Amid Medicaid fraud charges, advocates note most providers and beneficiaries follow rules
As Alaska charges several providers with fraudulent billing, champions of Medicaid remind the public that most are committed to serving with integrity.
In June, the Medicaid Fraud Control Unit of the Alaska Department of Law brought charges against more than a dozen healthcare providers, charging them in five separate cases with roughly $1.83 million in fraudulent billing submitted to the state’s Medicaid program, the Anchorage Daily News reported.
Kim Champney, executive director of the Alaska Association on Developmental Disabilities, told the Alaska Independent that the Medicaid Fraud Control Unit had shared information on the specific cases it was investigating.
“They are egregious,” Champney said. “It’s people who go out with the intent to make money, and they’re putting people in harm’s way. They’re not documenting how the services are being provided, and there needs to be a process to hold providers accountable and ensure the public that people are being well cared for and that the money is being used effectively.
“And then most providers are adhering to the Medicaid rules, and because of these situations where people have taken advantage of the system, sometimes there’s an overprotectiveness from the state as far as many, many audits to providers who have a proven track record of adhering to rules and using the services effectively and safely and making sure services are documented and billed,” she said.
In a letter to the Anchorage Daily News published this month, Champney wrote: “While national and state narratives can focus on those who do not live up to identified standards, it’s important to counter that story and acknowledge and appreciate providers with a deep commitment to serving Alaskans with integrity. Most significantly, the people most harmed by fraud are the individuals who depend on these services.”
Rebecca Racenet is a Wasilla mother of three daughters. She said she worries about how people will perceive Medicaid fraud and assume it applies not only to providers, but to those who are dependent on it, like her 20-year-old daughter Caitlin.
“I just worry that people will see a headline about fraud and assume that that reflects everyone who receives the services or provides the services,” Racenet told the Alaska Independent. “There’s a lot of red tape to getting these services. We go through annual eligibility reviews, not just from financial eligibility, but it’s a highly regulated system. We have to follow all the rules. She has to be found medically eligible every year. Then we have to get the services approved every year and make sure we’re using those according to what the services are.”
Caitlin was diagnosed with tuberous sclerosis complex, a genetic disorder that causes benign tumors to grow in various organs and causes a severe seizure disorder.
Racenet, who works as a care coordinator for people with disabilities at Pathfinder Care Coordination in Wasilla, said Caitlin has had five brain surgeries, takes multiple medications, and recently had to get a feeding tube because it’s no longer safe for her to eat or take her medications. She will also need supplemental oxygen at night soon, due to severe fatigue and the disease’s impact on her lungs.
Racenet explained that before Caitlin turned 19, her healthcare was provided by Medicaid through the Tax Equity and Fiscal Responsibility Act (TEFRA) program, which waives family income in determining eligibility for benefits and opens the door to in-home support, respite care, and specialized medical services that would otherwise be out of reach for many families. As an adult, Caitlin receives standard Alaska Medicaid for adults and Supplemental Security Income (SSI).
She said it makes her sad that so many safety checks on the system failed, but added, “Behind these programs are families who have spent years, even decades, caring for someone they love, and it saves families. And you know, if it wasn’t for these services, I don’t know how we would care for her and continue to do this long term.”
Racenet said she hopes people understand that Medicaid waivers do not replace family caregiving, but help to support it: “Families are still providing the vast majority of care. Waiver services give us enough help that we can keep doing it because, you know, it’s not a replacement for us, but it is a supplement that allows her to remain healthy and cared for at home.”
