing with the Department of Human Services officials for a number of months, he said.

He added that nursing homes have already been struggling financially as a result of the pandemic and that some have taken out personal loans to stay afloat.

“There’s been some strain on that industry anyway,” he said. “DHS needs to get these people placed and get those back payments.”

Rice said the pandemic and staffing shortages are legitimate excuses, but said he expects the government to hold itself accountable like a private business would.

“When you’re talking about some of these homes going out of business, they will not be back, and I keep preaching that to them,” he said.

Webb said in an email that the contract, in addition to addressing the backlog, allows the department to “staff up and provide support” as it prepares to deal with the end of the public health emergency.

The federal government’s public health emergency declaration is set to expire at the end of March, but it could be extended.

Under that declaration, there are limited circumstances by which the Department of Human Services can remove someone from the Medicaid programs, such as death, Webb said, so there will be lot of casework and eligibility re-determinations once the public health emergency ends.

“Obviously, we don’t have to do it overnight or all at once. We would have six months to redetermine eligibility once it ends,” she said.

The Department of Human Services also recently launched a new eligibility system, which it piloted in a few counties in December 2020 and launched statewide in April 2021. Webb said the system is working well, and the department launched a pilot to include Supplemental Nutrition Assistance Program, or food stamps, cases in some counties in the new system.

There were 330,421 people enrolled in Arkansas Works, the state’s Medicaid expansion, as of November 2021. More than 1 million adults and children were enrolled in Medicaid programs overall. At the beginning of March 2020, prior to the onset of the coronavirus pandemic, Arkansas Works enrollment was 250,233 and overall enrollment was just over 903,000.

Clipped from: https://www.arkansasonline.com/news/2021/dec/15/backlog-of-medicaid-applications-spurs-arkansas/

Posted on by

Houston County counselor pleads guilty in Medicaid Fraud case

MM Curator summary

[ MM Curator Summary]: A GA counselor stole more than $600,000 from Medicaid using fake documentation in her pediatric mental health practice.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

Attorney General Chris Carr announced that Brenda Copeland has pleaded guilty in Houston County Superior Court to two felony counts of Medicaid Fraud.

File Photo/MDJ

ATLANTA — Attorney General Chris Carr announced that Brenda Copeland has pleaded guilty in Houston County Superior Court to two felony counts of Medicaid Fraud. Superior Court Judge Edward D. Lukemire accepted the plea on Nov. 30 and sentenced the defendant to 10 years, including two years to be served in prison with the remainder on probation.

The court also ordered restitution to the Medicaid Care Management Organizations impacted, Wellcare and Peachstate, in the amount of $631,843.

“Georgia’s health care providers are an essential component of our Medicaid program, and we expect the best,” Carr said in a news release. “By violating public trust and stealing taxpayer dollars, Brenda Copeland harmed the very people in need of care — Georgia’s children and older and at-risk adults. This sentence sends a strong message that the state of Georgia will not tolerate this type of illegal and deceptive behavior.”

Copeland owned and operated The Counseling and Training Center in Warner Robins. Though she was not authorized to run a group practice, Copeland was enrolled as an individual practitioner to provide mental health services to children. In doing so, she submitted billing for upwards to 18 hours a day — including weekends, early mornings and late evenings — to cover for her non-credentialed staff, who also were not authorized to provide services.

Among the intentional lapses in her practice, Copeland enrolled Medicaid recipients in her program that were not properly diagnosed by a licensed clinical professional — a critical first step in authorizing treatment and billing claims for that recipient. Documentation attesting to such assessments was false.

This case was prosecuted by Assistant Attorney General Henry A. Hibbert of the Medicaid Fraud Division and was investigated and prepared by Investigator Johnny Brooks along with Investigator Ulecia Daniel, Investigator Melanie Mayone Sawdye and Intel Analyst Zwella Boyd.


Clipped from: https://www.henryherald.com/news/houston-county-counselor-pleads-guilty-in-medicaid-fraud-case/article_1264e66f-bf14-5dbb-ac07-1e43b31e6add.html

Posted on by

$1.8B in additional Medicaid funds headed to several Florida hospitals

MM Curator summary

[ MM Curator Summary]: Nearly $2B in “directed payments” will start flowing to Florida hospitals soon.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

Hospitals across the state will begin receiving their share of $1.8 billion in additional Medicaid funds under a new supplemental financing initiative called the Hospital Directed Payment Program.

