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As attorney general, my highest priority has always been public safety. Whether through the elimination of the backlog at the State Crime Laboratory, or ramping up the Internet Crimes Against Children (ICAC) initiative, protection of the public has been the polestar of my administration.
There are many ways to protect and enhance public safety. I was reminded of that again during Older Americans Month. One of the ways we protect vulnerable people on a daily basis at the Department of Justice is through the efforts of the Medicaid Fraud Control and Elder Abuse Unit (MFCU).
As the name suggests, the purpose of the unit is twofold. The MFCU acts aggressively both to protect Wisconsin Medicaid so that program assets are available to help those who truly need it, and to protect the physical health of people who are vulnerable due to infirmities of aging or disabilities that require long-term care.
Medicaid is the jointly funded federal and state program that provides medical assistance to our neediest residents. Many of them are the elderly in long-term care facilities and nursing homes. According to the U.S. Department of Health & Human Services, Administration on Aging, when Older Americans Month was first established in 1963 there were only 17 million living Americans who had reached their 65th birthdays. That number increased to approximately 36 million in 2004 and is projected to increase to 86 million by 2050. Almost half of the costs of long-term care in nursing homes is funded by Medicaid.
As medical care advances and people live longer, concerns about protection from unscrupulous care providers grow. While the vast majority of care providers are conscientious, compassionate and professional, some are not. Abuse and neglect of vulnerable adults can be either physical or financial. Medicaid provider fraud costs American taxpayers hundreds of millions of dollars every year and hinders the integrity of the program itself. In 1977 Congress established Medicaid Fraud Control Units to strengthen the capability of government to detect, prosecute and punish fraudulent activities by providers in the Medicaid program. Perpetrators of Medicaid billing fraud can run the gamut from the sole provider who submits claims for services never provided, to conglomerates who engage in schematic fraud.
In 2006, the MFCU recoveries comprised approximately $500,000 in restitution for Wisconsin Medicaid. After I took office, in 2007 the unit recovered approximately $4 million, $8 million in 2008, $16 million in 2009, and over $25 million in 2010. My office will not tolerate fraudulent activities by those who would seek to line their own pockets at the expense of either taxpayers or recipients who really need the help. But its not all about the money. Abuse and neglect of the elderly in care facilities cannot happen. In 2008 I changed the name of the unit to emphasize the importance we place on preventing elder abuse, thereby raising visibility and encouraging the reporting and prosecution of illegal behavior.
The Medicaid Fraud Control and Elder Abuse Unit is the only identifiable entity in Wisconsin state government, annually certified by the Secretary of the U. S. Department of Health & Human Services, that conducts a statewide program for the investigation and prosecution of providers that defraud the Medicaid program, and pursues abuse and neglect in qualified board and care facilities. It is designed as a strike force with investigators and prosecuting attorneys who take cases from start to finish, investigation to conviction. The MFCU has recently prosecuted cases such as the following:
· A care provider who forced a resident into a bathtub of scalding water, resulting in significant burns over his body;
· A home health care worker who was assigned as a temporary caregiver to a man who suffers from multiple sclerosis who failed to show, leaving the man calling for help after deprivation of his medications, food and water for over 24 hours;
· A former care provider who returned to a facility and removed a pain reliever patch from an elderly uncommunicative resident for the provider's own use;
· A care provider who left a long-term care facility unstaffed, during which an elderly resident fell and could not get up;
· A wound nurse who refused to provide care for an elderly patient's bed sores, which became infected and ultimately caused his death;
· A care provider who pulled the hair and slapped a resident out of frustration.
So while the vast majority of care providers and residential facilities provide invaluable assistance, some don't, and we owe it to our most vulnerable elderly citizens to protect them from abusive or neglectful behavior.
I was recently asked to testify before the Legislative Council Committee on Public Assistance Program Integrity to discuss the MFCU prosecution model as a way to address other forms of public assistance fraud. The success of the model in Wisconsin and nationwide warrants consideration as an effective way to safeguard both limited taxpayer dollars and the safety of some of our most vulnerable citizens.
You can be assured that I will continue to utilize the MFCU to protect both the assets of the Wisconsin Medicaid and safety of the elderly, and in that way ensure we do all we can to protect both persons and property.