Department of Health

Medicaid Payments to Home Care Providers While Recipients Were Hospitalized (Follow-Up Report)

Home care services can be reimbursed by Medicaid when they enable the recipient to live at home. In our prior audit 2006-S-77, we identified about $5.7 million in payments for home care services that were potentially inappropriate because the recipients appeared to be hospitalized at the time the home care services were supposedly provided. We recommended that the Department of Health investigate the potential overpayments, recover all actual overpayments, and develop controls to prevent such overpayments in the future. We also recommended that the Department investigate the billing practices of certain home care providers, as our detailed review of medical records at one of these providers identified numerous inappropriate and otherwise questionable billing practices. When we followed up on these matters, we found that Department officials had made progress in implementing our audit recommendations.

For a complete copy of Report 2008-F-23 click here.