The $1.8 billion in payments will be made through the state’s Medicaid managed care system. Managed care plans can begin distributing the funds under a budget amendment Agency for Health Care Administration officials sent to legislative leadership Nov. 19. Those amendments take effect 14 days after submission so long as there are no objections.

The Hospital Directed Payment Program is a supplemental payment program that is meant to bridge the difference between Medicaid reimbursement rates and the actual costs of providing the care. It is funded through local dollars that are used to draw down federal Medicaid dollars.

Florida used more than $622 million in local funds to draw down $1.24 billion in matching federal Medicaid funds for state fiscal year 2021-2022, or Year 1 for the program.

The program is administered regionally and provides supplemental payments to three different types of hospitals: cancer, public, and private.

 
 

In order to qualify, all regional hospitals in the class must agree to participate in the program and be subject to an assessment.

In order for private hospitals to participate, they must agree to work with a local government partner to create what is known as a “local provider participation fund.”

According to the budget amendment, all public hospitals in the state participated in the DPP program Year 1. None of the cancer hospitals participated in the program in Year 1. And private hospitals in Medicaid Regions 5,6 and 10 were not able to participate the first year because they weren’t able to find a governmental partner.

The budget amendment notes that “in all other regions the private hospitals were at least able to find one governmental partner who will fund the region’s state share.”

No facility will receive more than Jackson Memorial Hospital in Miami, the state’s largest provider of Medicaid services. It will collect more than $208 million in so-called DPP funds, a budget spreadsheet shows.

 
 

Jackson netted an increase of more than $138 million in supplemental DPP funds, after accounting for the funds the hospital contributed to help finance the program.

While the Year 1 DPP funds have been approved and are being sent to hospitals there are concerns about the financial security of the supplemental Medicaid program going forward after the federal Centers for Medicare & Medicaid Services recently rejected three direct payment programs in Texas.

Senate Health and Human Services Appropriations Committee Chair Sen. Aaron Bean said previously he thought CMS was being punitive to Republican states.

“Do I think it’s punishing red states? Yes, I do. Do I think they have singled out certain states? Yes, I do,” Bean said.

Post Views: 985

Clipped from: https://floridapolitics.com/archives/477616-1-8b-in-additional-medicaid-funds-headed-to-many-florida-hospitals/

Posted on by

Louisiana Medicaid contractor search slower than planned

MM Curator summary

[ MM Curator Summary]: The LA MCO awards are expected “next week.”

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

Louisiana’s latest search for contractors to manage the health care services of nearly 1.6 million Medicaid patients is taking longer than expected, blowing past an early November timeline for announcing the contract awards.

The last bid process started by Gov. John Bel Edwards’ administration for the multibillion-dollar Medicaid managed care contracts was derailed two years ago in a legal dispute. The Louisiana Department of Health has been using emergency contracts to keep the current managed care companies in place while it evaluates new bids.

The health department released its request for proposals from contractors interested in handling the taxpayer-financed Medicaid work in June. The deadline for submissions was Sept. 10. At the time the bid solicitation was issued, the agency released a timeline that said it planned to announce the contract awards “on or about” Nov. 5.

That announcement hasn’t happened.

Health department spokesperson Kevin Litten said the agency hopes to have its recommendations to the Office of State Procurement, which oversees the bid solicitation process, by the end of this week.

“The expected dates first announced for awarding the Request for Proposals for Managed Care Organizations was an approximate timeframe, and LDH has continued working through this process over the past month,” Litten said in a statement. “The department is finalizing our internal evaluations.”

The managed care contracts account for roughly one-quarter of Louisiana’s annual operating budget and cover the health care for one-third of Louisiana’s residents. They allow private companies to oversee health services for about 90% of Louisiana’s Medicaid enrollees — mostly adults covered by the Medicaid expansion program, pregnant women and children.

The new contracts will be awarded for up to five years and are expected to start around the beginning of the new budget year in July, according to the bid solicitation.

Until new contractors are chosen, the health department has continued its existing emergency deals with the five companies currently managing Medicaid services: Aetna Better Health, AmeriHealth Caritas of Louisiana, Healthy Blue, Louisiana Healthcare Connections and United Healthcare of Louisiana.

Health Department Secretary Courtney Phillips announced in August that she would redo the Medicaid managed care contractor search, rather than continue a legal fight over the deals that her predecessor approved.

