Kip Piper

Medicaid, Medicare expert | Advise providers, life sciences, et al | Formerly OMB, CMS, Medicaid director, health agency head, pvt sector exec |

[Kip Piper @KipPiper]

Massachusetts sues UnitedHealth insurance unit for alleged Medicaid fraud https://t.co/NNZab2Htkx

[Brian Blase @brian_blase]

🔥Incentives matter.

The incentives push toward enrollment in govt health programs, even when it is improper.
1) Insurers make more $
2) Brokers make more $
3) Hospitals receive more $
4) People get enrolled

So, eligibility verification is crucial.

https://t.co/DTKdVRJDdM

[Paragon Health Institute @Paragon_Inst]

Paragon's Kev Coleman has authored a new paper on improving the reliability and safety of AI-enabled medical devices.

Many AI systems perform well during development but less reliably when used on patients who differ from the training data.

The paper proposes Digital Similarity Analysis (DSA) -- comparing a patient's medical image against the AI model's training data and warning clinicians when the tool may be less reliable for that patient.

https://t.co/oeKx1cCjPF

[Fox News @FoxNews]

NEW: VP Vance shares a gut-wrenching example of Medicaid fraud uncovered by his task force:

"A man who was supposed to be providing services to allow elderly people to live full and independent lives... What happened instead is that the man who was supposed to provide these services, reimbursed by the Medicaid program, was providing nothing, no services, no help, no check ins."

"The vulnerable elderly man that he was supposed to be protecting and looking after, was reimbursed by the taxpayer in order to do exactly that, that man died."

"That man lived his final moments on this earth, neglected while a fraudster got rich by providing services that he never actually provided."

[Kip Piper @KipPiper]

Attorney general seeks audit of poor, weak state oversight of Medicaid managed care contractors. Provider complaints are pilling up.

https://t.co/6lDR1qXZDd

[Kip Piper @KipPiper]

AI can outperform physicians in emergency room diagnoses: study.

https://t.co/b14OGUgiJO

[Chris Pope @CPopeHC]

From 2019 to 2023, Medicaid spending on nursing facilities per senior increased by 5%; that on home/community care by 47%.
https://t.co/OZuDyiL8yV

[Kip Piper @KipPiper]

Maine Medicaid is delaying some provider claims payments ~two months until next fiscal year starts on July 1. Services will continue but provider cash flow will get hit.

[Kip Piper @KipPiper]

Minnesota’s spending doubled across 14 Medicaid programs at ‘high risk’ of fraud in past 5 years.

https://t.co/By28qzTd5O

[The FGA @TheFGA]

States should remove deceased enrollees from their Medicaid programs to restore program integrity.

READ ⤵️ https://t.co/ncwZ46ln0u

[Kip Piper @KipPiper]

@ADVIhealth Lindsay is exceptional and provides valuable insights. Article is well worth reading for anyone wanting to understand what's happening in the market. 🎯👍

[ADVI @ADVIhealth]

On March 31, ADVI's Lindsay Bealor Greenleaf was featured in Pharmaceutical Executive's article, "How Will MFN's Effects on Medicare Impact Innovation?"

Lindsay shared her insights on the current state of #MFN and how it's expected to evolve. Read more: https://t.co/0NnXNQc2q4

[Kip Piper @KipPiper]

Texas lawmakers hold hearing on Medicaid and social services fraud.
https://t.co/7CgXk4O4we

[Kip Piper @KipPiper]

Utah Hospitals Kept $500M Meant for Skilled Nursing Facility Patient Care, State Audit Finds. https://t.co/5LgBxvigqp

[Kip Piper @KipPiper]

Oregon improperly spent $15 million in state health benefits. Agency handed adverse audit opinion, the toughest rebuke possible.

https://t.co/55yqcr1yJq

[Paragon Health Institute @Paragon_Inst]

States can protect Medicaid for the people who truly need it — but only if they're willing to act.

@brian_blase and @NKleinworth lays out exactly how states can limit waste, fraud, and abuse in the program.

https://t.co/XCgooEVTY3

[Kip Piper @KipPiper]

Missouri GOP state legislators move to cover food as Medicaid benefit.

https://t.co/yoJ7Qo0VU9

[Kip Piper @KipPiper]

States Pay Contractors Millions to Comply With Medicaid Cuts. Complex IT System Upgrades are Necessary.
https://t.co/CTrO1U9zfs

[Kip Piper @KipPiper]

Head of Colorado’s Medicaid program resigns as state Senate was preparing to take “no confidence” vote. https://t.co/qXNjeCbsM8 via @coloradosun

[Kip Piper @KipPiper]

Wells Fargo sees 2% quarterly drop in US Medicaid enrollment.

https://t.co/R5aTlJeub2