(The Center Square) — New York has spent billions of dollars in Medicaid funding on home care programs without verifying that the services were provided, according to a scathing new report from the state’s fiscal watchdog.
The audit released by New York State Comptroller Tom DiNapoli said a review found that 44% of more than $14.5 billion in personal care claims for 82 million services had no matching electronic visit verification record, as required by a 2021 state law aimed at reducing fraud.
DiNapoli said his review uncovered a “disturbing lack of oversight and failure to comply with the required service verifications” by state health officials who oversee the home care programs.
“Medicaid’s home care services are vital and allow many New Yorkers to remain in their homes and communities,” he said in a statement. “We need to know that Medicaid recipients and New York state are getting the services that were paid for. The state Department of Health needs to do a better job of protecting the integrity of these services and safeguard Medicaid funds.”
New York State implemented an electronic visit verification program to confirm the delivery of Medicaid personal care services (2021) and home health care services (2023) to validate service delivery and reduce improper charges to the program. Providers can submit information about their home visit using a phone app, landline phone or fixed object placed in the home.
During the audit period, from January 2021 through March 2023, the state Department of Health, which administers the state’s Medicaid program, paid providers more than $31 billion for personal care and home health care services, including medical care and assistance with housekeeping, meals, bathing and toileting.
DiNapoli’s audit also found nearly 90% of more than $97.6 million in home health care claims lacked records of a matching electronic visit and another $11.6 million in claims for visits that lasted less than eight minutes, which investigators say was too short to be billable under Medicaid rules. Another $9.7 million was spent on home services when the patient was hospitalized and not home, supposedly receiving the care, according to auditors.
The report made 14 recommendations for improving the verification program, including that DOH officials review the Medicaid payments flagged by the audit for lacking verification and create an electronic visit verification compliance program to deny improper claims and recoup improper payments.
In response to the audit, DOH’s Executive Deputy Commissioner Johanne E. Morne said the lack of verification data for Medicaid home care claims “may not indicate that the underlying claim was inappropriate and that a recovery should be made” and pointed to a review by the Office of the Medicaid Inspector General suggesting that about $2.7 billion in claims identified by the comptroller shouldn’t have been included in the audit.
