Federal Bill Would Expand Crackdown on Medicaid Home Health Fraud

Democratic Rep. Peter Welch of Vermont on Tuesday unveiled bipartisan legislation to combat Medicaid fraud and abuse originating outside of institutional health care settings.

The bill would build on the authority of state Medicaid Fraud Control Units (MFCUs) and expand the scope to encompass all Medicaid services including non-institutional settings, such as home health care.

The legislation, announced during a press conference at the Vermont Statehouse, is expected to be approved by the House Energy and Commerce committee, which Welch is a senior member of, this week. The bill was co-authored by Republican Rep. Tim Walberg of Michigan.

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“Medicaid provides vital health care services to over a third of Vermonters, including low-income seniors,” Welch said in a press release. “This bipartisan initiative will empower state attorneys general to crack down on bad actors exploiting Vermonters, while ensuring Medicaid remains an efficient and effective program.”

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

MFCUs operate in 49 states and the District of Columbia. The Units are typically a part of the state attorney general’s office and must be separate from the state Medicaid agency. The Office of Inspector General (OIG) annually recertifies each MCFU, according to OIG.

“The attorney general’s office right now does not have the legal authority to pursue [Medicaid home health fraud], so fraudsters have got a good deal,” Welch said at the press conference, reported by Vermont Public Radio. “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.”

Joining Welch at the press conference were Vermont Attorney General T.J. Donovan and Secretary of Human Services Al Gobeille.

“This is going to open up the door to allow the subject matter experts to do their job to keep our communities safe,” Donovan said at the press conference.

There is a good chance that the U.S. House will vote on the legislation by the end of the month, according to Vermont Public Radio.

Written by Kaitlyn Mattson