The latest audit by the Department of Health and Human Services discovered that numerous Medicaid patients in Maine who suffered exploitation, neglect, or abuse were neither investigated nor reported immediately.
Auditors were called in to investigate after it was discovered that patients with developmental disabilities were being abused in group homes.
“Our objective was to determine whether the Maine Department of Health and Human Services complied with federal waiver and state requirements for reporting and monitoring critical incidents involving Medicaid beneficiaries with developmental disabilities residing in community-based settings,” the report states.
People with developmental disabilities may have physical and/or mental impairments that may be severe or chronic; such disabilities are likely to get severe as the person continues to age. Individuals with such impairments are provided funds by the Medicaid Home and Community-Based Services Waiver program so that they can live in a care community. However, in order to get the waiver, states have to prove that they are taking proper measures to safeguard the health and wellbeing of the beneficiaries.
The report determined that 2,640 Medicaid patients suffered situations, called “critical incidents” that had impacted their dignity, safety, rights, or welfare. It is required by law that such incidents be reported immediately alongside a written report.
However, the audit discovered that the agency failed to comply with the requirements to report critical incidents. “The State agency failed to demonstrate that it has an adequate system to ensure the health, welfare, and safety of the 2,640 Medicaid beneficiaries with developmental disabilities covered by the Medicaid waiver,” the report states.
Investigators found that 104 incidents were labeled high-risk, with a majority being fatal head injuries, but none were reported to the state.
Furthermore, auditors discovered that medical care providers, in addition to not reporting critical incidents, refrained from recommending preventive care.
“Community-based providers reported through [Enterprise Information System] to the State agency 8,678 critical incidents involving serious injuries, dangerous situations, and suicidal acts for 1,781 beneficiaries during our audit period,” the report states. “The state agency, however, was unable to provide us with copies of the 8,678 administrative reviews associated with these critical incidents.”
98% of cases in which Medicaid beneficiaries were subject to verbal or physical abuse, sexual abuse, and neglect were not reported either.
“Examples of the rights violations not sent to [Disability Rights Maine] included threats or intimidation by the staff in group homes, denial of access to religious services, denial of access to medical treatment and unnecessary restraint or use of unapproved restraint techniques, such as floor takedowns,” the report said.
“The Department is confident that current practices are in line with many of the OIG’s recommendations offered and serve to protect individuals with developmental disabilities in Maine,” said Ricker Hamilton, the acting commissioner of Maine’s DHHS. “The Department appreciates the opportunity to respond to the OIG draft report and to resolve the outstanding issues and recommendations.”