Vermont has come under federal investigation regarding possible fraud, waste, and abuse associated with its Medicaid program. On March 3, state officials were notified by congressional representatives from the Committee on Energy and Commerce, who requested detailed information related to the state’s Medicaid operations. Vermont is expected to respond to this inquiry by March 17. The same request was sent to nine other states, including Maine and Massachusetts.

The investigation appears to be stimulated by findings in Minnesota, where there are concerns about fraudulent practices regarding billing procedures by health care providers for low-income residents. A letter from the committee raised issues about the potential vulnerabilities of Vermont’s Medicaid programs, suggesting they could negatively impact enrollees, legitimate care providers, and taxpayers.

Ever reliant on federal funding through the state-federal partnership, Vermont’s Medicaid program disbursed $2.3 billion in 2024, of which approximately $1.45 billion was sourced from the federal government. The number of Vermonters enrolled in Medicaid exceeds 156,900. The state’s Department of Vermont Health Access sought a $33 million budget increase from the federal level to accommodate current Medicaid expenses earlier this year.

The congressional document declared Vermont’s heavy dependence on Medicaid renders it particularly prone to fraud and errors. The report pointed to actions taken by the state’s Attorney General’s Office, highlighting a significant case where the Burlington-based mental health provider Eden Valley faced a $200,000 settlement for submitting over 150 fraudulent claims tied to Medicaid. Another instance involved felony charges against a couple in Lamoille County for submitting deceptive timesheets for unauthorized caregiving services.

Areas such as home health care, community care, and mental health services were mentioned as especially vulnerable to such fraudulent activities. Specific mention was made of Applied Behavioral Analysis (ABA) therapy for those diagnosed with autism, as Vermont Medicaid implemented a notable billing shift for ABA therapy at the end of 2025, aiming to address concerns of potential fraud and ensure future compliance with federal standards.

The congressional committee’s inquiry also seeks insights into Vermont’s procedures for investigating and safeguarding against Medicaid-related fraud. The Agency of Human Services has indicated that it is collaborating with the Department of Vermont Health Access to provide the requested information before the deadline set by the committee. A representative from the agency emphasized the commitment to maintaining program integrity and highlighted ongoing partnerships with the Attorney General’s Office for addressing any suspected fraudulent activities.