By Guy Page
The U.S. House Committee on Energy and Commerce has formally requested detailed information from Vermont Governor Phil Scott and Secretary of Human Services Jenney Samuelson regarding the state’s Medicaid program integrity.
The move comes as federal lawmakers raise concerns that Vermont’s $2.3 billion program may be vulnerable to the same “industrial-scale” fraud recently uncovered in states like Minnesota.
VDC has asked Gov. Scott’s office for comment and will publish it as soon as it is received.
The March 3 letter does not cite any allegations involving Vermont’s immigrant community, unlike allegations, charges and convictions involving Minnesota fraud. Neither does it mention the the Vermont Attorney General’s recent referral to the Medicaid Abuse unit of the Office of Professional Regulation of a case in which a Central Vermont Medical Center nurse allegedly fraudulently obtained fentanyl and other narcotics, as reported in today’s Vermont Daily Chronicle.
However, the letter from Rep. Brett Guthrie (R-Kentucky) and two other members of Congress does cite five Vermont incidents:
- Late last year, Burlington-based nonprofit Revolution Youth was ordered to pay $200,000 to resolve allegations of Medicaid fraud occurring between 2022 and 2024. Investigators found that the mental health provider had fabricated entire patient records, backdated documents, and inflated billing hours to secure payments that did not meet state standards.
- In October 2025, a licensed psychologist from Bethel was charged with defrauding the Medicaid program of more than $600,000. The charges allege that the provider submitted claims for psychotherapy sessions that were never actually provided and failed to maintain the required patient records to support the billing.
- In June 2024, the Vermont Attorney General filed civil enforcement actions against two behavioral health providers for an “upcoding” scheme designed to inflate reimbursements. One licensed psychotherapist reportedly allowed an unlicensed business partner to provide therapy to Medicaid patients at a professional rate and billed for an “impossible” amount of time—sometimes claiming to have provided more than 24 hours of services in a single calendar day.
- Last year, two Lamoille residents were charged as co-defendants in a scheme where a husband allegedly provided unauthorized caretaking services. This arrangement reportedly allowed his wife to submit false timesheets to bill Medicaid for those services while she was simultaneously being paid as a caretaker for another individual.
- In February 2026, a Richford woman pleaded guilty to misdemeanor Medicaid fraud after being charged with a felony the previous year. She admitted to submitting false timesheets for caretaker services she never performed, resulting in over $14,000 in fraudulent payments from the state.
The Committee’s inquiry highlights a concerning trend: while Vermont’s Medicaid enrollment has declined, costs continue to rise. In January, the Commissioner of the Department of Vermont Health Access requested a $33 million budget adjustment to cover higher-than-expected costs for the current fiscal year. Federal investigators are particularly focused on “high-risk” areas such as behavioral health and home and community-based services (HCBS), which rely heavily on self-attestation and are prone to phantom claims.
The investigation is part of a broader federal effort to root out fraud, waste, and abuse (FWA) nationwide. Expert testimony provided to the Committee suggested that fraud schemes are increasingly crossing state lines and targeting programs like Applied Behavioral Analysis for children with autism and non-emergency medical transportation.
Vermont officials have been asked to provide a comprehensive response by March 17, 2026.
The Committee is seeking documents regarding the state’s use of innovative tools like artificial intelligence and data analytics to detect irregular claims, as well as details on how the state screens providers and makes criminal referrals to law enforcement.