Announced three days before VP J.D. Vance to visit Maine re: fraud
Ahead of Vice President J.D. Vance’s Thursday visit to Bangor Maine to discuss fraud, Vermont Attorney General Charity Clark announced Monday, May 11 the settlement of a Medicaid overbilling case against one of Vermont’s regional social services contractors.
“Thursday, May 14, Vice President JD Vance will visit Bangor, Maine. The Vice President will deliver remarks on the Administration’s efforts to combat fraud,” the White House announced this morning, Tuesday May 12.
Per the May 11 AGO press release: The Attorney General’s Office today announced a settlement with Northeast Kingdom Human Services, Inc. (NKHS), resolving allegations of neglect of a vulnerable adult and overbilling Vermont Medicaid. Under the settlement, the designated agency will pay the State of Vermont $65,335 and undertake several organizational reforms to improve the process of preparing behavioral support plans and other documents detailing behavioral interventions and required levels of supervision for clients.
Through its investigation, the Attorney General’s Medicaid Fraud and Residential Abuse Unit (MFRAU) found that NKHS provided services to a vulnerable adult with severe developmental disabilities such that they posed a risk to themselves and others. MFRAU alleged that NKHS neglected and failed to provide adequate care to the vulnerable adult by failing to properly assess the risks posed to the client and others, failing to create accurate and adequate care plans, and repeatedly failing to take corrective action despite knowing the client was not being safely supervised in their Shared Living situation and was exhibiting escalating behaviors.
Additionally, the settlement resolves a separate issue of Medicaid “upcoding”— billing for a higher level of services than was actually performed — that NKHS detected and promptly self-reported. MFRAU’s investigation found that NKHS incorrectly billed Vermont Medicaid for 149 psychotherapy appointments at the 60-minute session level when, in fact, shorter sessions had been provided to clients. In total, this pattern of upcoding resulted in a Medicaid overpayment of $8,425.73 to NKHS. NKHS reported the conduct to MFRAU and cooperated in the ensuing investigation.
“Vermont’s Medicaid providers must engage in robust compliance monitoring and promptly self-report errors,” said Attorney General Charity Clark. “These actions help us protect the integrity of the Vermont Medicaid Program, which thousands of vulnerable Vermonters rely on.”
Under the terms of the settlement announced today, NKHS has agreed to pay the State $65,335 and undertake several organizational reforms. These reforms include improvements to the process of preparing behavioral support plans and other documents that detail Medicaid beneficiaries’ behavioral interventions and required levels of supervision; communication of those important parameters to caretakers and other stakeholders; and training for NKHS staff and supervisors. NKHS has also agreed to engage a consultant to assist with preparing behavior support plans for individuals who have forensic or criminogenic needs such that they pose a known risk to themselves or others.
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. If you suspect Medicaid fraud, contact MFRAU.
The Medicaid Fraud and Residential Abuse Unit receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $1,497,780 for Federal fiscal year FY 2026. The remaining 25 percent, totaling $499,260 for FY 2026, is funded by the State of Vermont.