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AG Kilmartin Seeks to Expand Medicaid Fraud Authority to Address Home Healthcare and Community-Based Abuse Cases

Attorney General Peter F. Kilmartin joined attorneys general from 36 states and the District of Columbia in urging the U.S. government to change its policy giving Medicaid Fraud and Control Units (MFCU) greater authority to investigate and prosecute Medicaid abuse and neglect cases, specifically those that happen at home and non-Medicaid funded residential facilities.

Medicaid is a joint federal-state program that provides free or low-cost medical benefits to millions of Americans. In Rhode Island, there were approximately 311,640 Medicaid beneficiaries as of March 2017, according to the Executive Office of Health and Human Services. Of those, approximately 20,100 are age 65 or older. According to the Centers for Disease Control and Prevention, one in 10 persons age 65 or older who live at home will become a victim of abuse.

Medicaid Fraud and Control Units are restricted to investigating and prosecuting state Medicaid provider fraud and resident abuse complaints in Medicaid-funded health care facilities. Medicaid regulations currently prohibit MFCUs from investigating and prosecuting abuse and neglect in private homes or non-Medicaid funded residential facilities.

In a letter to the Tom Price, Secretary of the U.S. Department of Health & Human Services (HHS), the federal agency that is responsible for the Medicaid program, the attorney generals request HHS allow MFCU federal funds to be used to investigate and prosecute abuse and neglect of Medicaid beneficiaries in non-institutional settings (i.e. home health care), and to allow use of MFCU federal funds to freely screen or review any and all complaints or reports of whatever type, in whatever setting.

As the attorneys generals noted in the letter, "…the current strict federal limitations on states' ability to use MFCU assets to investigate abuse and neglect are outdated, arbitrarily restrict our ability to protect Medicaid beneficiaries from abuse and neglect as Congress intended, and should be replaced or eliminated."

Attorney General Kilmartin added, "As a policy, states recognize the cost savings and health benefits of patients of shifting from institutionalized-based case to home health care. The shift to home health care, however, has contributed to improper payments, significant fraud, and places vulnerable beneficiaries at risk for abuse and neglect."

In addition to seeking expanded authority for the state's MFCU to investigate and prosecute abuse and neglect, Attorney General Kilmartin continues to advocate for national background checks for those who perform home health care services to Medicaid beneficiaries.

"For patient safety, especially due to the vulnerability of our seniors, workers in this field need to be subject to a national background check, training and regulation. As more patients return to home, we need to ensure the most vulnerable are being treated by professional workers to protect them from victimization and exploitation," said Attorney General Kilmartin.

Kilmartin's legislation requires all personal care attendants to be subject to a national background check as a condition of certification and employment. It also allows for the biannual renewal of registrations, which would be granted as a matter of course with proof of completion of continuing education unless the Department of Health (HEALTH) finds that the registrant has acted or failed to act in a manner that would constitute grounds for suspension or revocation of a certificate.

The legislation allows for HEALTH to deny, suspend or revoke a person's certificate of registration in any case in which it finds that there has been failure to comply with the requirements, or that the registrant has been convicted of a disqualifying offense.

"This is a safety issue for our most vulnerable citizens. Although personal care attendants do not provide medical services, they provide assistance with physical activities, such as grooming and bathing, and financial activities, such as paying bills and shopping, as well as companionship for their clients. I strongly believe it is necessary, due to the intimate physical tasks required of personal care attendants, that they be required to receive a national criminal records check and basic training, as well as individualized training to suit the needs of their client," concluded Kilmartin.

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