Tag: State News

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FWA- Eastern District of Louisiana | Destrehan Man Pleads Guilty to $11.4 Million Medicare and Medicaid Fraud Scheme

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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.

 
 

[MM Curator Summary]: Craig Lovelace stole $11.4M using a broad-reaching DME scheme.

 
 

 
 

Clipped from: https://www.justice.gov/usao-edla/pr/destrehan-man-pleads-guilty-114-million-medicare-and-medicaid-fraud-scheme

NEW ORLEANS, LOUISIANA –  CRAIG L. LOVELACE, age 53, a resident of Destrehan, pled guilty to defrauding Medicare and Medicaid of approximately $11.4 million in medically unnecessary durable medical equipment (“DME”), announced U.S. Attorney Duane A. Evans.

The government filed a bill of information charging LOVELACE with healthcare fraud, in violation of Title 18, United States Code, Section 1347. According to court documents, from approximately January 2016 through June 2022, LOVELACE, through his company Advanced Medical Equipment Inc., billed Medicare and Medicaid for durable medical equipment (“DME”) that was medically unnecessary. That included equipment for respiratory support and nutritional support, including ventilators, tracheostomy supplies, and feeding tubes. In reality, those items were medically unnecessary, not ordered, or not provided as represented.  In some instances, the patients had already died. LOVELACE billed Medicare and Medicaid approximately $11.4 million in connection with this scheme, and his company was reimbursed over $7.9 million. To cover up his scheme, LOVELACE directed the falsification of documents, including medical records, order forms, and supporting documentation, in response to Medicare audits and record requests. The falsification of documents included forging provider signatures, medical notes, and dates, as well as using tape, white-out, and scissors, to make it falsely appear that the audited DME was ordered and delivered.

LOVELACE faces up to ten years in prison. LOVELACE also faces up to three years of supervised release after release from prison, a fine of up to $250,000 or twice the gross gain to LOVELACE or the gross loss to any victims, and a mandatory $100 special assessment fee.

U.S. District Judge Jane Triche Milazzo set the sentencing hearing for November 29, 2023.

U.S. Attorney Evans praised the work of the Health and Human Services Office of Inspector General and the Louisiana Medicaid Fraud Control Unit. U.S. Department of Justice Trial Attorneys Kelly Walters and Samantha Stagias of the Criminal Division’s Fraud Section and Assistant U.S. Attorney Nicholas Moses, Health Care Coordinator for the Eastern District of Louisiana, are prosecuting the case.

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FWA- Mississippi couple to pay over $315K after submitting false Medicaid forms

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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.

 
 

[MM Curator Summary]: Manjit and Gurmej lied about their income and ended up getting $315k in Medicaid-covered services.

 
 

 
 

Clipped from: https://www.supertalk.fm/mississippi-couple-to-pay-over-315k-after-submitting-false-medicaid-forms/

 
 

Two individuals are having to pay $315,380 for falsifying their income to unlawfully create eligibility for Mississippi Medicaid health care benefits for their dependents.

 
 

Manjit Kaur and Gurmej Singh reportedly received Medicaid benefits for their dependents despite not meeting low-income requirements. Kaur and Singh, a husband-wife duo, collectively owned and/or were associated with at least 15 convenience stores, gas stations, and wine stores located in Mississippi.

The two intentionally omitted their multiple businesses from health benefit applications. Kaur and Singh also own an 8,804-square-foot home located in Madison, which was most recently valued at $2.25 million.

Despite having these assets, the two represented on numerous Mississippi Medicaid healthcare benefit applications and renewals that Kaur was the sole source of income from one business receiving approximately $1,500 per month.

In addition, it was falsely documented that Singh was not residing in the home or contributing to the household income. As such, prosecutors allege that from January 1, 2016, to December 22, 2022, Kaur and Singh caused the Mississippi Division of Medicaid (MDOM) to pay $157,690 in federal healthcare coverage benefits on behalf of ineligible recipients.

“The Medicaid Program is intended to provide access to quality health coverage for our most vulnerable populations in Mississippi,” U.S. Attorney Darren LaMarca said. “Our office is committed to uncovering individual fraudsters and protecting the funding for eligible Mississippians and their families.”

The Medicaid program is a state and federally-funded health benefits program intended to assist low-income individuals and families. MDOM is the single state agency responsible for administering these healthcare benefits for those eligible.

