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Generally, federal regulations ban paying Medicaid dollars to companies facing credible accusations of fraud.
But, in the case of Rever Grand, the Grants Pass disability provider that has been charged with making false claims to Oregon officials, the state is making an exception.
According to a Sep. 11 letter recently posted on the Oregon Department of Human Services website, the Oregon Health Authority declined to suspend payments to Rever Grand despite “a credible allegation of fraud” because doing so “could disrupt the continuity of services to many vulnerable beneficiaries over a large area of the state.”
Rever Grand has over 2,000 clients receiving Medicaid payments, according to the letter, “who reside in most or all of Oregon’s 36 counties.” WW has reported that the company receives over $100 million per year in payments from the state.
“An immediate withdrawal of Medicaid payment reimbursing Provider for these services would place vulnerable individuals at serious risk of neglect or hospitalization,” the letter explains.
ODHS has been sending letters to the firm’s clients this week, warning that the agency “in the next few months may be unable to make payments to Rever Grand.”
There are hundreds of agencies like Rever Grand across the state, although none nearly as large. The state’s letter says caseworkers can help clients transition to another agency, if they so desire.
Rever Grand has denied the state’s accusations, and has tried to reassure its employees, known as direct service providers, that its business—providing home care to people with intellectual disabilities—is sound.
“The state has sent letters informing clients and DSPs about their choices for service, alleging fraud when no fraud charges have been brought or proven, and without providing Rever Grand due process. Rever Grand is confident that the allegations will be shown to be meritless,” says a statement published on its website on Thursday.
The firm’s lawyer has asked a judge to throw out the case, arguing the charges are unconstitutional.
The Sep. 11 letter from the Oregon Health Authority is addressed to Rever Grand’s Chief Operation Officer Kristi Bonham. It explains that OHA found “good cause” not to terminate payments, but warns the company that it may still cut them off in the future.
“[OHA] has determined that good cause will exist for such time period as there remains a substantial number of beneficiaries who are actively seeking alternate arrangements but have not been able to access a suitable alternative,” it says.