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By Attorney General Peter F. Kilmartin
There has been a lot of talk lately in Rhode Island about Medicaid waste, fraud and abuse. With Medicaid costing Rhode Island taxpayers nearly one billion dollars annually, there is great expectation that our government is ensuring that each and every Medicaid dollar is spent as intended and that those who abuse the system are prosecuted. As Attorney General and as a taxpayer, I agree wholeheartedly with that expectation.
The Office of Attorney General has a Medicaid Fraud Control Unit, which is responsible for investigating and prosecuting those who commit Medicaid fraud here in Rhode Island. While it is the one Unit within the Office that does have investigative powers, it relies heavily on other state agencies, law enforcement and providers – those who have direct and daily contact with individuals and businesses who benefit from the Medicaid program – to forward possible instances of Medicaid fraud for the Unit to investigate.
The 11-person Unit, which operates under a $1 million budget that is 75% funded by the federal government, opened 23 investigations into Medicaid provider fraud during 2012, closed 16 cases due to settlements or lack of evidence and prosecuted four.
As more patients return to home under the Global Medicaid Waiver, I anticipate an increase in fraud cases committed by those who work in the home care services, specifically the unregulated personal care attendant field. To curb existing fraud in the personal care attendant field, and to prevent our seniors from being taken advantage of – or worse, abused by a home health care worker – I have proposed legislation that would require national background checks and a licensing program for all people who serve as personal care attendants.
Recognizing that individuals need different levels of care at home, the home health care system relies on the expanded use of personal care assistants. Personal care assistants do not provide any medical services, but do provide services to help consumers stay in their home, such as grooming, household tasks and transportation. Current laws do not to require personal care attendants to be subject to national background checks, but 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.
The legislation I have put forth (H5538/S0461) requires all personal care assistants be subject to a national background check as a condition of certification and employment. It also requires that personal care attendants obtain a certificate of registration issued by the Department of Health (HEALTH), and proper training. Additionally, it allows for the biannual renewal of registrations, which would be granted as a matter of course with proof of completion of continuing education unless 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 for HEALTH to deny, suspend or revoke a person’s certificate of registration in any case in which it finds that there has been failure to comply with the requirements, or that the registrant has been convicted of a disqualifying offense. Finally, the legislation provides criminal penalties and fines for those who fraudulently serve as a personal care assistant.
From my viewpoint, this is a safety issue for our most vulnerable citizens, as well as a fiscal issue for taxpayers. Medicaid fraud units across the country estimate that more than 50 percent of reported Medicaid fraud cases involve home care services, yet in Rhode Island, home care Medicaid fraud accounts for only one to two percent of our Medicaid Fraud Unit’s case load. While it would be optimistic to say that Rhode Island has such a low percentage of Medicaid fraud attributed to home care services because these criminal acts are not occurring, it is likely due to the fact that personal care attendants are not aptly regulated. Therefore, there is not an adequate process to determine whether fraud is taking place.
Personal care attendants provide vital services for patients who want to stay in their own homes, helping them maintain their independence while ensuring their safety and well-being. However, especially as the home care field continues to expand, it is imperative that we regulate businesses and workers in this field.
While the personal care attendant legislation makes its way through the General Assembly, there are things you can do if you believe you or someone you know is a victim of Medicaid Fraud. I have created an online, anonymous form, available at www.riag.ri.gov, for to report incidents of Medicaid Fraud. My team of investigators will review and, if fraud is found to occur, prosecute the individual who committed the fraud.
Do you have an opinion you'd like to share in "Your Voice, Your Turn"? Email kim@630WPRO.com
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