This case was investigated by the U.S. Department of Health and Human Services, Office of the Inspector General, and supported by the MDOM and the Mississippi Attorney General’s Office’s Medicaid Fraud Control Unit.

Stay up to date with all of Mississippi’s latest news by signing up for our free newsletter here. 

Copyright 2023 SuperTalk Mississippi Media. All rights reserved.

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Are Medicaid cuts heartless? Republicans aren’t villains for right-sizing it after COVID.

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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.

 
 

[MM Curator Summary]: There might be a little bit of bias in how the media is reporting on the return to normal operations.

 
 

Clipped from:

https://www.usatoday.com/story/opinion/2023/08/11/medicaid-cuts-ineligible-enrollees-protect-taxpayers/70560500007/

 
 

Perhaps you’ve heard: Republican states are heartless. 

Such is the media narrative on Medicaid as states begin the long-overdue process of removing millions of now ineligible recipients who signed up for the program during the pandemic. The real story is that Republican states are defending taxpayers and the truly vulnerable, while reversing the country’s march toward socialized health care.

Get a few paragraphs into news stories about reductions in the number of people receiving Medicaid, and the villain and victim become clear: Republicans and the less fortunate, respectively.

Yet, this caricature bears no resemblance to reality. Republican-led states are leading the effort to disenroll about 20 million Americans who were ineligible for Medicaid yet couldn’t be removed due to federal mandates during the pandemic.

Pandemic led to huge expansion of the welfare state

That restriction led to one of the biggest welfare expansions in American history, pushing the number of people on Medicaid to more than 100 million for the first time while costing taxpayers at least $16 billion a month.

Despite the Biden administration’s efforts to extend the mandate, the Medicaid expansion expired April 1.

 
 

States report having removed at least 4.1 million individuals since then. Texas and Florida have done the most work, right-sizing Medicaid by a combined 900,000 people. Arkansas has removed at least 300,000 people out of an estimated 422,000 who are potentially ineligible, the fastest pace in the nation.

These states are rushing to restore Medicaid to its intended purpose, save taxpayers billions of dollars and preserve resources for the truly needy.

The news media give the impression that ineligible Medicaid recipients are especially vulnerable, but in fact, they generally are ineligible because they make too much money. Many signed up after temporarily losing jobs during pandemic-related shutdowns, but states were unable to remove them for more than three years, even as the economy bounced back and they returned to work.

Biden Medicaid cuts will hurt millions.Democrats need to stop him.

Good options are available for people not eligible for Medicaid

A majority of removed Medicaid enrollees have access to employer-sponsored coverage, federal subsidies on the insurance exchange or other affordable coverage options.

Much of the news coverage focuses on the “procedural reasons” that states are using to remove people from Medicaid rolls. That explanation accounts for about 75% of those who lose Medicaid benefits. The phrase gives the impression that people are kicked off Medicaid on technicalities. In fact, it means enrollees did not establish their eligibility for the program.

Many might have failed to comply with state requests for information because they knew they were ineligible or already had other coverage.

‘Bidenomics’ in action:Democrats’ excessive spending, mounting debt earn US credit downgrade

Some states do deserve criticism. California and New York have removed about 385,000 people from Medicaid, but with up to 2.8 million ineligible enrollees in California and more than 1 million in New York , they’re clearly slow-walking the process.

Blue states are likely waiting for the Biden administration to roll out a new rule that will keep Medicaid broken indefinitely. Last year, the Centers for Medicare and Medicaid Services proposed a mandate that would block states from using commonly used practices to discover ineligible Medicaid recipients.

The transparent goal is to keep them on Medicaid, further eroding the private market and paving the way to socialized health care. The regulation could be made final later this year or early next, before states finish right-sizing Medicaid.

The contempt for taxpayers and the truly vulnerable is astounding. Medicaid is already consuming a bigger and bigger share of state budgets, leaving less funding for critical needs such as public safety and education. Yet, blue states and the Biden administration are content to let this crisis continue. 

 
 

This is the essence of socialized health care: Subsidizing subpar coverage for people who can get other health insurance, while leaving less money for the vulnerable people who need Medicaid. The news media is right that someone is heartless, but the culprits aren’t in Republican-led states.

Jonathan Ingram is vice president of policy and research at the Foundation for Government Accountability.

