Medicaid improperly paid $724M for personal care attendants

The Medicaid program made $724 million in "inappropriate" payments for personal care attendants, according to a new report by the Office of the Inspector General.

The new 30-page report found that 18 percent of personal care Medicaid claims paid between September 2006 and August 2007 "should not have been paid because they lacked documentation of the personal care provider's criminal background checks, minimum age, health status, education or training requirements." Such claims totaled 6.5 million in all, although the OIG sampled only 450 claims at random to reach that figure.

Although the personal care sector is a relatively small portion of Medicaid, it is growing at a quick rate. Claims totaled $9.9 billion in 2006, up 20 percent from 2004, notes Healthcare Finance News. Attendants help Medicaid enrollees--often dual-eligible Medicare enrollees--in their homes rather than a skilled nursing facility.

Qualifications for such attendants differ from state to state, but they usually require an attendant be a minimum age, have no criminal record, and some level of education and training.

Among the inappropriate claims, 2 percent did not provide any records of providing services to the recipients at all. More than 40 percent of the claims indicated that the attendants did not meet any of the qualifications at all.

The OIG recommended that the Centers for Medicare and Medicaid Services withhold payments to attendants who do not fully document their qualifications, and that it work with states to recover inappropriate payments. The CMS concurred, according to the report.

For more:
- read the Healthcare Finance News article
- read the OIG report

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