Weekly Column: Medicaid Patient Abuse Prevention Legislation

In June, Idaho Attorney General Lawrence G. Wasden asked me to introduce legislation to affirm the state’s authority to address Medicaid resident abuse beyond traditional health care facility settings.  As providers are encouraged to treat patients in home and community-based settings, Medicaid integrity programs need to be able to conduct appropriate oversight to keep Idahoans safe and ensure that taxpayer funds are not misused.  In July, I introduced S. 2379 that would clarify the authority of Medicaid Fraud Control Units (MFCUs) to investigate and prosecute Medicaid fraud and beneficiary abuse in non-institutional settings, because it is important to ensure Medicaid patients have access to safe, effective home and community-based services that are good stewards of taxpayer dollars.     

In Idaho, the state Attorney General’s office operates the MFCU and investigates Medicaid abuse and neglect cases in traditional health care settings.  However, federal law has not kept pace with the changing settings in which Medicaid patients may obtain care. 

Idaho Attorney General Wasden explained the need for the legislative update, “With the dramatic increase in the provision of home and community-based services, rather than institutional nursing home care, millions of Medicaid recipients remain outside the protective umbrella provided by the MFCUs.  The authority of the MFCUs to investigate and prosecute abuse and neglect has not evolved with the changing landscape for long-term care.  Since the current statute, P.L. 95-142, was enacted decades ago, substantial growth has also occurred in office-based services, transportation services, and other settings that are neither health care facilities nor board and care facilities, but where Medicaid reimbursed health care services are provided and where abuse or neglect may occur.” 

Further, the Attorney General made it clear that the office is not seeking authority to investigate family members or volunteers providing care in a home or community-based setting without any Medicaid funding or reimbursement.  The legislation is focused on enabling the investigation of abuse and neglect cases in the changing settings where patients receive Medicaid-funded care. 

In testimony before the House Energy and Commerce’s Oversight and Investigations Subcommittee, Christi Grimm, Chief of Staff of the Department of Health and Human Services, Office of Inspector General, commented on the vital role of MFCUs as the front line of defense for patients.  Ms. Grimm referenced an elderly Idahoan who was hospitalized to treat malnutrition and dehydration.  An investigation found her caregiver failed to supply water and food, despite the fact that her provider was a Medicaid-covered personal care attendant.  Ms. Grimm noted the need for legislation to explicitly grant MFCUs the authority to protect patients in their homes when Medicaid-funded professionals are involved. 

Senators James E. Risch (R-Idaho), Benjamin Cardin (D-Maryland), Chuck Grassley (R-Iowa), Margaret Wood Hassan (D-New Hampshire), Pat Roberts (R-Kansas) and John Thune (R-South Dakota) have joined me in co-sponsoring the bipartisan S. 2379.  This legislation is a Senate companion bill to the also bipartisan H.R. 233, the Medicaid Patient Abuse Prevention Act, introduced by Representatives Tim Walberg (R-Michigan) and Peter Welch (D-Vermont) in the U.S. House of Representatives.  Updating federal law to make certain that local authorities have the proper tools in place to ensure the availability of safe, effective home and community-based services that properly utilize Medicaid resources for the benefit of Idaho patients is a reasonable and necessary step, and I look forward to enactment of this legislation.

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