 
 

From <https://www.usatoday.com/story/opinion/2023/08/11/medicaid-cuts-ineligible-enrollees-protect-taxpayers/70560500007/>

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STATE NEWS (CA)- This is reform? California wants to let its billionaires go on Medicaid

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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.

 
 

[MM Curator Summary]: There are very few limits on the wealth you can have and still get on Medicaid in CA if you are over 65.

 
 

Clipped from: https://thehill.com/opinion/healthcare/4138033-this-is-reform-california-wants-to-let-its-billionaires-go-on-medicaid/

Politicians and investigative journalists have long complained about the billionaires that have no taxable income and pay no taxes despite their wealth. In response, politicians have advanced many constitutionally dubious proposals to tax wealth on grounds of equity and fairness.

It is odd, then, that there has been so little attention paid or protest given to the pending proposal in California — phase II of its 2021 reform — to strike all asset testing for those above age 65 in determining eligibility for long-term care benefits from Medicaid.

Lest anyone dismiss this as another crazy California idea that will never be enacted, like universal state government health insurance and racial reparations, this Medicaid expansion proposal is well on its way to approval, part of a series of incremental steps over the last several years that have already loosened Medicaid eligibility standards.

And this one offers a dangerous precedent for other states. Because Medicaid is jointly financed by the federal government, at fifty cents on the dollar or more, non-California taxpayers, including many middle-income workers living in states with stricter Medicaid rules, will actually end up paying a huge chunk of this costly California policy’s billion-dollar annual price tag.

Medicaid was designed as a jointly financed federal-state program to provide health care for the poor. It also pays for nursing-home care and increasingly for home healthcare for individuals, especially the disabled and elderly who spend down their assets before becoming eligible. Eligibility for various types of long-term care benefits is determined by medical need and a set of income and asset tests, which differ by state and have changed over time, but are within a federal framework.

California has long played loose with eligibility, benefits and other rules, even beyond the allowable leniencies in federal law. For example, under “Phase I” of the state’s 2021 reform legislation, its asset-test maximum for Medicaid eligibility is $130,000 (compared to just $2,000 in most states) for individuals and $195,000 (compared to $3,000) for couples.

Also, the “look-back” period to identify and disallow strategic transfers of assets to gain Medicaid eligibility is only 30 months, whereas federal law calls for 60 months. California’s look-back also does not apply if the applicant is not in a nursing home at the time of application. Federal law penalizes such strategic transfers, regardless of whether the person is institutionalized. California also turns a blind eye to as much as $12,000 in daily transfers of wealth to relatives per day, meaning that the wealthy can strategically shift as much as $4.4 million per year in order to pass the asset test.

California also completely disregards applicants’ net housing equity, which most states start to count as an asset after exempting the first $688,000 to $1,033,000. Retirement assets, including spousal retirement assets, are also disregarded, unlike in most other states.

Estate recovery from deceased recipients only applies to assets going through probate, thus bypassing retirement and insurance assets entirely. Unlike in some states, no liens are placed on housing. Despite the great wealth held in California, with home values averaging $750,000, the Medicaid program’s estate recovery efforts have lagged over the years, falling from $72 million collected in 2015 to $17 million in 2020.

Many of these leniencies directly contradict federal law, yet they were somehow approved by federal regulators at the Center for Medicare and Medicaid Services (CMS), without request for public comments, through a series of state plan amendments. Today, Phase II of California’s pending proposal — the total elimination of asset testing — is before CMS.

California officials told CMS that the total disregard of assets would annually cost the federal government only $115 million. Their own budget showed an increase of 37,000 newly eligible individuals and a $400 million total cost.

This is low compared to the approximately $35 billion that California spends on long-term care benefits through Medicaid. My own rough calculation, based on data from the Health and Retirement Study on asset holdings and another survey on long-term care needs, is that the annual additional cost to Medicaid from California’s disregard of assets will actually be at least $1.2 billion, with over 100,000 newly-eligible individuals.

Roughly half of this bill will be picked up by the federal government, not just by California taxpayers.

Even more concerning than the bad policy — which is contrary to the financial self-reliance of those who can afford it — is the poor precedent this circumvention of federal law would set for other states in designing their own Medicaid programs. Also, the complete lack of democratic process and bureaucratic transparency at a time of massive federal budget deficits is profoundly disturbing.

It is not too late for CMS and Congress to call these harmful actions into question and stop them.

Mark J. Warshawsky is a senior fellow at the American Enterprise Institute. He served as Vice-Chair on the federal Commission on Long-Term Care in 2013.

