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Vermont Press Bureau: Legislation looks to curb Medicaid fraud

November 10, 2015
In The News

By Josh O'Gorman

BARRE — Vermont’s lone member of the U.S. House of Representatives is proposing legislation intended to reduce Medicaid fraud.

Rep. Peter Welch, D-Vt. is one of three sponsors of a bipartisan bill that calls for states who convict health care providers of Medicaid fraud to report that information to the federal government, which will then share the information with other states.

“There are a number of bad actors that provide fraudulent Medicaid reimbursement bills, and a failure at the federal level to jump on this and get that information out to other states where Medicaid providers might be ripping off the taxpayer,” Welch said during a stop Monday morning at Capstone Community Action, which provides social services to the neediest of Washington County area residents.

One of the results of the Patient Protection and Affordable Care Act — commonly referred to as Obamacare — has been an increase in the number of people who are enrolled in Medicaid, which is funded through federal and state dollars.

From left, Rep. Peter Welch, Attorney General William Sorrell and Human Services Secretary Hal Cohen.
Stefan Hard / Barre-Montpelier Times Argus
From left, Rep. Peter Welch, Attorney General William Sorrell and Human Services Secretary Hal Cohen.
With an annual budget of $1.2 billion dollars and 200,000 people — or approximately one-third of the state population — Vermont is among the states with the highest number per-capita of Medicaid recipients in the country.

“With Obamacare, and states increasingly taking advantage of Medicaid programs, we’re seeing Medicaid rolls nationally increasing significantly,” said Vermont’s Attorney General William Sorrell. “With government taking up more and more of the cost of health care, better communication between governmental entities is needed to weed out those bad actors who have been removed from the Medicaid or Medicare program for cause.”

Sorrell, whose office prosecutes Medicaid fraud cases, said that, for the most part, the type of fraud found in Vermont differs from incidents found in other states.

“An awful lot of our fraud is smaller, home care workers and such, but we have had some large-dollar amounts of fraudulent billing,” Sorrell said. “But fortunately, the size of the state, people know each other, we haven’t been victimized the same way, the same amounts, as other states.”

Under the terms of the bill, within two years, it will be the responsibility of a state to check the federal list of disqualified providers before issuing reimbursement. If reimbursement is given to a disqualified provider, the state will have to repay the federal government its share of the payment.

“There’s a recognition the state’s need to get their acts together, too,” Welch said.

Hal Cohen, secretary of the Agency of Human Services, said the state is in complete support of the bill.

“I think the idea this bill will disallow costs is a great incentive for states to follow and make sure that providers who have been decertified are not providing services in their states,” Cohen said. “This is an essential program and one in which we really need to protect the integrity of the program.”

The bill has already received the unanimous support of the House Energy and Commerce Committee, and Welch expressed optimism the bill will receive wider approval.

“A lot of my Republican colleagues aren’t in favor of the Medicaid program and the Medicaid expansion,” Welch said. “They voted against Obamacare. On the other hand, they are with me on rooting out fraud.”