The prior bid process began in early 2019, under then-Secretary Rebekah Gee. Four companies were chosen for the Medicaid managed care work – three of the insurance companies that already hold contracts with health department and one new contractor. The contracts would have been worth an estimated $21 billion over three years.

But two losing bidders currently doing the managed care work that were slated to lose their lucrative contracts, Louisiana Healthcare Connections and Aetna Better Health, filed protests raising objections about the bid solicitation process and contract awards.

After reviewing the protests, Louisiana’s state procurement officer scrapped the contract awards, determining that the health department mishandled the bid process and failed to comply with state law or the agency’s own evaluation guidelines.

The health department and the four insurance companies chosen for the Medicaid deals initially challenged that decision. But Phillips decided it was best to start the process over when she became health secretary near the start of the coronavirus pandemic and as Louisiana’s Medicaid rolls ballooned larger.

___

Follow Melinda Deslatte on Twitter at https://twitter.com/MelindaDeslatte

Clipped from: https://www.theintelligencer.com/news/article/Louisiana-Medicaid-contractor-search-slower-than-16683320.php

Posted on by

Four Texas Democrats Call for Restoration of Medicaid Section 1115 Waiver Funding

MM Curator summary

[ MM Curator Summary]: After 4 months of uncertainty created by CMS retroactively denying the TX DRSIP waiver, now even dems are showing signs of worry.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

Four Texas Democratic members of Congress have appealed to the federal government to restore health care funding that has been frozen over the last few months.

Those legislators are Reps. Veronica Escobar (D-TX-16), Henry Cuellar (D-TX-28), Marc Veasey (D-TX-33), and Filemon Vela (D-TX-34).

Funding to Texas’ Directed Payment Programs (DPPs), which reimburses health care providers for uncompensated care, was suspended on September 1.

“[T]he approval of new DPPs and the successful renewal of existing waivers are critical to sustaining access to health care services and lowering health inequalities for Medicaid enrolled and uninsured people across the state,” reads Veasey’s letter.

Over $10 billion in annual funding is at risk in DPP funding.

“Texas is now entering its fourth month without funding for Directed Payment Programs which support vital healthcare services for our most vulnerable,” said Texas Essential Healthcare Partnerships President, Don Lee.

Texas is embroiled in a fight with the federal government over its Medicaid Section 1115 Waiver, and the funding that comes with it.

Back in April, the Biden administration’s Department of Health and Human Services (HHS) retroactively denied Texas’s waiver application. Before the regime changed hands, the Trump administration’s HHS and Centers for Medicare & Medicaid Services (CMS) approved Texas’ application for a 10-year renewal.

Texas then sued the federal government and secured a temporary injunction. A final decision has not yet come.

The waiver grants funding for certain categories of uncompensated care and is something certain hospitals rely upon heavily because of the large amounts of patients they serve who cannot pay. It is estimated to be worth about $30 billion for hospitals in Texas.

Overarching this dispute is a broader one featuring the expansion of Medicaid and Texas’ refusal to acquiesce Democrats’ demands to exercise that section of Obamacare. Texas Republicans view the federal government’s reneging as an effort to force the state’s hand into expanding Medicaid.

Expanding Medicaid would increase the number of people eligible for the state-sponsored program that supplies health insurance to poor individuals and families. It would also increase the percentage of health care spending that the federal government takes on.

But the move would only give the option of coverage for 15 percent of Texas’ uninsured population, the largest in the nation, that weren’t already eligible for it — about even with the percentage of Texas’ uninsured that are already eligible but have chosen not to enroll.

Texas is currently negotiating with the federal government to reapprove the waiver and has until September 2022 before the current waiver expires.

Veasey’s letter concluded, “While over a million uninsured Texans may acquire coverage because of Democrats’ unshakable commitment to extending health-care coverage in the state, over 3 million will remain uninsured, making these financing sources even more vital to guaranteeing access to care and needed resources.”

 
 

Clipped from: https://thetexan.news/four-texas-democrats-call-for-restoration-of-medicaid-section-1115-waiver-funding/

Posted on by

Public comment period open for draft Medicaid waiver renewal application

MM Curator summary

[ MM Curator Summary]: Oregon’s next version of its big 1115 waiver will include actual performance dollar measures tied to health equity metrics yet to be defined.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

Emily Boerger | Dec 7, 2021 | Oregon

The Oregon Health Authority (OHA) opened the public comment period for the state’s draft 1115 waiver renewal application on Tuesday, signaling the latest step forward in the state’s effort to reform the Oregon Health Plan (OHP). OHA is preparing to submit the new five-year Medicaid program waiver to the Centers for Medicare & Medicaid Services (CMS) in February 2022. 

