Nevada starts six-month effort to tackle Medicaid fraud

(The Center Square) - All Nevada hospice and home health providers are set to be reviewed over the next six months due to what officials call “elevated fraud risk."

A temporary pause on hospice and home-health care licenses issued by the state and a six-month moratorium on new enrollments for Nevada Medicaid was officially approved and implemented on June 11.

“We expect to have a more legitimate network of providers and an efficient system for validating new providers and detecting fraud so that patients needing hospice care are provided the services they expect and deserve to receive,” Josh Meny, press secretary for Gov. Joe Lombardo, said, answering The Center Square's questions by email.

“Conducting site visits and checking these facilities helps protect patients and families by helping identify bad actors and unsafe facilities,” Meny added.

Over the past few years, there has been a rapid increase in licensure and enrollment for hospice and home health providers, according to Chloe Chism, spokesperson of the Nevada Health Authority.

Chism said the federal Centers for Medicare & Medicaid Services identified Nevada as a state with an “elevated fraud risk” for hospice providers.

According to Meny, there are currently 209 hospice and home health providers enrolled in the Nevada Medicaid program. Each one will be subject to an onsite review, the Nevada Health Authority said in a prior press release.

“Over the next six months, state staff will be conducting extensive onsite reviews of all Medicaid-enrolled hospice and home-health providers to identify any instances of potential Medicaid billing and payment fraud that require immediate attention and action,” the press release said.

Patients currently receiving care should not be affected by the temporary pause, according to Chism.

“The temporary pause does not affect Medicaid eligibility for recipients, Medicaid coverage for hospice and home-health services, or hospice and home health providers currently enrolled and in good status with Nevada Medicaid," Chism said, answering The Center Square's questions by email. "Members who receive hospice and home health services through Nevada Medicaid should not see any change to their coverage or access to care.”

The Governor’s Office and the Nevada Health Authority said they could not comment on the amount of money at stake in the fraud investigations.

“The state believes action was critically needed to protect scarce taxpayer dollars that fund these lifesaving healthcare programs,” Chism said.

According to Meny, all allegations of fraud that Nevada Medicaid deems credible are referred to the state Attorney General’s Office and the Medicaid Fraud Control Unit.

"As the person who actually won back $40.9 million and dozens of convictions cracking down on Medicaid fraud for Nevada, let me set the record straight: Joe Lombardo is using Medicaid fraud to justify his despicable political ploy of taking away dying Nevadans' health care to appease Donald Trump,” Attorney General Aaron Ford said in a statement posted on X.

Ford is the Democratic candidate challenging Lombardo, a Republican, in the Nov. 3 election for governor.

As the result of a federal investigation, a Las Vegas woman, Marizel Yukee, was charged with money laundering in an alleged $906 million scheme to defraud Medicare and Tricare in Texas earlier this week, according to the U.S. Attorney's Office for the Southern District of Texas.

“The indictment alleges Yukee, through four mobile wound clinics she owned in four different states, targeted elderly Medicare patients, many of whom were terminally ill in hospice care,” the U.S. Attorney's Office said in a press release.

The Center Square reached out to Ford's office, but the attorney general declined an interview.