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REFORM- Home Visits With A Registered Nurse Did Not Affect Prenatal Care In A Low-Income Pregnant Population

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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.

 
 

[MM Curator Summary]: Sending a nurse in the home didn’t help.

 
 

 
 

Clipped from: https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2022.01517?journalCode=hlthaff

Abstract

There is an urgent need to improve maternal and neonatal health outcomes and decrease their racial disparities in the US. Prenatal nurse home visiting programs could help achieve this by increasing the use and quality of prenatal care and facilitating healthy behaviors during pregnancy. We conducted a randomized controlled trial of 5,670 Medicaid-eligible pregnant people in South Carolina to evaluate how a nurse home visiting program affected prenatal health care and health outcomes. We compared outcomes between the treatment and control groups and found little evidence of statistically significant differences in the intensity of prenatal care use, receipt of guideline-based prenatal care services, other health care use, or gestational weight gain. Nor did we find treatment effects in subgroup analyses of socially vulnerable participants (46.9 percent of the sample) or non-Hispanic Black participants (52.0 percent of the sample). Compared with the broader Medicaid population, our trial participants had more health and social risk factors, more engagement with prenatal care, and similar pregnancy outcomes. Delivering intensive nurse home visiting programs to the general Medicaid population might not be an efficient method to improve prenatal care for those who need the most support during pregnancy.

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PHE- Biden administration warns states as millions lose Medicaid

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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.

 
 

[MM Curator Summary]: More on the CMS effort to get faster states to slow down their RTNO. Including links to the letters they sent August 9 to all 50 states.

 
 

 
 

Clipped from: https://www.politico.com/news/2023/08/10/biden-administration-states-medicaid-00110686

More than 4 million people have had their Medicaid benefits terminated in the last four months, including nearly three-quarters who have lost coverage because of paperwork problems.

 
 

The criteria don’t reflect all potential challenges with states’ unwinding processes, the letters are only based on data reported by states in May and some states are missing data.

Still, CMS’ decision to make the letters available online represents a sharp about-face for an agency that has refused for months to single out any state it believes may be violating federal law — or even name specific criteria that would trigger stronger action against states — for fear of damaging its relationships with them.

“It looks like this is certainly part of the paper trail to move to more explicit and hopefully rigorous enforcement activities,” said Joan Alker, executive director and co-founder of Georgetown University’s Center for Children and Families. “It’s a positive sign that CMS is becoming more transparent about their enforcement activities.”

It also comes as the agency faces increasing pressure both from Congress and state-level advocates who are alarmed by the high rates of coverage losses and have called on the agency to take more forceful action for noncompliant states, like yanking federal funding.

More than 4 million people have had their Medicaid benefits terminated in the last four months, including nearly three-quarters who have lost coverage because of paperwork problems.

More than half of states were flagged by CMS as having high rates of people who lost their Medicaid benefits for procedural reasons, meaning the state was unable to make a determination about whether the person was or was not eligible for coverage.

CMS said the data indicate people may not be receiving renewal notices, are unable to understand them or are running into challenges submitting renewal forms — in short, eligible people may be losing coverage. The agency noted that federal regulations require it to continue to provide Medicaid to eligible individuals until they are found ineligible.

Sixteen states were flagged for having long call center wait times and high call abandonment rates, which CMS said are “impeding equitable access” to Medicaid coverage and may indicate potential noncompliance with federal requirements under the Social Security Act.

Sixteen states were also singled out because a large number of Medicaid applications based on income were not processed within the 45-day window required by regulation.

Jim Beardsworth, a spokesperson for Rhode Island’s Department of Human Services, said the state has a “rigorous quality control program” to review procedural terminations and has delayed ending coverage for families and children until the beginning of 2024.

He added that the state has plans to soon increase its call center support through a cross-agency partnership, and is working with federal officials to build additional capacity, and that the state had reduced its application processing times to meet federal guidelines as of Aug. 1.

The four other states flagged for all three criteria did not respond to requests for comment on Thursday, nor did CMS.

While much attention has been paid to Republican-led states that have prioritized removing ineligible people from their Medicaid rolls as quickly as possible and have, as a result, seen high rates of coverage losses, the letters suggest significant problems in blue states, which are by and large taking their time with the unwinding process.

New Mexico and Rhode Island, two of the states flagged for all three criteria, are run by Democrats. And four more blue states were identified as falling short on two of the criteria.

