E&C Leaders Expand Investigation into Medicaid Fraud Nationwide
WASHINGTON, D.C. – Congressman Brett Guthrie (KY-02), Chairman of the House Committee on Energy and Commerce, Congressman John Joyce, M.D. (PA-13), Chairman of the Energy and Commerce Subcommittee on Oversight and Investigations, and Congressman Morgan Griffith (VA-09), Chairman of the Energy and Commerce Subcommittee on Health, are continuing their ongoing investigation into waste, fraud, and abuse within Medicaid programs by sending letters to ten additional states to request information and documents on the actions each state is taking to strengthen Medicaid program integrity. These requests come amidst reports and law enforcement actions that have demonstrated high levels of Medicaid fraud across numerous states. For example, in Massachusetts, a woman pleaded guilty to fraudulently billing MassHealth for $500,000 in Personal Care Attendant, home health, and adult foster care services after enrolling disabled, elderly, and homeless people in services without their knowledge or consent and billing Medicaid as their caretaker despite not providing these services. In Colorado, two individuals were charged in separate cases for defrauding Health First Colorado’s non-emergency medical transportation (NEMT) program. The first defendant allegedly billed over $1 million in NEMT rides—$400,000 of which were billed for rides for herself and family members, and most of which were not associated with transportation to medical appointments. The second defendant billed Health First Colorado for $3.3 million in NEMT rides, including $283,000 for 64 rides for a single beneficiary, $165,000 of which occurred after the beneficiary had died. In Oregon, a woman was sentenced to federal prison for using stolen identities to submit fraudulent health care claims to Oregon’s Medicaid Program, totaling over $3 million and triggering $1.5 million in fraudulent Medicaid reimbursements. In New York, two individuals involved in a Brooklyn-based scheme involving adult day cares and home health pleaded guilty to $68 million in Medicaid fraud over a seven-year period. In addition, two men in Queens who owned adult daycare centers and a pharmacy were recently charged with $120 million in alleged Medicaid and Medicare fraud schemes. This included illegal kickbacks to Medicaid recipients to fill prescriptions at their pharmacies and enroll in their adult day care. It’s no secret that Medicaid fraud schemes have possibly cost the program billions of dollars annually across the country. These schemes contribute greatly to rising health care costs and strain our health care system, all at the expense of Medicaid beneficiaries and taxpayers. The Committee on Energy and Commerce is committed to rooting out waste, fraud, and abuse in our government health programs like Medicaid to ensure Americans who need them get the quality, affordable care they deserve. Chairmen Guthrie, Joyce, and Griffith issued the following statements regarding the ongoing investigation: “Fraud shouldn’t be a partisan issue. It's our most vulnerable Americans who are most at risk from fraudsters diverting precious resources intended for critical, needed care , ” said Chairman Guthrie. “ We owe it to our fellow Americans to preserve the Medicaid program for those that need it most, and states have an important role to play in ensuring that Medicaid programs operate with integrity. The Committee will continue to combat rampant waste, fraud, and abuse across the entire country.” "Medicaid was established to ensure the most vulnerable Americans are never left behind. That is why fraud and abuse within Medicaid will not be tolerated. Medicaid fraud robs both taxpayers and patients, and we will pursue it wherever it hides," said Rep. John Joyce, M.D. "Expanding this investigation is part of our responsibility in Congress to ensure that the government upholds the standards it was created to serve. Our Committee will work diligently to strengthen the integrity of the Medicaid system and to ensure that those who engage in fraudulent misuse or abuse are held fully accountable." “Americans support federal health care programs that serve American communities, not fraudsters! Led by the House Committee on Energy and Commerce, this latest series of letters is the next step in our investigations to protect our social safety net programs and secure them for the most vulnerable Americans,” said Rep. Griffith. “Republicans in Congress will continue to do the necessary legwork to investigate allegations of waste, fraud and abuse within our Medicaid system.” BACKGROUND: In January, Congressman Brett Guthrie (KY-02), Chairman of the House Committee on Energy and Commerce, Congressman John Joyce, M.D. (PA-13), Chairman of the Energy and Commerce Subcommittee on Oversight and Investigations, and Congressman Morgan Griffith (VA-09), Chairman of the Energy and Commerce Subcommittee on Health, wrote to Minnesota Governor Tim Walz and the Temporary Commissioner of Minnesota’s Department of Human Services, Shireen Gandhi, requesting communications, documents, and information to better understand the ongoing Medicaid fraud occurring in the state of Minnesota and actions the state is taking to strengthen program integrity. On February 3, the Subcommittee on Oversight and Investigations held a hearing titled Common Schemes, Real Harm: Examining Fraud in Medicare and Medicaid . During this hearing, expert witnesses testified on common examples of Medicaid fraud schemes and the potential scale of fraud in Medicaid programs nationwide. Now, as part of the Committee’s ongoing efforts to address Medicaid fraud, the Committee sent letters to CA , CO , MA , ME , NE , NY , OR , PA , VT , and WA . Each of these states displayed concerning cases of Medicaid fraud over the last several years. The purpose of this investigation is to assess the extent of fraud in state Medicaid programs and understand what states are doing to address the issue and protect the integrity of Medicaid for Americans. Read More About this Ongoing Investigation: CLICK HERE to read the New York Post's exclusive coverage of the letter.