OIG-HHS finds rampant deficiencies in documentation for Personal Care Service workers under Medicaid

by Ben Vernia | December 14th, 2010

In a report released on December 13, the Office of Inspector General of HHS found that for a one-year period spanning 2006 and 2007, nearly one-fifth of all Medicaid claims for Personal Care Services – assistance provided to the elderly and disabled to remain in their homes and communities – were performed by workers who failed to provide documentation of their qualifications. For these 6.5 million claims, the total cost to the government was $724 million.

The OIG also found that in approximately 2% of the cases – over half a million claims – there was no evidence that the PCS workers provided any services to beneficiaries.

The OIG urged CMS to “[e]nsure that Medicaid claims for PCS provided by attendants with undocumented qualifications are not paid,” and review the specific claims the OIG identified as deficient. CMS concurred with both recommendations, and pledged to work with states to educate providers, target PCS for program integrity efforts, and implement a method to verify caregivers’ qualifications.

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