Celebrating Great Work- Making a Difference for Medicaid Members

We hope you are reading this message from the comfort of your home office or mobile device  as you take time to enjoy family and friends on this well earned day off.

Labor Day was set aside on June 28th, 1894 as a national holiday.  This day was dedicated to the working men, women and children who have become the industrial foundation on which America was built.  It is a day to pay tribute to all of those who contribute to the social and economic success of the nation.

We want to wish you all the happiest of Labor Day’s and extend an extra special “shout out” to all of those who go beyond expectations to make the “work” of bringing Medicaid benefits to thousands of needy Americans their life’s passion. Take a moment and listen to their stories.

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New Search: Medical Director-Southern Location

Richard Yadon, President of Managed Medicaid Services has initiated a search for a Medical Director for a key southern health plan. The selected individual will have the opportunity to provide the medical leadership that will ensure excellent quality of care and service is provided to all of members of the plan.

Would you like to learn more? Schedule a confidential phone consultation with Richard to determine if this role would be an ideal fit for you. Click Here For Schedule

Use your prior experience to lead/direct the following key functions:

Provide technical expertise in medical management by direct decision making in the areas of pre-authorization, concurrent review of hospitalized patients, discharge planning, complex case and chronic care management, and credentialing.

Oversee the clinical aspects of the quality management, credentialing, pharmacy, and medical management program.

Chairs (or staffs) all peer-review committees such as Quality Improvement, Pharmacy and Therapeutics, Credentialing, and others that are deemed appropriate for the health plan. Take part in periodic consultations and/or conversations with peers and practitioners in the field.

Analyzes medical cost drivers and develops specific plans to reduce excessive cost.

Works with senior leadership to develop strategic approaches to improve company performance and expand growth by optimizing provider network, evaluating provider (hospital, physician, ancillary) contracts, and developing other creative approaches.

A new Medicaid trend, Walmart gift cards?

Is the aggressive recruitment of Medicaid recipients the latest trend? Is it legal?

We hear of cases of Medicaid fraud in which a member’s identity is obtained, they are enrolled in Medicaid and then never receive any of the services in which Medicaid is billed. Fighting this fraud continues to be one of the top areas of concern for the entire industry. This is clearly crossing the legal line.

Today we are struck by the number of times we are hearing about the legal line being pushed in regard to the recruitment of patients covered by Medicaid to go to a particular doctor, not fraud per say but a practice that many question. With millions of dollars at stake healthcare companies are becoming aggressive in the methods they use to attract patients who are covered by Medicaid.

One example is the for profit hospitals who are updating their facilities to make them more attractive to Medicaid patients who are normally served at the non for profit hospital across the street. We read with interest the following article about large dental practices in Texas that have 100’s of recruiters on the street looking to encourage patients to see the dentist. These recruiters give out gift cards or pizza coupons to encourage a Medicaid covered patient to visit the dental office that has hired them. Servicing Medicaid patients is big business and dentists in Texas are clearly scrambling to get a bigger piece of the pie.

Recruiters Scramble for Texas Dental Patients

This is an interesting trend since we often hear from Medicaid experts/guests on the Medicaid Matters Talk Show that finding providers can be one of the main issues in delivering quality care. We may be seeing the tables turn and providers looking to capitalize on serving Medicaid patients rather than turning them away. We will keep you posted.

Memorial Day 2012

Richard Yadon, Host Medicaid Matters Talk Show

Memorial Day 2012. I am struck by the number of times in the past week that I have seen the slogan “Freedom isn’t free”, these words are often spoken but rarely reflected upon. Memorial Day was created with this goal in mind, a day for reflection for the American Soldier, Sailor, Airman, and Marine who never returned to their families.

Last month the Medicaid Matters Talk Show traveled to Washington D.C. for the MHPA Awards Forum, while I was there I got to visit the U.S. Navy Memorial for the first time. As I stood in the halls looking at images of fellow seamen past and present I was reminded of how it felt to be proud of my service to my country and at the same time looking forward to coming home.

I was fortunate, I served and I returned home. My life is filled with what FREEDOM affords every American… family, friends, church, and business ownership. The slogan “Freedom isn’t free” is a great reminder that my lifestyle has come at a cost. Many were not as lucky as I; they served our great country and never returned home. I am not only thankful for each of these brave men and women but also challenged by their sacrifice. Memorial Day reminds me that along with FREEDOM comes great responsibility to use my freedom to benefit the lives of others. It could be at home, in our communities, within our church families, or the office, we are all called to make a difference.

Enjoy this special holiday weekend. I hope that you get to spend it with friends and family enjoying all that the first weekend of summer has to offer. Please also join me in reflecting and remembering those that have made the greatest sacrifice to our country.

Happy Memorial Day,

Richard Yadon

Win A Free MHPA Webinar!

Knowledge is Power

Would you like to attend the 1st MHPA (Medicaid Health Plans of America)webinar on fraud and abuse? Register for our BLOG, top right hand corner of our website to enter to win a pass to attend for FREE!

Are you already registered for our BLOG? Cool! You have been entered to WIN!

Fraud, Waste and Abuse
for Managed Medicaid Plans
March 12, 2012 / 11 AM EST

Thomson Reuters
– Thomson Reuters works with over 20 state Medicaid agencies, CMS and several commercial payers to identify and reduce fraud, waste and abuse. We will share successes, strategies, and insights into how managed Medicaid plans can reduce fraud, waste and abuse and maximize their value. We will outline, enumerate and categorize the various kinds of fraud patterns in the Medicaid market, and will show specific results in collection, prosecution and prevention that have been achieved by our clients in this area.

Medicaid Video: Fraud Prevention