Attorney General Fox Asks for Federal Policy Change to Expand Medicaid Fraud Authority to Address More Resident Abuse Cases

Attorney General Tim Fox announced today Montana joined 36 other states and the District of Columbia in a letter to U.S. Department of Health and Human Services Secretary Tom Price urging the expansion of Medicaid fraud authority to address more resident abuse and neglect cases.

Medicaid is a joint federal-state program that provides free or low-cost medical benefits to millions of Americans. More than 6.4 million people enrolled in the Medicaid program are aged 65 or older.

The Montana Department of Justice’s Medicaid Fraud Control Unit (MFCU) resides within its Division of Criminal Investigation.  The MFCU investigates and prosecutes state Medicaid provider fraud and resident abuse complaints in Medicaid-funded health care facilities. The MFCU has the option to review abuse and neglect complaints of those residing in board and care facilities.  According to the Centers for Disease Control and Prevention, 1 in 10 persons age 65 and older who live at home will become a victim of abuse.

“Home healthcare helps address a huge portion of Montanans’ healthcare needs.  But the current federal policy limits our Medicaid Fraud Control Unit’s ability to investigate reports of abuse and neglect that occur in the home healthcare setting,” Attorney General Tim Fox said.   He added, “Abuse and neglect in the home takes many forms, including physical abuse, sexual abuse, and drug diversion.  Abuse and neglect is perpetrated by family, friends, and caregivers alike.  The requested change in policy would allow our MFCU to investigate reports of the abuse and neglect of Medicaid beneficiaries as Congress intended, regardless of where they reside, whether that’s at home or in a healthcare facility.”

In their letter to Secretary Price, which was sent by the National Association of Attorneys General (NAAG), the attorneys general say “…the current strict federal limitations on states’ ability to use MFCU assets to investigate abuse and neglect are outdated, arbitrarily restrict our ability to protect Medicaid beneficiaries from abuse and neglect as Congress intended, and should be replaced or eliminated.”  NAAG offered two recommendations:

•            Allow MFCU federals funds to be used to investigate and prosecute abuse and neglect of Medicaid beneficiaries in non-institutional settings (i.e. home health care).
•            Allow use of MFCU federal funds to freely screen or review any and all complaints or reports of whatever type, in whatever setting.

Deb Fosket, MFCU Director at the Montana Department of Justice, said, “Our aging population is increasing. Most likely that increase will result in the elderly opting to stay at home for care rather than receive institutionalized care in a nursing home or assisted living setting. That could potentially increase a target population for caregivers so inclined to abuse the trust of their patients who have given them full access to their medications and personal assets, both financial and real, among other things.”

The letter can be read here.