Attorney General Charity Clark today announced that her office’s Medicaid Fraud and Residential Abuse Unit (MFRAU) has entered into a civil settlement with Green Mountain Support Services (GMSS), a state-designated special service agency that provides crucial support to developmentally disabled Vermont Medicaid recipients. The settlement resolves the State’s allegations that GMSS made fraudulent Medicaid claims for neglectful care of vulnerable adults related to reimbursement for ineligible services or services GMSS did not actually provide and for payment based on falsely inflated cost estimates. MFRAU’s investigation showed that each of these fraudulent practices was related to inadequate staff training and case management and to GMSS’s failure to document and monitor the delivery of services to its clients, some of Vermont’s most vulnerable adults. As a result of the settlement agreement, GMSS will make organizational improvements and pay the State of Vermont $459,190 in civil damages and penalties.
“The safety and dignity of vulnerable Vermonters is my office’s foremost concern in all Medicaid fraud investigation and enforcement efforts,” stated Attorney General Charity Clark. “This settlement furthers those goals and protects the integrity of the Vermont Medicaid system.”
The settlement resolves the following allegations:
- GMSS billed Medicaid for seven hours per week, or approximately 365 hours per year, to support their service coordination for a client who they consistently provided substantially less service coordination to;
- GMSS employed an individual to provide services to a client while the employee was also the guardian of the client, in violation of Medicaid Rules and Regulations;
- GMSS failed to conduct a background check and properly contract with an individual who was providing direct services to a client, in violation of Medicaid Rules and Regulations;
- GMSS did not make home visits and had limited contact with two clients living at the same residence with contracted Shared Living Providers. GMSS subsequently learned that the Shared Living Providers had left the country and their clients were being cared for by people unknown to GMSS. In addition, an unknown number of other adults had also moved into the residence, none of whom had been vetted for the client’s safety;
- GMSS did not ensure the proper management of a client’s medication by their Shared Living Providers, knowing that the client needed full assistance with medication management;
- GMSS billed Vermont Medicaid for services to a client from August 2022 through April 2023, despite disenrolling the client from services in August 2022; and
- GMSS instructed some of their direct support staff in 2019 to set aside up to an hour each week to complete paperwork, potentially causing GMSS clients to receive less direct care per week, while GMSS represented and billed Medicaid for the full number of hours in violation of Medicaid Rules and Regulations.
The settlement acknowledges the important role that private care agencies play in Vermont’s Medicaid program and GMSS’s cooperation with MFRAU’s investigation. The agreement accordingly includes organizational reforms to ensure permanent improvement in GMSS’s care to vulnerable adults. Under the agreement, GMSS will hire a Director of Quality to ensure consistent practices in client placements, case management, and monitoring of recipient services, as well as to oversee employee training and support. GMSS has also agreed to continue their relationship with another special service agency, Champlain Community Services (CCS), for focused oversight and organizational mentorship. CCS will monitor GMSS’s recordkeeping, hiring, training, and policies and procedures and, in conjunction with independent State monitors, will provide routine assessments and recommendations for GMSS’s improvement.
In addition to these and other organizational improvements, GMSS will pay the State of Vermont $459,190 in civil damages and penalties, with $75,000 of that sum suspended on the condition of GMSS’s ongoing cooperation with MFRAU.
The Attorney General is grateful for the support of the Department of Disabilities, Aging, and Independent Living (DAIL), which provided valuable assistance during MFRAU’s investigation.
A copy of the settlement is found here.
If you suspect someone is being or has been neglected or abused, contact local law enforcement immediately. Neglect and abuse may also be reported to Adult Protective Services by calling 800-564-1612 and MFRAU at https://ago.vermont.gov/medicaid-fraud-report-form/.
MFRAU receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $1,229,616 for Federal fiscal year 2024. The remaining 25 percent, totaling $409,870 for FFY 2024, is funded by the State of Vermont.
CONTACT: Lauren Jandl, Chief of Staff, 802-828-3171