Bill expanding Medicaid fraud investigations wins support but appears stalled

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“We are removing needless federal barriers to investigating Medicaid fraud and helping ensure beneficiaries are protected from abuse and neglect,” said Rep. Tim Walberg (R-MI).
“We are removing needless federal barriers to investigating Medicaid fraud and helping ensure beneficiaries are protected from abuse and neglect,” said Rep. Tim Walberg (R-MI).

A bipartisan bill that would expand the reach of Medicaid Fraud Control Units to any setting where beneficiaries receive services has gained the backing of the National Association of Attorneys General but appears stuck in the House of Representatives.

H.R. 3891, sponsored by Rep. Tim Walberg (R-MI) and Rep. Peter Welch (D-VT), was introduced Sept. 28, then referred to the Energy and Commerce Committee and then to the Health Subcommittee. No action on the measure has occurred since late September.

“We are removing needless federal barriers to investigating Medicaid fraud and helping ensure beneficiaries are protected from abuse and neglect,” Walberg said at the time.

According to the bill's language, the legislation's goal is “clarifying authority of state Medicaid Fraud and Abuse Control Units to investigate and prosecute cases of Medicaid patient abuse and neglect in any setting.”

The National Association of Attorneys General endorsed the legislation in late March, noting that most MFCUs are located in state attorneys general offices.

“Under current law, MFCUs may investigate and prosecute patient abuse and neglect only if it occurs in a healthcare facility or, in some circumstances, in a board and care facility,” the organization said. “Other cases of abuse and neglect of Medicaid patients – such as in a home healthcare setting – fall outside the unit's authority. Since the current statute was enacted decades ago, substantial growth has occurred in home- and community-based services, office-based services, transportation services and other settings that are neither healthcare facilities nor board and care facilities.”

States electing to operate under the expanded authority of H.R. 3891, if enacted, would be able to use their MFCUs to investigate and prosecute cases of abuse or neglect of Medicaid beneficiaries in non-institutional settings.

The NAAG previously had written to the Department of Health and Human Services asking for a policy change but was told that legislation would be necessary, according to the endorsement letter the group sent to Walberg and Welch.

Forty-nine states (all but North Dakota) and the District of Columbia have MFCUs.

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