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Authors Posts by Tim Sohosky

Tim Sohosky

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Hole torn in a dollar bill with medicaid text

The U.S. House Energy and Commerce Committee recently sent a letter to Governor Josh Shapiro and DHS Secretary Valerie Arkoosh requesting information about fraud, waste, and abuse prevention in Pennsylvania’s Medicaid program. The request is part of a broader federal oversight effort examining Medicaid program integrity following recent fraud investigations in multiple states. Similar letters were also sent to officials in ME, NE, NY, OR, WA, VT, CO, CA, and MA.

The Committee is seeking details on Pennsylvania’s fraud prevention efforts, including audits, provider screening processes, improper payment recovery, enforcement actions, and oversight of Medicaid programs, such as Home and Community-Based Services.

The letter references several recent Medicaid fraud prosecutions in Pennsylvania. However, it also highlights that Pennsylvania’s Medicaid Fraud Control Section charged more fraud cases than any other state in FY 2024 and ranked third nationally in criminal convictions. The fact that these cases were identified and prosecuted demonstrates that Pennsylvania’s fraud, waste, and abuse prevention systems are actively working to detect and address wrongdoing.

RCPA recognizes that this new federal focus on Medicaid program integrity may intersect with our ongoing advocacy to eliminate the requirement for signed encounter forms in Medicaid-funded services. RCPA has long maintained that the current requirement is administratively burdensome and does not meaningfully strengthen program integrity compared to other documentation and verification mechanisms already in place. While our advocacy continues, increased federal scrutiny around fraud prevention may influence how state and federal policymakers evaluate documentation and verification requirements moving forward.

The Pennsylvania Department of Human Services must submit responses to the Committee by March 17, 2026. RCPA will continue to monitor developments and provide updates as appropriate.

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The U.S. Department of Labor’s (DOL) Wage and Hour Division (WHD) published a proposed rule concerning the process and criteria used to determine a worker’s classification as an employee or an independent contractor under the Fair Labor Standards Act and related federal laws.

This proposed rule would rescind DOL’s 2024 Final Rule addressing the classification of independent contractors and replace it with an analysis for employee classification similar to the one adopted by DOL in 2021. The classification analysis in the proposed rule would:

  • Apply an “economic reality” test to determine whether a worker is in business for himself or herself as an independent contractor or is an employee economically dependent on an employer for work;
  • Identify and explain two “core factors” to help determine if a worker is economically dependent on an employer for work or in business for him- or herself:
    • The nature and degree of control over the work; and
    • The worker’s opportunity for profit or loss based on initiative and/or investment;
  • Identify other factors to help determine a worker’s status as an employee or independent contractor, including the amount of skill required for the work, degree of permanence of the working relationship, and whether the work is part of an integrated unit of production;
  • Advise that the actual practice of the worker and the potential employer is more relevant than what may be contractually or theoretically possible; and
  • Provide eight fact-specific examples applying the factors to real-life circumstances.

Last year, DOL published guidance advising WHD field staff on the analysis to apply when determining employee or independent contractor status. That guidance instructed agency investigators to stop applying the analysis from DOL’s 2024 rule in current enforcement matters but, instead, rely on the principles outlined in Field Assistance Bulletin No. 2025-1 and Fact Sheet #13.

The 2024 final rule prompted a number of federal lawsuits challenging its legality. As a result, DOL said last year that it would be “…reconsidering the 2024 Rule, including whether to rescind the regulation.”

DOL will be accepting comments on this proposed rule through 11:59 pm (ET) April 28, 2026.

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