Department of Health
Inappropriate Medicaid Payments for Community-Based Services While Recipients Resided in Nursing Homes (Follow-Up Report) Community-based services are intended to help recipients live at home rather than in a residential health care facility, such as a nursing home. In audit 2006-S-106, we examined selected Medicaid payments for community-based services and nursing home services over a five-year period, and identified about $2.1 million in potentially inappropriate payments for community-based services. The payments were potentially inappropriate because the recipients appeared to be residing in nursing homes at the time the community-based 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. When we followed up on these matters with Department officials, we found that they had taken some of the recommended actions, but additional actions still needed to be taken.
For a complete copy of Report 2008-F-33 click here.