Department of Health

Medicaid Payments for Personal Care Services

Personal care services are provided through New York’s Medicaid program. These services consist of feeding, housekeeping, assistance in personal hygiene and other tasks that enable a patient to live at home. However, we determined that, during our three-year audit period, New York’s Medicaid program paid $1.5 million for personal care services for periods during which the Medicaid recipients were either hospitalized or living in nursing homes. We recommended that these claims be investigated by the Department of Health, and all overpayments be recovered. In addition, our review of the personal care services provided to a sample of Medicaid recipients determined that some of the services were not provided as authorized. For example, in some instances, more hours of service were reimbursed than were authorized or the services were provided by unauthorized providers. We determined that more than $100,000 was paid to unauthorized providers whose claims duplicated the claims of authorized providers. We recommended that these payments be investigated by the Department, and all overpayments be recovered. We also recommended that the prior approval process be strengthened for personal care services.

For a complete copy of Report 2001-S-14 click here.
For a copy of the 90-day response click here.