In a follow up to last month's blog post regarding a recent study that was co-sponsored by the Coleman Institute for Cognitive Disabilities and the University of Illinois at Chicago's Department of Disability and Human Development, this post is going to focus on the study as it relates to state trends.  

As we travel across the country meeting with provider agencies, a commonality shared by most is the anxiety of what the future of state Medicaid waivers will bring them.  It's no secret that the country and states are looking for measures to be more efficient with Medicaid and Medicare dollars.  This threatens the vitality of provider agencies, sometimes to the point that we see agencies paralyzed to make any changes (especially with software) as they are unsure of future cash flow and regulations. 

News recently broke in Virginia of a human service agency employee that was sentenced to ten months in prison for altering client records in order to cover up Medicaid fraud.  You can find the article here.  Over a three year period, under the direction of the owner, the agency billed for and received reimbursements for 900 fake claims for providing respite services to 30 clients.  In total, the agency received over $630,000 of fraudulent Medicaid money.  Staff were told to falsify and make false entries to time sheets and office records to make it seem as though respite service had occured when, indeed it had not.  Ultimately, the case was investigated at the highest level - the FBI - and the Virginia State Attorney General's Office.  The employee has been charged with health care fraud, alteration of records and aggravated identity theft.