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Tuesday, Jan 12 2016

Full Issue

N.C. Legislative Panel To Get Briefing On New Managed Care Medicaid System

The lawmakers will hear about how the initiative is being rolled out. Also in the news, a Chicago woman is sentenced for Medicaid fraud.

Legislators and the health-care industry will today get their first update on the roll out of the state鈥檚 controversial Medicaid reform initiative. ... The reform plan coordinates Medicaid physical, behavioral, dental, pharmacy and long-term-health services. Under the plan, three insurers would contract to run statewide managed care organizations (MCOs), and up to 10 provider-led entities, or groups of doctors and hospitals, would enroll patients in regional networks. (Craver, 1/11)

A Chicago woman was sentenced to six years in prison last week for stealing more than $250,000 in Medicaid funds over three years. Debra Gaines, 55, was convicted of theft of state property and vendor fraud in July for a scheme to collect Medicaid funds for mental health services that were not provided by a doctor, according to the state鈥檚 attorney general鈥檚 office. Gaines billed Medicaid for $276,000 between 2007 and 2010 for services provided by Dr. Ernest Mensah under her business called Heavenly Interventions, the attorney general鈥檚 office said. (1/11)

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