Department of Health

Inappropriate Medicaid Payments for Community-Based Services While Recipients Resided in Nursing Homes

Community-based services are intended to help recipients live at home rather than in a residential health care facility, such as a nursing home. We examined selected Medicaid payments for community-based services and nursing home services over a five-year period. We 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.

For a complete copy of Report 2006-S-106 click here.
For a copy of the 30-day response click here.
For a copy of the associated follow-up report click here.