Complete Text of Report is available in PDF format (367 kb). Copies can also be obtained by contacting the Office of Public Affairs at 202-619-1343.
EXECUTIVE SUMMARY:
The purpose of this review was to determine whether payments for services provided during October 1, 1998 through September 30, 1999 were: (i) provided by eligible providers (ii) medically necessary, and (iii) in compliance with the required Medicaid billing practices. We found that the State agency had performed only limited program monitoring to assure that compliance requirements were met. Based on a statistical sample of 100 personal care service claims, we identified 33 improper payments amounting to $14,844 and 17 claims lacking compliance documentation for requirements that negatively affect the quality of service rather than the propriety of the payment. These later non-compliance situations may affect the well being of a large number of vulnerable recipients and should be addressed by increased State agency monitoring of the personal care program. We recommended that the State agency recover payments for the improper claims totaling $14,844 and develop oversight mechanisms that would ensure compliance with program requirements. The State agency concurred with our findings and recommendations.