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.