The Vermont Attorney General’s Medicaid Fraud and Residential Abuse Unit (MFRAU) has entered a settlement agreement with Upper Valley Services, a designated agency that provides services and supports for people with developmental disabilities in Orange County and Moretown, Vermont. The settlement resolves MFRAU’s investigations into three incidents involving Upper Valley Services. These separate incidents included allegations of neglect that resulted in the death of a vulnerable adult, the confinement of a vulnerable adult in a basement, and the use of Medicaid funds to pay an Upper Valley Services employee who was on Vermont’s Adult Abuse Registry.
Through its investigations, MFRAU determined that each incident was related to Upper Valley Services’ inadequate staff training and case management and failure to adequately document and monitor the delivery of services to their clients. The settlement announced today requires Upper Valley Services to implement reforms that will bring lasting change to the quality of care it provides to the vulnerable adults it serves. This includes creating a new permanent position tasked with ensuring consistent practices in case management and monitoring of recipient services, creating a clinical review committee, improving employee training, and paying $112,000 in damages and penalties.
“Vermonters put their trust in designated agencies, like Upper Valley Services, to provide care and services to vulnerable members of their communities,” said Attorney General Susanne Young. “It is the responsibility of these agencies to ensure that the needs of vulnerable adults are appropriately and safely met with dignity and respect so that tragedies like those uncovered by the MFRAU investigation do not occur. Implementation of the reforms now required by the settlement has been ongoing during the course of the investigation and will be monitored by MFRAU.”
MFRAU investigated three separate incidents involving Upper Valley Services—two alleging substandard services provided to clients and one involving an employee who was hired despite being listed on the Vermont Adult Abuse Registry. Through these investigations, MFRAU obtained evidence that in October 2018, Upper Valley Services approved the placement of a vulnerable adult into a shared-living home with a pond but failed to determine whether the vulnerable adult could swim and failed to ensure that adequate supervision and safety requirements were included in the support agreement with the provider. Tragically, the vulnerable adult died as a result of drowning.
In an unrelated incident, investigators and Upper Valley Services learned that a shared-living provider for a vulnerable adult had placed the vulnerable adult in a locked basement room for extended periods of time when the provider wanted a break from caregiving responsibilities. Although the shared-living provider alerted a former Upper Valley Services case manager to the existence of the room five years earlier, though not that it locked from the outside, the case manager did not inspect the room and did not ascertain the purpose for which it was used.
MFRAU’s investigation also revealed that Upper Valley Services employed an individual who was listed on the Vermont Adult Abuse Registry and was thereby disqualified from providing the services they were employed to deliver. Upper Valley Services knew that the employee was on the registry. In May 2017, when the employee produced a fabricated letter claiming they would be removed from the registry, Upper Valley Services proceeded with their hiring without taking any steps to verify the content of the letter or re-checking the registry.
Under the terms of the settlement, Upper Valley Services has agreed to the following:
- Create a new permanent position, Director of Quality, who will provide written performance evaluations to MFRAU over a three-year period.
- Establish a Clinical Review Committee to review and approve recommended changes to individual safety plans and behavioral support plans, in addition to providing a proactive forum for problem-solving to ensure the dignity and personal safety of all clients.
- Conduct an environmental risk assessment for any client moving into a new home or when there is a change in shared-living providers. If environmental risks are identified, the Clinical Review Committee must review and approve recommended changes to the individual’s safety plan.
- Revise, review, and approve individual service agreements with respect to safety provisions which also honor the human rights of each client. These agreements must include the behavioral interventions that are necessary for an individual’s care and the level of supervision necessary. Additionally, on a monthly basis, case managers must confirm and notate that shared-living providers are providing appropriate levels of supervision.
- Develop a standard home visit form to be completed on each visit to a client’s home which documents inspection of the location(s) where the client receives care, and any features inside or outside the home that pose potential danger.
- Develop and adopt polices related to transitions in clients’ care and living environments, respite review, and screening of new hires.
- Implement employee-training improvements, including the formation of a Training and Development Committee to ensure that employees are appropriately and consistently trained, and to develop support and monitoring standards for case managers.
- Develop a Learning Community which will create learning opportunities for shared-living providers, families, respite care, staff, and individuals supported through Upper Valley Services. These learning opportunities will include virtual and in-person access to resources, training, national leaders, best practices methodologies, information, and practical support.
- Pay $112,000 in damages and penalties, of the total settlement amount of $194,231.46, under Vermont law. If Upper Valley Services fails to meet certain standards at any point in the next three years, it will be required to pay the remaining $82,231.46.
The Attorney General’s Office thanks the Department of Disabilities, Aging, and Independent Living, for their support and assistance during MFRAU’s investigation.
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 and MFRAU at https://ago.vermont.gov/medicaid-fraud-report-form/.
A copy of the settlement is available here.
MFRAU receives 75 percent of its funding from the U.S. Department of Health and Human Services under a grant award totaling $1,127,468 for Federal fiscal year FY 2023. The remaining 25 percent, totaling $375,823 for FY 2023, is funded by the State of Vermont.
Contact: Lauren Jandl, Chief of Staff, 802-828-3171