Lawmakers Troubled by Medicaid Patient Abuse


Medicaid provides care for some of the most vulnerable patients in the country, but recent government investigations have uncovered troubling reports of patient abuse and outright fraud. Lawmakers are now jumping into action, and I attended a recent Energy and Commerce hearing focused on vulnerabilities within the Medicaid personal care services program.

The scope of the problem was outlined by Energy and Commerce Chairman Greg Walden (R-Ore.), who said the Health and Human Services Office of Inspector General has documented more than 200 cases of fraud and abuse in the Medicaid personal care services program since 2012. The personal care services program allows Medicaid beneficiaries to receive care in their homes rather than having to be moved to inpatient facilities.

Some of the documented patient abuse included an autistic Medicaid beneficiary who died from exposure while under the care of a personal care services attendant.

Walden said the fraud and abuse has happened due to a lack of program safeguards from the Centers for Medicare & Medicaid Services, as well as a lack of data from state Medicaid programs. For example, the most recent data on Medicaid personal care services is from 2012 and is incomplete, Walden said.

The 2012 data covered only 35 states and 34 percent of the claims didn't have any information on the amount of services provided, Karen Iritani, a director for health care at the Government Accountability Office, testified at the hearing.

“Without timely, complete, and consistent data, CMS is unable to effectively oversee state programs and verify who is providing personal care services or the type, amount, and dates of services provided,” Iritani said.

Christi Grimm, the OIG’s chief of staff, testified that all Medicaid personal care services attendants should be required to enroll and register with Medicaid, which could help the program weed out bad actors and result in better care for beneficiaries.

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