“They need to apply these criteria across the board, and they’re doing that, and that’s good,” Alker said.

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Human Services Department Announces Intent to Award Medicaid Contracts

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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.

 
 

[MM Curator Summary]: Winners – BCBS, Presby, UHC and Molina.

 
 

 
 

Clipped from: https://www.hsd.state.nm.us/2023/08/11/human-services-department-announces-intent-to-award-medicaid-contracts/

SANTA FE – Today, the New Mexico Human Services Department (HSD) announced its intention to award Medicaid managed care organization (MCO) contracts to four health plans for Turquoise Care, the state’s Medicaid managed care program. The state will negotiate contracts with BlueCross BlueShield, Presbyterian Health Plan, United Health Plan, and Molina Health Plan with a start date of July 1, 2024. The state announced that it does not intend to negotiate a Medicaid contract with current MCO Western Sky Community Care. 

The Human Services Department also announced a decision to rescind the cancellation of the Turquoise Care Request for Proposals (RFP), which was made on January 30, 2023, to allow agency leadership an opportunity to assess the design of the procurement.  

“HSD spent the past several months reviewing the MCO contracts in depth and making improvements that focus on advancing and incentivizing health plan performance and ensuring that Medicaid customers have access to this information when they pick their health plan,” said HSD Acting Secretary Kari Armijo. “We will be negotiating contracts that reflect these improvements with the expectation of achieving better health outcomes for Medicaid customers.”  

HSD has engaged with a consultant to make recommendations for improving MCO contract enforcement and compliance, and the agency is making several contract improvements with the existing health plans that will go into effect September 2023. 

The new go-live date for the MCO contracts is July 1, 2024, a change from the original planned go-live date of January 1, 2024. The extension will allow HSD to complete the Medicaid unwinding, which requires a full recertification of every Medicaid customer over a 12-month period that extends through March 2024. This process was suspended during the COVID-19 Public Health Emergency. Open enrollment for the new MCO contracts will begin in April 2024 after the unwinding is complete. 

“The new contract go-live date will minimize disruption for Medicaid customers by allowing HSD to focus on the important work of recertifying eligibility for the 934,305 customers who are enrolled in the program,” said Armijo. “We want all Medicaid customers to be watching for their turquoise envelopes and submitting the required paperwork to make sure they stay covered if eligible and to help them transition to other health insurance coverage if they no longer qualify for Medicaid.” 

Medicaid customers can learn more about how to renew their Medicaid coverage by visiting HSD’s Renew New Mexico! website at renew.hsd.nm.gov or by calling HSD at 1-800-283-4465. 

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We talk, interpret and smile in all languages.  We provide written information to our customers in both English and Spanish and interpretation services are available in 58 languages through our provider, CTS Language Link. For our hearing, and speech impaired customers, we utilize Relay New Mexico, a free 24-hour service that ensures equal communication access via the telephone to individuals who are deaf, hard of hearing, deaf-blind or speech disabled. 

The Human Services Department provides services and benefits to 1,046,816 New Mexicans through several programs including: the Medicaid Program, Temporary Assistance for Needy Families (TANF) Program, Supplemental Nutrition Assistance Program (SNAP), Child Support Program, and several Behavioral Health Services.

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Carter, Dunn introduce Medicaid Staffing Flexibility and Protection Act

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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.

 
 

[MM Curator Summary]: States can (and do) already contract for help with this. So this must be aimed at letting the contractors do more than they are currently authorized to do.

 
 

 
 

Clipped from: https://buddycarter.house.gov/news/documentsingle.aspx?DocumentID=11368

Washington, D.C. — Reps. Earl L. “Buddy” Carter (R-GA) and Neal Dunn (R-FL) this week introduced the Medicaid Staffing Flexibility and Protection Act, which alleviates staffing shortages at state Medicaid agencies so that beneficiaries do not lose their coverage due to procedural or staffing issues.

During the pandemic, states were required to continuously enroll people into Medicaid for the duration of the public health emergency, regardless of changes to the enrollee’s eligibility. Four months after this program ended, some states are still struggling to work through redetermining the eligibility for the nearly 95 million Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries, which has already caused eligible Americans to lose their coverage. With 229,000 local government jobs and 133,000 state government jobs yet to be recovered since February 2020, some states do not have the workforce to handle this massive task.

