Yet another report from the HHS Office of Inspector General (OIG) indicates that Medicaid personal care services are vulnerable to fraud and require greater oversight.
The Dec. 8 brief indicates that while CMS has made efforts to combat fraud involving personal care services, states generally haven’t implemented the specific recommendations that Medicaid Fraud Control Units have provided them to strengthen program integrity.
The fraud issue has been ongoing for years for providers of personal care services, which cover activities of daily living such as bathing, dressing, light housework, meal preparation and transportation (PDI 8/17).
The volume and growth of Medicaid Fraud Control Unit investigations and prosecutions show the continued vulnerability, according to the brief.
The OIG continues to support its prior recommendations that CMS do the following to reduce fraud involving personal care services:
  • Require states to enroll or register personal care attendants as Medicaid providers or assign each attendant a unique identifier;
  • Institute qualification requirements and screening requirements for personal care services providers;
  • Require that personal care services claims include the specific date(s) when services were performed and the identity of the rendering service providers;
  • Issue operational guidance for beneficiary assessments, plans of care and supervision of attendants; and
  • Consider whether more controls are necessary to ensure personal care services are allowed under program rules and are provided.
In addition, the brief states, federal funding authority should be expanded so that Medicaid Fraud Control Units can investigate and prosecute cases of patient neglect and abuse in non-facility settings.
Related link: Find a copy of the full report at