Report: Oversight of Medicaid personal care services comes up short

Patient in wheelchair entering car

Photo credit: Getty/KatarzynaBialasiewicz

After finding “significant and persistent compliance, payment and fraud vulnerabilities” in Medicaid personal care services (PCS), a watchdog agency recommended that the federal government improve oversight and monitoring of PCS programs across all states.

PCS attendants--often working for personal care agencies--provide nonmedical assistance provided to the elderly, people with disabilities and those with conditions keeping them at home, the Office of Inspector General noted in its report. PCS reimbursements are optional based on state law, but HHS encourages states to provide reimbursements under Medicaid.

It’s been a long-standing problem. Back in 2010, for example, OIG identified $724 million in improper payments for personal care attendants. It said that 18 percent of personal care Medicaid claims paid between September 2006 and August 2007 lacked key documentation and shouldn’t have been paid. Meanwhile, a House bill introduced last year that would require states to have electronic visit verification systems for PCS, HR 2446, is still sitting in committee.

In its new report, OIG expressed concern that state programs “will remain susceptible to fraud unless CMS takes preventive, nationwide action to address systemic vulnerabilities.” The report describes several schemes to defraud PCS programs, often by billing for services not provided or unnecessary, as well as cases in which patients died or were otherwise harmed through abuse or neglect by PCS providers.

The OIG highlighted what it called key unimplemented recommendations from previous communications:

  • Establish minimum federal qualifications and screening standards for PCS workers, including background checks.
  • Require states to enroll or register all PCS attendants and assign them unique numbers.
  • Require that PCS claims identify dates of service and the attendant who provided the service.
  • Consider whether additional controls are needed to ensure that PCS are allowed and provided under program rules.