PROVIDENCE – R.I. Attorney General Peter F. Kilmartin joined attorneys general from 36 states and the District of Columbia to urge the federal government to change its policy, giving Medicaid Fraud and Control Units more authority to investigate and prosecute those Medicaid abuse and neglect cases that occur at home and in non-Medicaid-funded residential facilities.
Medicaid is a joint federal and state program that provides free or low-cost medical benefits to millions of Americans. In Rhode Island, there were approximately 311,640 Medicaid beneficiaries – about 20,100 of whom are 65 or older – effective March 2017, the attorney general’s statement reported, citing data from the R.I. Executive Office of Health and Human Services. According to data from the Centers for Disease Control and Prevention, 10 percent of individuals 65 or older who live at home will become abuse victims, the attorneys general statement said.
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Medicaid Fraud and Control Units can only investigate and prosecute state Medicaid-provider fraud and resident-abuse complaints in Medicaid-funded health care facilities; regulations currently bar MFCUs from pursuing investigations and prosecutions related to abuse that may be occurring in private homes or non-Medicaid-funded residential facilities, reported Kilmartin.
In a letter to Secretary of the U.S. Department of Health & Human Services Tom Price, the attorneys general request HHS allow MFCU federal funds to be used to investigate and prosecute abuse and neglect of Medicaid beneficiaries in non-institutional settings, such as home health care, and to allow use of MFCU federal funds to screen or review any and all complaints or reports of whatever type, regardless of the setting.
As the attorneys general noted in the letter, “[T]he current strict federal limitations on states’ ability to use MFCU assets to investigate abuse and neglect are outdated, arbitrarily restrict our ability to protect Medicaid beneficiaries from abuse and neglect as Congress intended, and should be replaced or eliminated.”
In the statement, Kilmartin added, “As a policy, states recognize the cost savings and health benefits of patients shifting from [an] 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 this expanded authority, Kilmartin continues to advocate for national background checks for those who perform home health care services to Medicaid beneficiaries. To that end, said Amy Kempe, spokesperson for the office, he has introduced legislation – in some form or another – every year since 2011, which has always been held for further study. This year, his bill has been introduced in the House by Rep. Jeremiah O’Grady (H 5677) and in the Senate by Sen. Frank Lombardi (S 0586), Kempe told Providence Business News.
“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,” he said in the statement.
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 R.I. Department of 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 DOH to deny, suspend or revoke a person’s certificate of registration when it determines that the registrant has failed to comply with the requirements or 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,” Kilmartin’s statement said. “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.”
Nancy Kirsch is a PBN contributing writer.
