State AGs call for more authority to investigate Medicaid abuse and neglect

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A group of 38 state attorneys general have requested expanded authority from Department of Health and Human Services Secretary Tom Price, M.D., to tackle fraud and abuse within the Medicaid program.

Price has previously stated that the Medicaid program is “broken” and in need of a stronger focus on fraud and waste.

In a letter sent Wednesday, the bipartisan group asked that Medicaid Fraud Control Units be granted permission to pursue fraud and abuse investigations outside of institutional healthcare settings, as current regulations place “blinders” on the groups as they work to identify cases of abuse. The letter also requested an expanded use of MFCU funds to screen complaints of potential abuse or neglect.

“The current strict federal limitations on states' ability to use MFCU assets to investigate and prosecute abuse and neglect are outdated, arbitrarily restrict our ability to protect Medicaid beneficiaries from abuse and neglect as Congress intended, and should be replaced or eliminated,” the attorneys general said.

Allowing MFCUs to “cast a wide net” at the screening stage could help weed out cases of abuse or neglect that would otherwise go undetected, they said.

MFCUs netted nearly $1.9 billion through 18,730 investigations in fiscal year 2016, HHS officials shared in March. Around 3,000 of those investigations dealt with neglect and abuse.