[V]ermont officials have joined a nationwide push to expand states’ ability to investigate and prosecute abuse and neglect of Medicaid patients.
That change could come via federal legislation cosponsored by U.S. Rep. Peter Welch, D-Vt. The bill, H.R. 3891, would allow states’ Medicaid Fraud and Abuse Control Units to probe potentially criminal activity in home health care settings – not just in institutions like hospitals or nursing homes.
The policy shift would relieve a logistical and financial burden on states like Vermont by drawing down more federal money for investigations. Officials say it also may allow for more convictions.
“This is about protecting the most vulnerable,” state Attorney General TJ Donovan said. “This is just common sense.”
Welch’s bill, which may come up for vote this week in the House Energy and Commerce Committee, is spurred by a change in demographics and changes in the way money is distributed by Medicaid – a program jointly administered by the federal and state governments.
Years ago, when Congress first authorized state-level Medicaid fraud investigation units, most care was provided in “institutional settings,” Welch said. So the work of those fraud and abuse-control units was focused on such settings as mental health facilities, hospitals and nursing homes.
Welch said he believes that investigatory model “has worked extremely well.”
But times have changed. An example is Vermont’s Choices for Care program, which offers long-term care options including in-home services for those with disabilities or increased needs due to aging.
“Everything that we are working on is trying to get people out of facilities, into their community and allow them to be where they are able to flourish,” state Human Services Secretary Al Gobeille said. “The problem with that is the Medicaid law didn’t keep up with it.”
Gobeille was referring to the fact that investigators with the Vermont attorney general’s Medicaid Fraud & Residential Abuse Unit can’t investigate alleged abuse and neglect in home health care settings. Instead, such complaints are handled via Adult Protective Services and fully funded by the state budget.
Welch’s bill, which was introduced last year and co-authored by U.S. Rep. Tim Walberg, R-Mich., clarifies that state-level fraud and abuse-control units can “investigate and prosecute cases of Medicaid patient abuse and neglect in any setting” including home health.
There are several advantages to that switch, officials said Tuesday at a press conference held at the Vermont Statehouse.
First, it would provide more federal money for investigations. Probes that are now funded entirely via the state budget “will move into what we call global commitment funding, which will be 60 percent or more paid by the federal government,” Gobeille said.
“The financial implications of this are tremendous,” he said.
The change also could allow for more investigations. Gobeille said he doesn’t believe any resulting cost savings at the state level should be put aside for some other program.
“I don’t think we’d spend less money. I think we would expand what we can do,” he said. “The caseloads are high.”
Also, Donovan said passage of Welch’s bill would allow officials to “streamline” investigations. “This is going to open up the door to allow the subject matter experts to do their job to keep our community safe,” he said.
There’s already no shortage of work for those experts. The latest report from Donovan’s Medicaid Fraud & Residential Abuse Unit says the unit has been able to recoup more than $30 million over the past five years via criminal and civil actions.
The unit’s recent work included a record $6.75 million settlement with the former Burlington Labs after allegations of large-scale Medicaid fraud there.
The fiscal 2017 report says 80 percent of the unit’s current investigations involved provider fraud, and only 15 percent involved patient abuse and neglect – the kinds of cases covered under Welch’s legislation.
“However, the unit has and will continue to place an emphasis on both Vermont provider fraud and the abuse, neglect and exploitation of vulnerable adults in Vermont,” the report says.
The National Association of Attorneys General has endorsed Welch’s legislation, saying it would “improve states’ ability to combat abuse and neglect of Medicaid patients.”
