Walden: Medicaid program abuse ‘outrageous,’ ‘unacceptable’

Continuing his efforts to strengthen Medicaid, Rep. Greg Walden (R-Hood River), chairman of the House Energy and Commerce Committee, led a hearing Tuesday to identify solutions to root out neglect, fraud and abuse in the Medicaid personal care services program.

During the hearing, Walden noted the progress Oregon has made to improve the integrity of the critical Medicaid service, and called for the need for continued action. Below is a transcript of Walden’s remarks:

“We are here today to talk about a program that serves our nation’s most vulnerable individuals. Through Medicaid, personal care services provide essential care to millions of elderly people, disabled children and adults, and those who need long-term care to cope with a crippling disease,” said Walden. “It used to be that these folks had to be institutionalized or cared for in a nursing home. Instead, personal care services provide an attendant to help people do things like shop for groceries, do the laundry, drive to the doctor and take medication on the right schedule.

“Without personal care services — and home health care at large — these folks would not be able to live at home, in their communities. Personal care services are quite literally a life-saver for many. I truly believe in programs like personal care services and home health care. Oregon experimented in these types of programs long ago. The vast majority of personal care workers are good people. They take care of people and they care for the most vulnerable populations and make the lives of others healthier, brighter and a little easier.

“That’s why I was so disturbed when the Office of Inspector General reported instances of fraud, abuse, and mismanagement in this important program. Stories of attendants stealing pain medication, abandoning mentally ill beneficiaries in public places, leaving elderly folks alone for weeks at a time this is outrageous and this is unacceptable. What’s worse, is that OIG has made clear that these are not just individual bad actors. The OIG investigations have uncovered more than 200 cases of fraud and abuse in the program just since 2012. And as we learned from witnesses earlier this year, the Government Accountability Office has designated Medicaid as a ‘high risk’ program since 2003. We have an obligation to get to the bottom of this, for the taxpayers and for the patients, alike.

“Late last year, GAO released a report on the need to harmonize requirements for Personal Care Services across the various states. GAO reviewed the policies and procedures of my home state of Oregon and three other states while performing this work. While I was heartened to learn of the safeguards Oregon has in place to prevent this fraud, the audit made clear that there is more work to be done.

“More recently, GAO released a second report on the need for better data on PCS. The most recent data at the time of the audit — released in 2017 — was from 2012. Five years ago. And the data GAO did receive was incomplete. Without complete and up-to-date data, those who are tasked with rooting out waste, fraud, and abuse in this program are hamstrung.

“So, both the OIG and GAO have sounded the alarm for years. This fraud and abuse is happening because the states and the federal government failed to put in safeguards to protect these beneficiaries. It is sickening to see hard-earned taxpayer dollars going to people who take advantage of and mistreat elderly and disabled people in their own homes.

“And these beneficiaries are particularly susceptible to harm because they often lack the physical or mental ability to speak up. Many times, a personal care worker is the only person a beneficiary will see for weeks, so they go along with fraud or abuse because they are dependent on their attendant for help.

“We can do better. Our citizens deserve to know that the attendant they allow into their home, the attendant paid by state and federal taxpayers, will take good care of them and have their best interests at heart. And while most do, it’s clear we have a serious problem in this program.

” Today , we are here to talk about the steps we are going to take to correct the problems identified for us by the Office of Inspector General and Government Accountability Office.”

Over the last four years, the Office of Inspector General (OIG) has opened over 200 investigations involving PCS fraud and harm caused to enrolled patients throughout the country. Oregon was one of four states examined by the Government Accountability Office to review implemented safeguards to protect beneficiaries receiving in-home personal care services from harm. To view the GAO report released in 2016, please click here.