Collateral damage in tackling Medicaid fraud

The Trump administration has made it clear it’s aiming to stop the waste, fraud and abuse of federal funds, and those efforts include Medicaid programs.

Heather Sachs, policy and advocacy co-director of the National Down Syndrome Congress, says money shouldn’t go to programs that aren’t using funds properly.

But she says the Trump administration’s broad efforts to withhold funds from states, such as its actions in Minnesota, are hurting good programs and the families that rely on them.

In an interview with Chief Healthcare Executive®, Sachs says that some programs have had to cut staff and some families aren’t getting needed services as the federal government pauses Medicaid funds in Minnesota. And she’s worried about the Centers for Medicare & Medicaid Services taking similar steps in other states.

“Addressing real fraud is very important, and nobody is in doubt that some fraud does exist. Most of that fraud is at the provider level and not at the individual level,” she says.

But Sachs says the concern is that the Home and Community-Based Services program, which provides essential support services to those with Down syndrome and other developmental disabilities, is being unfairly targeted and portrayed as problematic.

Sachs says the program “is being increasingly singled out in political messaging and enforcement efforts.”

“Much of what they're deeming fraud in the home and community-based services system is just improper payments, tied to paperwork errors,” she says. ‘There's documentation gaps, there's processing issues … this is not intentional fraud at the individual level.”

Referring to Minnesota, Sachs says, “There absolutely is some fraud going on.”

“We want them to get to the bottom of it, but they're withholding entire categories of funds. And this is really a shift from previous administrations,” she says.

“Federal funding is really being used as leverage in this case, and again, it has ripple effects down on the actual individuals and families that use the system,” Sachs continues. “Because … you know, good programs are shutting down, becoming collateral damage. Providers are having to fire staff, and there's already a massive shortage in direct support professionals, and so this is really exacerbating it as well.”

Plus, Sachs says the ongoing depiction of community-based providers as fraudulent is doing damage.

“We're seeing really a focus and sort of a political narrative now on HCBS, as this fraudulent, corrupt system, when it is not,” Sachs says. “And so that's really become problematic for people with disabilities.”

Barbara Merrill, vice president of public policy for ANCOR, which represents home and community-based service providers, told members of Congress last week that she supports efforts to eliminate fraud and abuse.

But she said the government shouldn’t cut funds to providers who aren’t abusing the system.

“ANCOR shares in the goal of ensuring that Medicaid is free from waste, fraud and abuse,” Merrill said. “But such efforts must be precise and targeted, cutting off funding from all providers of a given service serves to threaten the most vulnerable people and their families and runs counter to the goal of saving taxpayer dollars.

“In conclusion, discussions about health care affordability must recognize the crucial role of HCBS investments that prevent people from needing costlier, more intensive care,” she said.