Government Report Blasts Lax Regulation of Medicaid Home Care Fraud
Government officials in charge of the Medicaid program have done a poor job of guarding against fraud when it comes to home care services.
In a new report from the inspector general (IG) for the Department of Health and Human Services, the Centers for Medicaid and Medicare Services (CMS) was criticized for inadequate oversight of personal care services programs.
“Historically, CMS has left a lot of the responsibility for overseeing waste, fraud and abuse to the states,” Christi Grimm, special assistant to the principal deputy inspector general, told The Center for Public Integrity. “As a result, we have 301 different sets of requirements for caregivers across the states.”
Among the problems reported by the IG were subpar claims documentation, lax monitoring of claims data for fraud and waste, and too much variation among states as far as rules for personal care workers.
For instance, some states mandate criminal background checks for workers, while other states not only don’t have this requirement, but also lack basic rules such as age minimums. Consequently, there have been cases of juveniles posing as qualified care workers, getting caught, but not being prosecuted because they are not adults.
The IG noted that it previously issued recommendations to CMS and state agencies that were never implemented. In 2008, CMS agreed to do something about making payments to care workers who falsely claimed to help patients in their homes, when in actuality they were still in hospitals. But the agency never followed through on its promise.
To Learn More:
Blistering Inspector General Report Says Feds Are Failing To Fight Medicaid Home Care Fraud (by Joe Eaton, Center for Public Integrity)
Personal Care Services (Department of Health and Human Services, Inspector General) (pdf)
Health Care Waste Costs more than Pentagon Budget (by Noel Brinkerhoff, AllGov)
- Top Stories
- Unusual News
- Where is the Money Going?
- U.S. and the World
- Appointments and Resignations
- Latest News
- Federal Judge Rules Employers do not have to Provide Insurance Coverage for Contraception even if their Objection is not Religious
- VA Medical Errors Up; Investigations of Medical Errors Down
- Taxpayers Pick Up Hefty Tab for KBR’s Defense in Iraqi Toxic Exposure Lawsuits
- Majority of Americans Want Background Checks for all Gun Sales and a Ban on Assault-Style Weapons
- Only 44 of 190 Countries Meet Goal of 30% Women in Legislature…U.S. Isn’t One of Them