Briefs

DiNapoli: Billions spent on Medicaid home care claims that lacked documentation

November 14, 2024 Brooklyn Eagle Staff

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STATEWIDE— Billions of dollars have been spent on Medicaid home care services for New Yorkers without the required verification that the services took place, according to a new audit from State Comptroller Thomas P. DiNapoli. 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. The visit verification program enabled providers to submit visitation data via using a phone app, landline phone or fixed object placed in the home. During the audit period of January 2021 through March 2023, the state Department of Health (DOH), through Medicaid, 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. However, 44% of these personal care claims, or $14.5 billion, lacked any matching electronic visit verification record. Moreover, $97.6 million in home health care claims reflecting 400,557 services (89%) lacked a matching electronic visit verification record. Claims totaling $9.7 million were paid for home services provided when the patient was hospitalized and home visits should have been suspended. The state also paid $11.6 million in claims for visits that lasted less than eight minutes —too brief to be billable under Medicaid rules.

While DOH officials disputed the number of claims that had no matching verification (due to timing differences), they did say they are implementing a compliance program.

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