The new waiver, which would be in effect from 2022-2027, focuses on improving health equity within the Medicaid program. Concept papers released last month identified the five policy concepts that form the basis of the application. They include a focus on maximizing OHP coverage, stabilizing transitions to minimize disruptions in care, value-based global budgets, incentivizing equitable care, and focusing on equity investments. 

The public notice highlighting the public comment period lays out the state’s specific requests related to health equity. 

Through the waiver, the state is requesting authority to allow coordinated care organizations (CCOs) to spend 3% of their per-member per-month capitation rate on health equity investments, and for those to be counted as medical expenses when determining rates. The state is also requesting federal spending for infrastructure to support equity, and investments to support community-led equity interventions. 

The state is looking to change the process of selecting CCO incentive metrics to focus on equity and is requesting an expanded benefit for American Indian/Alaska Native OHP members so that Tribal-based practices are considered covered services. 

These are just a few of the many changes to the program that OHA is seeking public comment on. 

The public comment period will run from Dec. 7 through Jan. 7. The public can submit written comments through email at 1115Waiver.Renewal@dhsoha.state.or.us or through Oregon.gov/1115WaiverRenewal. 

The feedback will then be used to revise the draft and prepare it for final submission to CMS in February.  

 
 

Clipped from: https://stateofreform.com/featured/2021/12/public-comment-period-open-for-draft-medicaid-waiver-renewal-application/

Posted on by

Medicaid contractor stops trying to recoup payments from mental health providers

MM Curator summary

[ MM Curator Summary]: Colorado will no longer recoup payments from providers who say they submitted them correctly in the first place.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

The announcement came two days after The Colorado Sun reported that mental health providers would no longer accept Medicaid patients because of the debacle.

 
 

 
 

The logo for the Colorado Department of Health Care Policy and Financing, which administers Medicaid in the state, on a sign in the department’s offices on Feb. 26, 2019. (John Ingold, The Colorado Sun)

Colorado mental health therapists will no longer have to pay back money they received for seeing Medicaid patients after a state contractor that had threatened to “recoup” the payments reversed course Wednesday. 

Mental health counselors at practices in eight Front Range counties received emails from Colorado Community Health Alliance — the contractor that processes their Medicaid claims — notifying them it was “stopping the current recoupment project.” This comes after the health alliance sent letters asking therapists to return thousands of dollars in payments they had already received, a financial debacle blamed on a software error.  

This week’s reversal by the state contractor came after reports in The Colorado Sun and 9News exposing the claims fiasco. Several mental health counselors and therapists working in small group practices told The Sun they would no longer accept Medicaid patients because of the paperwork headache and the latest fight with the state contractor. 

TODAY’S UNDERWRITER

For some, the reversal is too little, too late.

Carla D’Agostino-Vigil, one of the only specialists in obsessive-compulsive disorder who accepted Medicaid in Colorado, was among those who decided she would no longer see Medicaid patients because of the latest hassle. While she welcomed the health alliance’s announcement, D’Agostino-Vigil said Wednesday she had no plans to change her mind about accepting Medicaid clients. 

“I am cautiously optimistic this will result in a timely correction,” said D’Agostino-Vigil, who runs Ignite Counseling in Westminster. 

The licensed counselor already was suffering from a 20% rate cut for Medicaid patients that the health alliance put in place in January 2020. And D’Agostino-Vigil is still in the midst of an unrelated dispute with the health alliance over claims that were denied due to an alliance software issue, she said. 

Therapists who already paid a recoupment fee to the health alliance will get a refund, the alliance said.

The recoupment letters, copies of which were reviewed by The Sun, told providers they had 60 days to return the money or Colorado Community Health Alliance could withhold future payments. The health alliance, which is owned by insurance giant Anthem, is essentially the middle man between the providers and the state Medicaid department and is responsible for processing claims and dispensing payment. 

The therapists were not overpaid — they were asked to return money for services they provided during prior years because claims were missing a provider identification number. 

