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VPR: Vt. Officials Call For Federal Law That Expands Ability To Investigate Medicaid Fraud

September 12, 2018
In The News

Rep. Peter Welch said he's optimistic that his bipartisan bill that expands the authority of state Medicaid Fraud Units will soon be passed by Congress — and Vermont officials say the bill will give them greater ability to investigate a wide range of fraud cases.

Under current law, state Medicaid Fraud Control Units are allowed to investigate alleged cases of fraud and abuse only if the incident took place in a health care facility.

Welch's bill expands the scope of these state Fraud Units to encompass all Medicaid services, including home care.

"The Attorney General's Office right now does not have the legal authority to pursue it, so fraudsters have got a good deal,” said Welch. “They basically know nobody's going to be looking over their shoulder. And if we pass this legislation, that's not going to be the case. So it's also a deterrent because it's not a free ride and no one's looking anymore.”

Attorney General TJ Donovan said Welch's bill will also allow the Medicaid Fraud Units to investigate cases of abuse and neglect of older Vermonters by their own family members, which is something they haven't been able to do under the existing law.

"This is about abuse and neglect — it's also about fraud, but ... let's make no mistake, this is about abusing vulnerable Vermonters,” said Donovan. “This is going to open up the door to allow the subject matter experts to do their job to keep our communities safe."

Al Gobeille, secretary of the Vermont Agency of Human Services, said that 30 years ago, most Medicaid services were delivered within institutional settings.

But he said that's no longer the case, and he said the fraud law needs to reflect this new reality.

"You fast forward to today and 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," said Gobeille. "And the problem with that is that the Medicaid law didn't keep up with it."

Gobeille said his agency's "Choices for Care" program is a perfect example of how the state is moving away from institutional care. He said this program provides the support services that are needed to help older Vermonters stay in their own homes for as long as possible.

"In the nursing home, it costs around $71,000 a year on average. At home, it's about $30,000,” said Gobeille. “It's less expensive, people love it, however we haven't had the oversight that we would like for programs like this and in the right place in government."    

Welch said there's a very good chance that the U.S. House will vote on the legislation by the end of the month.