Department of Human Services Investigations of Alleged Kickbacks in the Early Intensive Developmental and Behavioral Intervention Program
Learn how the AI-generated research projects were createdOverall Conclusion
DHS has long-standing authority to impose sanctions for kickbacks under federal SSA provisions and state law; however, a decades-old error in DHS's administrative rules defining fraud and ambiguous suspension authority limited action on kickbacks alone. The 2025 legislative changes expanded sanction authority and criminalized kickbacks, but clear authority to suspend payments during investigations remains contingent on rule or legislative action. The report recommends amending the fraud definition to explicitly include kickbacks to provide clear enforcement authority.
Source Document
Audit Scope
Limited special review of DHS OIG investigations of EIDBI providers, focusing on complaints received July 2017 through February 2024; reviewed 25 complaints closed without investigation and 7 investigations, analyzed OIG policies, and examined DHS legal authority related to kickbacks.
Key Findings Summary
DHS has long authorized sanctions for kickbacks by citing federal Social Security Act provisions.
DHS’s administrative rules have contained a decades-old error in the definition of fraud, which limited its authority to address kickbacks.
Without correcting the rule or state law definitions, it is unclear whether DHS can suspend payments for kickbacks alone during an investigation.
View the Findings tab to see all 8 findings
AI-Assisted
AI Scope Summary
This limited special review assessed whether DHS OIG's handling of EIDBI provider complaints was appropriate and whether DHS had authority to address kickbacks independent of other fraud findings. It found that DHS had preexisting authority to sanction kickbacks under federal SSA provisions and state law, but a decades-long rule error and ambiguity around suspension authority limited action. The 2025 legislative changes began to address these gaps, but the report recommends rule amendments to clearly include kickbacks in the fraud definition to ensure timely sanctions in future audits.
AI-Generated Insight
The report identifies a long-standing misalignment between federal/state sanctions authority and the regulatory definition of fraud, arising from an erroneously cited federal statute in DHS rules. It highlights that rule corrections, rather than solely legislative changes, would strengthen DHS’s ability to suspend payments and sanction kickbacks in MA, potentially improving program integrity for future audits.
Audit Objectives
Examine the reasons why Department of Human Services Office of Inspector General closed complaints about EIDBI providers without further investigation.
Evaluate whether OIG staff took reasonable steps when determining whether to investigate allegations of fraud, theft, abuse, and error by EIDBI providers.
Audit Findings (8)
DHS has long authorized sanctions for kickbacks by citing federal Social Security Act provisions.
DHS’s administrative rules have contained a decades-old error in the definition of fraud, which limited its authority to address kickbacks.
Without correcting the rule or state law definitions, it is unclear whether DHS can suspend payments for kickbacks alone during an investigation.
The 2025 Legislature added explicit authority to sanction MA providers for kickbacks and criminalized kickbacks; however, suspension authority remains unclear and not clearly established by statute or rule.
DHS’s interpretation that it needed a determination by the Health and Human Services agency before suspending payments for kickbacks was overly cautious.
OLA found that in the majority of OIG investigations, actions were appropriate, but three kickback-related complaints were closed without investigation due to perceived lack of authority.
OIG closed 25 complaints without investigation (7 were investigations) involving EIDBI providers; three complaints involved kickbacks.
DHS could have acted under existing authority prior to 2025 to sanction kickbacks; the rule error and unclear authority created ongoing limits.
Recommendations (3)
Amend the administrative rule defining fraud to clearly include kickbacks.
If the rule is not amended, the Legislature should act to resolve the issue.
Clarify authority to suspend payments during an investigation into kickbacks by updating rule or statute to explicitly include kickbacks as fraud.