 
 

 

Mental health professionals said they included the provider identification number on their claims. It was the computer system used by the health alliance that scrubbed the identification numbers — required by state and federal law — from its claims. The contractor realized the mistake in July 2019 and fixed its software system in October 2020, said spokeswoman Colleen Daywalt. Mental health providers have been warned of the issue via email and in meetings since March 2020, but many said they were caught off guard when they received the recoupment notifications requesting payment this fall. 

Colorado Community Health Alliance is the payer for 1,175 behavioral health providers in Boulder, Broomfield, Clear Creek, El Paso, Gilpin, Jefferson, Park and Teller counties. About 200 providers who did not resubmit claims received the recoupment letters, which asked for amounts up to $18,000.

The health alliance said Wednesday that it was taking back the recoupment action “in light of recent feedback from behavioral health practices.” 

Instead of requiring therapists to pay up or resubmit claims, the health alliance is making plans to contact each counseling practice to retrieve the needed provider identification numbers, Daywalt said in an email to The Sun. “We plan to work with providers to collect the data to ensure we have proper documentation without requiring the providers to resubmit the claims,” she said. 

TODAY’S UNDERWRITER

She said the alliance is “dedicated to ensuring access” to mental health care in Colorado, noting there are now 3,514 practitioners in the network.

The billing issue comes as Colorado has tried to expand the number of mental health professionals who accept Medicaid, a government insurance program for low-income residents and those with disabilities. The Colorado Department of Health Care Policy and Financing, which runs the Medicaid program and contracts with the health alliance to disperse payments to the providers, said the number of providers statewide taking Medicaid reached 8,371 in June, compared with 6,029 in April 2020.

The department said Wednesday that it was pleased the state and its contractor “identified an easier way” to collect the required claim information. The process “was never intended to be about recouping payments from providers but rather to have accurate and compliant claims,” department spokesman Marc Williams said in an email to The Sun.

“While 84% of providers were able to comply with the claim data request during the 20-plus months of time provided, we understand that this issue presented a heavier administrative burden for the remainder of the providers.”

Williams added that the resolution “enables all our behavioral health providers to continue to deliver care to our Medicaid members — especially during this time of increased demand for such services due to the impacts of COVID-19.”

TODAY’S UNDERWRITER

Christia Young, a Brighton therapist who received a recoupment notice for $7,200, was skeptical that the announcement meant things with the alliance would improve. 

“It’s good news, but I already paid an attorney, drafted a letter, and spent a large chunk of my time faxing them all of the corrected claims,” said Young, who sees patients with chronic suicidal thoughts at Badass Therapy. “It also doesn’t fix all of the other issues providers have with them. I already had so many issues with billing prior to this.”

Young has stopped taking Medicaid patients through the health alliance. 

“My Medicaid clients are some of my favorites to work with,” she said. “It has been heartbreaking to have to prioritize my mental health and financial well-being because it is so difficult to work with Medicaid.” 

 
 

Clipped from: https://coloradosun.com/2021/12/02/medicaid-mental-health-claims-2/

Posted on by

NYS Comptroller: Department of Health paid over $100M in improper Medicaid payments

MM Curator summary

[ MM Curator Summary]: 3 recent audits of the NY Medicaid program show significant preventable losses.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

(Photo: Getty Images)

ALBANY, N.Y. (NEWS10) – New York State Comptroller Thomas P. DiNapoli has released three reports that found more than $100 million in improper payments made by the Department of Health (DOH) for the Medicare buy-in program, maternity care, and drug and therapy claims. Nearly $400,000 in premiums may have been paid for deceased individuals.

AdChoices

ADVERTISING

How New York will benefit from the federal infrastructure bill

“The Medicaid program provides critical health care services to millions of New Yorkers but the program is dogged by oversight problems and payment errors,” said DiNapoli. “Over the years, we’ve uncovered billions of dollars of waste and abuse in the system. DOH should act on our recommendations to ensure significant unnecessary expenses and preventable mistakes don’t end up costing taxpayers.”

The New York State Medicaid program is administered by DOH and is a federal, state, and local government funded program that provides medical services to economically disadvantaged populations. As of March 2021, the program had about 7.3 million recipients and claim costs totaled more than $68 billion.

