Government Report Blasts Lax Regulation of Medicaid Home Care Fraud

Friday, November 16, 2012

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.

-Noel Brinkerhoff


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)


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