A federal audit of one part of the Medicaid system has uncovered hundreds of millions of
dollars in suspected fraud, including payments to caregivers to provide home-care services
to the disabled even when they are hospitalized or in nursing homes.
“It would seem inconceivable – even for today’s bloated government – if it wasn’t laid out
in a report … by the offending agency’s inspector general,” noted Judicial Watch, which
reported on the systemic failure.
Judicial Watch said the issue centers on personal care services provided by the federal and
state-funded health insurance Medicaid, which have been provided to the disabled since
the Supreme Court ruled in the 1990s that such care is a civil right.
“The idea is to allow the sick, disabled and those with chronic or temporary conditions [to]
stay home and, in turn, avoid sticking Uncle Sam with a hefty hospitalization bill,”
Judicial Watch said.
“Instead, Medicaid’s personal care services program is rife with corruption that was first
exposed more than five years ago and continues to be documented annually by the
agency’s watchdog. The budget has ballooned to more than $12 billion a year, just to
send what amounts to a nanny to provide supportive ‘nonmedical services’ like meal
preparation, housework, help with bathing and getting dressed, transportation and even
money management.”
The IG report on the troubling loss of federal taxpayer dollars said Obamacare provisions
that already have kicked in have contributed to the increasing number of dollars in the
program.
“The Patient Protection and Affordable Care Act (ACA) of 2010 removed barriers to
providing home and community-based services by allowing additional state plan
amendment options, increasing states’ timeframes to elect and renew PCS as a care option,
and streamlining processes for accessing home and community-based services,” the report
said. “The ACA also provided additional funding for programs supporting home care
goals, such as the Money Follows the Person demonstration and the Community First
Choice Option programs.”
But the program has significant troubles, including error rates on documentation of costs
as high as 40 percent in New Jersey, where more than $145 million in costs were
questioned.
“Since 2009, seven of the eight completed audits have identified over $582 million in
questioned costs,” the report said.
Also revealed was the fact that states don’t monitor the programs and payment
circumstances, leading some caregivers to be able to collect payments even when the
disabled person for whom they are supposed to be providing services is hospitalized or in
a nursing home.
“[An] evaluation examining PCS in 20 states over a one-year period found that 18 percent
of paid claims for Medicaid PCS in a universe totaling $724 million were inappropriate
because the required qualifications for PCS attendants were undocumented,” the report
said.
And,” it continued, “an audit examining paid PCS claims over a 30-month period in
Nebraska identified 464 instances in which PCS providers billed and were improperly paid
for PCS during the beneficiaries’ inpatient hospital stays.”
In many cases, neither the time frame for the provided service nor the attendant’s
identification was included on a bill.
John Alemoh Momoh, owner and operator of Hopecare Service Inc., was sentenced to two
years in jail and ordered to repay more than $656,000 after it was discovered he submitted
claims inflating the number of hours and claiming payments for services not provided, the
report said.
It noted that most fraud cases come to the attention of authorities through someone who
knows the person committing the fraud because there are few checks and cross-checks to
identify problems.
Among the steps that need to be taken, the report said, is the standardization of PCS
attendant qualifications, improved billing monitors and a cut in the rules and regulations.
“For example, PCS attendants and agencies that commit fraud often bill for impossibly or
improbably large volumes of services; for services that conflict with one another (e.g. a
PCS attendant purports to provide many hours of services to multiple beneficiaries on the
same dates); or for services that could not have been performed as claimed because of
geographical distances between beneficiaries purportedly served by the same PCS
attendant on the same day. If claims contained more specific details, including the exact
dates of service and the identity of the PCS attendants, such irregular billings could be
more easily and systematically discovered through claims analysis by state program
integrity units,” the report said.
Judicial Watch noted that the billings for home care have risen 35 percent since 2005, and
fraud also is on the rise.
Right now, under the system, “Medicaid recipients can hire practically anyone to help
them and collect the money and providers undergo virtually no scrutiny.”
In fact, auditors list examples of Medicaid recipients hiring juveniles, relatives and
girlfriends to provide services. One man was in jail while his girlfriend collected money
from the government to supposedly provide him with home care,” the report said.