One audit found that Medicaid made $31.7 million in improper Medicare premium payments from January 1, 2015 through December 31, 2019. Medicaid also paid $372,716 in Medicare premiums for 282 individuals who were deceased. Auditors found Medicaid paid $23.6 million in premiums for individuals who were automatically added to the buy-in program with coverage beginning more than two years retroactively, despite limitations on this.

Dashboard tracking spending of federal recovery aid and COVID relief programs launches in New York

The second audit examined Medicaid recipients who receive their services through managed care. DOH pays managed care organizations (MCOs) a monthly premium for each enrolled recipient and the MCOs pay for services their members require. MCOs can also receive a Supplemental Maternity Capitation Payment (SMCP) for prenatal and postpartum physician care and delivery costs. However, MCOs are not eligible to receive SMCPs for maternity cases that end in termination or a miscarriage.

Auditors found about $55 million in improper and questionable SMCPs to MCOs from August 1, 2015 to July 31, 2020. They found $29.1 million was paid without the required supporting data, $23.4 million was paid where the data or other evidence indicated the maternity case ended in termination or miscarriage, and $2.4 million was paid when the SMCP date of service preceded the birth by one to six months.

Comptroller releases interactive map of New York census results

A report released in October 2019 examined payments made for prescription drugs and therapy services. It found Medicaid paid $20.1 million for services that should have been paid by Medicare. A follow-up report found DOH made some progress in addressing these problems, however, auditors identified another $17.7 million in payments that should have been paid by Medicare.

You can read the full reports on the State Comptroller website.

 
 

Clipped from: https://www.mytwintiers.com/ny-news-2/nys-comptroller-department-of-health-paid-over-100m-in-improper-medicaid-payments/

Posted on by

Attorney General Ford Announces Sentencing of Las Vegas Medicaid Provider Randi Jewel Lewis in Fraud Case

MM Curator summary

[ MM Curator Summary]: 2 women who set up an entire shadow company solely for the purpose of defrauding Medicaid will get probation and have their prison sentences suspended.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

Las Vegas, NV – Nevada Attorney General Aaron D. Ford announced that Randi Jewel Lewis, 30, of Las Vegas, was sentenced in a Medicaid fraud case involving falsely billing for Medicaid services allegedly provided to Medicaid recipients.

Lewis pleaded guilty to one count of Medicaid Fraud and one count of Money Laundering. District Court Judge Jasmin Lilly-Spells sentenced Lewis to between 19 to 48 months in prison, suspended, and placed her on probation. Lewis was also ordered to pay more than $30,000 in restitution, penalties and costs.

“My office is committed to combatting Medicaid fraud to ensure the wellbeing of its recipients and to safeguard taxpayer resources,” said AG Ford. “Prosecutions of these types of crimes helps deter future crimes against the Medicaid system, and stop predatory fraudsters from gaming the system to their advantage.”

The investigation began after the Medicaid Fraud Control Unit (MFCU) received an allegation that Vegas Health LLC (Vegas Health) submitted false information to Medicaid. The investigation revealed that Lewis and her co-defendant, Shonna Nicole Marshall, formed a ghost company with the sole objective of fraudulently billing Medicaid.

Lewis and Marshall used Medicaid providers’ and recipients’ personal information without their knowledge or consent. Lewis and Marshall then transferred the fraudulently obtained funds into multiple bank accounts and to multiple associates in order to conceal the source of the funds. Marshall, who pleaded guilty to one count of Medicaid Fraud and twenty-six counts of Money Laundering, is scheduled to be sentenced in January for her role in the fraudulent scheme.

The MFCU investigates and prosecutes financial fraud by those providing healthcare services or goods to Medicaid patients. The MFCU also investigates and prosecutes instances of elder abuse or neglect. The Nevada MFCU receives 75% of its funding from the U.S. Department of Health and Human Services under a grant award. The remaining 25% is funded by the State of Nevada, MFCU. Persons convicted of Medicaid fraud may also be administratively excluded from future Medicaid and Medicare participation. Anyone wishing to report suspicions regarding any of these concerns may contact the MFCU at 702-486-3420 or 775-684-1100.

This case was investigated by the Attorney General’s Medicaid Fraud Control Unit and was prosecuted by Senior Deputy Attorney General Behnaz Salimian Molina.

The amended indictment for Randi Jewel Lewis is attached.

To file a complaint with the Office of the Nevada Attorney General, click here.

###

 
 

Clipped from: https://ag.nv.gov/layouts/Page_Style_1.aspx?id=345188