Medicaid shift sought on funds for abuse probes

AG asks U.S. to widen rules to take in home-care settings

Attorney General Leslie Rutledge
Attorney General Leslie Rutledge

Oversight gaps have emerged in some of Arkansas' long-term care programs for the elderly and disabled, exposing those individuals to risks of undetected abuse, fraud and neglect.

Arkansas Attorney General Leslie Rutledge on Wednesday became the second Arkansas official to suggest changes to the government's monitoring of community-based care programs in recent weeks. She penned a letter to the U.S. Department of Health and Human Services with 37 other state attorneys general requesting regulation tweaks that would expand the use of federal funds for investigating abuse in less traditional care settings for Medicaid recipients.

In an interview last week, state Department of Human Services officials acknowledged that some providers who care for benefit recipients in their homes have discovered ways to skirt governmental oversight, adding that the department may need to expand the types of facilities it regularly inspects.

The department's discovery of potential neglect at two central Arkansas adult family homes last month brought the issue into focus.

Both the agency and the attorney general's office have been investigating the homes, which are meant to provide elderly and disabled individuals with an alternative to nursing homes. In one of the cases, attorney general investigators were stonewalled when they visited a home suspected of elder abuse and neglect until they obtained a search warrant.

An attorney general's spokesman declined to comment on any investigations, but he said the letter's timing was coincidental. Rutledge in a news release said the federal rules were outdated and arbitrary.

"Regulations have restricted the use of federal funds in ways that hamper my ability to thoroughly investigate and prosecute abuse and neglect of Medicaid beneficiaries to the fullest extent of the law," she said.

"No one should live through mistreatment, and I am committed as the state's top law enforcement officer to holding individuals accountable whether that abuse takes place in an institutional or non-institutional setting."

States' Medicaid fraud-control units, often housed within the attorney general's office, are responsible for policing Medicaid fraud and the abuse of beneficiaries, according to federal law. However, the attorneys general argue in their letter that federal regulations are too narrowly written.

The regulations say the units may use federal money to investigate and prosecute abuse and neglect in "health care" or "board and care" facilities, which the letter said excludes adult family homes, for example.

As a remedy, the attorneys general asked U.S. Health and Human Services Secretary Tom Price to broaden regulations to permit the use of federal funds to prosecute, investigate and screen complaints of Medicaid-related abuse and neglect in any setting.

A Health and Human Services spokesman said the department received the letter and would respond.

At the end of last year, government estimates put the total number of Americans on Medicaid at about 74 million, with 6.4 million over age 65. The U.S. Centers for Disease Control and Prevention projects that 1 in 10 beneficiaries over age 65 and living at home will suffer abuse, and it is rarely uncovered. For every detected case of elder abuse, 23 cases go undiscovered, according to CDC statistics cited in the letter.

Arkansas' Medicaid fraud-control unit's funding is 75 percent federal funds and 25 percent state funds. The unit has increased its efforts since Rutledge took office in 2015, obtaining a record-number of Medicaid fraud convictions -- 17 -- last year.

The majority of those convictions have been in cases involving traditional clinics or health care facilities. Home-based care and other noninstitutional care settings present the challenges cited in the letter -- among others.

In Arkansas last month, the attorney general's office even faced a hurdle within state government, according to records obtained under the state Freedom of Information Act.

On April 7, the Human Services Department removed three residents from a southwest Little Rock group home after inspectors found signs of neglect and numerous rules violations, records show.

The home was shut down April 10, and the Arkansas Democrat-Gazette printed an article about it April 14. At 7:23 that morning, Deputy Attorney General Lloyd Warford, who oversees the state's Medicaid fraud unit, sent a strongly worded email to the director of the Human Services Department's Aging and Adult Services Division, Craig Cloud.

"Why am I first learning of this from the Arkansas Democrat," Warford wrote in the email. "I not sure what Division of DHS is lead on this mess but I need someone to catch us up on the situation ASAP."

Cloud responded that morning, taking issue with the message's tone, but said he would call Warford to "loop" him in. Cloud said the department's first priority was removing the residents and decertifying the provider.

Warford again messaged Cloud on April 17.

"Craig, I am sure you are really busy but would you or someone on your staff call me and brief me on this cases," Warford wrote.

On April 21, investigators from the attorney general's office received a search warrant for Wilson's Adult Foster Care Home -- two weeks after DHS inspectors discovered the problems.

The email exchange also suggested that people from both agencies met April 24. Brandi Hinkle, a Human Services Department spokesman, said the agency didn't intend to exclude the attorney general's office and said both departments had been working cooperatively on several group home investigations.

A Section on 05/14/2017

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