This bill provides states the flexibility and resources they need by allowing them the option to hire outside contractors to help work through this backlog, ensuring that those who need these essential health care benefits receive them.

“This common-sense solution allows states to meet their obligations to Medicaid and CHIP enrollees,” said Rep. Carter. “I’ve heard from Georgians who are concerned that their family will lose access to necessary, life-saving care, for no reason other than workforce and staffing challenges. This bill will equip states with the tools they need to review these applications and give beneficiaries the coverage and peace of mind they need.”


“As states work diligently to protect taxpayer dollars and maintain the integrity of their Medicaid programs, it is important that they have the options they need to efficiently execute the redetermination process. The Medicaid Staffing Flexibility and Protection Act will give states the freedom to contract out certain services related to the necessary redetermination process to private partners if they choose to. States may choose to do so due to workforce shortages which are being felt acutely across the nation,” said Rep. Dunn.


Read the full bill text here.

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STATE NEWS (NC)- Medicaid gives NC district free school meals

MM Curator summary

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.

 
 

[MM Curator Summary]: A look at how some school districts are bridging the gap from when COVID paid for all school meals to now.

 
 

Clipped from: https://www.ednc.org/medicaid-data-is-helping-students-in-this-n-c-county-eat-for-free/

 
 

Graham County Schools Nutrition Director Denise Moody walks into an office at Robbinsville Elementary School. Alli Lindenberg/EducationNC

There are 1,100 students enrolled in Graham County Schools. Thanks to a pilot program through the U.S. Department of Agriculture (USDA), all of those students will receive free school meals starting in the 2023-24 school year. 

The USDA’s Food and Nutrition Service approved 12 new states to participate in the Direct Certification with Medicaid Demonstration Project for the 2023-24 school year. North Carolina is one of those states.

The data associated with Medicaid caused Graham County School district’s identified student percentage (ISP) to jump from 43% to 66% across all three schools in the county. Identified students are students who qualify for free meals without a household application. This additional data from Medicaid allowed for the automatic enrollment of lower income, and potentially hungry, students. 

A school’s ISP is also what determines their ability to enroll in the Certified Eligibility Provision (CEP). The purpose of CEP is to provide meals “at no cost” to students in high poverty areas. It allows schools and districts to offer free school meals to all students if a certain percentage of the student body qualifies for free-and-reduced lunch.

“We’ve got a lot of people living below the poverty level, and then we have a lot of families that just barely made that cut off,” said Denise Moody, director of nutrition for Graham County Schools.
 

 
 

A summer school student works on her lesson at Robbinsville Elementary School in June 2023. Alli Lindenberg/EducationNC

Moody has been with the school system for 12 years. She started out as a teacher, both in first and third grade. Her degree is in nutrition, so when the previous nutrition director retired, she was a natural choice for the role.

Out of the 1,100 students in Graham county, 310 belong to families that receive Supplemental Nutrition Assistance Program (SNAP) benefits. An additional 300 students are in families that qualify for Medicaid.

“Before, we were only able to count our food stamp kids and homeless or runaway and foster kids, so we didn’t have that data,” said Moody.

Even though Graham County Schools previously had an ISP of 43%, which made them eligible for CEP, it wouldn’t have been financially worth it.

CEP works by reimbursing schools and districts. According to the CEP agreement with the federal government, the school system has to pick up any cost for the nutrition department that is above and beyond whatever reimbursement they receive from CEP. 

If Graham had enrolled in CEP last year, Moody said, they would have received a $4.43 reimbursement per meal for the majority of the children but $0.87 cents for the remaining children that ate meals.

The Child Nutrition Department at Graham County Schools is a self-sustaining budget. The magic number for the 100% free reimbursement rate is 63% for Graham County Schools, which they were finally able to reach because of Medicaid data. Last year was the first year the school was able to use that data, because of the pilot program through USDA. With a 63% ISP, the meals will be fully covered because they are able to reach that higher rate of reimbursement.

Paying down debt

During the first two years of the COVID-19 pandemic, all public school students were able to eat school meals for free, regardless of income. That flexibility ended during the last school year, although North Carolina’s legislature extended a provision allowing students who qualify for reduced lunch to receive free lunch.

“When everybody was eating for free, more kids did eat,” said Moody. “During those two years, during the pandemic, we had more participation.”

The more students that eat free meals, the more money Moody receives in the form of reimbursement. According to her calculations, if participation is as high as she is hoping for this upcoming school year, she could get $200,000 back. Not only does that help provide meals to students, but it also allows the department to cover rising costs of food due to inflation.

“You used to be able to get a case of fruit cocktail for $26. Now it’s like $66. Some of this stuff has doubled in price,” said Moody.

In the future, Moody hopes she can purchase some new equipment for her kitchens.

“I have a steamer that needs to be replaced. I have a refrigerator that needs to be replaced. We have some equipment that is 20 years old,” said Moody.

The new steamer costs $46,000. A new industrial fridge would cost about $5,000. In addition to kitchen equipment, the schools could use some new dining tables and chairs, she said.

Other food programs

In addition to the free meals, there are other resources available for families in the district that are experiencing food insecurity. The MANNA FoodBank, based out of Asheville, delivers 50 food boxes to the district’s central office every two weeks. These boxes include shelf-stable items and items that students can make themselves, like microwavable mac and cheese. Sometimes the boxes will also include fresh produce, like apples or oranges. 

Boxes of produce for the summer feeding program at Graham County Schools. Alli Lindenberg/EducationNC

Parents can sign up to receive boxes at the office or contact Denise Moody directly. There is also a soup kitchen in Robbinsville that MANNA supplies. They hand out bags of food on Wednesday nights. Families can drive up and pick up the bags.

While families wait for school to resume this fall, students can eat free breakfast and lunch at Robbinsville High School. The summer feeding program began on June 12 and will continue through July 31. Breakfast is served from 7:30 to 8:30 a.m. Monday through Friday. Lunch is served from 11:00 a.m. to 12:00 p.m. Monday through Friday.

Any child 18 and under is welcome.

Correction: An earlier version of this article stated that the free lunch Graham County Schools will provide in the 2023-24 school year was due to data available because of Medicaid expansion. It has been updated to reflect that these free meals are due to Medicaid data from the USDA’s Direct Certification with Medicaid Demonstration Project.

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FWA (AK)- Anchorage assisted-living home operator charged in Medicaid fraud case

MM Curator summary

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.

 
 

[MM Curator Summary]: Abdoulie Lowe stole about $800k of your tax dollars using bogus Medicaid claims.

 
 

 
 

Clipped from: https://alaskapublic.org/2023/08/04/anchorage-assisted-living-home-operator-charged-in-medicaid-fraud-case/

 
 

A sign directs visitors to either the Nesbett Courthouse or Boney Courthouse in downtown Anchorage. (Valerie Kern/ Alaska Public Media)

An Anchorage man is accused of fraudulently collecting nearly $800,000 in Medicaid payments over the past two years, state officials said Thursday.

According to a statement from the Alaska Department of Law, a grand jury indicted 47-year-old Abdoulie Lowe for receiving reimbursements for work which wasn’t documented as required by law. He also allegedly submitted another $7,000 in claims for services he claimed to provide to people in his care “when he was actually working elsewhere,” the statement said. 

An initial indictment in the case listed offenses spanning from October 2021 through April of this year. Lowe – who did business as Apapa Assisted Living Home – allegedly submitted more than $328,000 in fraudulent claims for care of a single patient, plus more than $248,000, $185,000 and $32,000 for three others.

Maeve Kendall, the assistant attorney general with the state Medicaid Fraud Control Unit prosecuting the case against Lowe, declined to discuss the developing case in detail Friday. She said none of the money has been recovered yet, in what she called one of the unit’s larger cases.

“A six-figure fraud is certainly a significant matter for our unit, and especially in Alaska,” Kendall said.

According to Kendall, Apapa had been providing care at an East Anchorage apartment, an arrangement she said was relatively common for small assisted-living facilities in Alaska.

“At the arraignment yesterday, Mr. Lowe did confirm with the court that he is no longer operating as a Medicaid provider,” Kendall said. “So he does not have clients in his care at this point.”

Lowe could not be reached for comment Friday. Court records didn’t list a lawyer for him.  A phone number for Apapa Assisted Living had been disconnected.

Lowe is charged with six felony counts of medical assistance fraud and one felony count of second-degree theft, plus failing to maintain workers’ compensation for his employees.

According to the Department of Law, the most severe charges against Lowe carry penalties of up to 10 years in prison, a $100,000 fine and payment of restitution to the state.

“A conviction on any of these charges can lead to Mr. Lowe’s exclusion from the Medicaid program,” prosecutors wrote.