Alleged Personal Care Medicaid Fraud Found in Missouri and Rhode Island
May 2, 2013 04:10 PM
On April 25, Angel’s Care Inc. (ACI), doing business as Angel’s Care Home Health Services, agreed to pay the state of Missouri $149,414 for billing Medicaid for services not rendered. ACI is a Medicaid provider of in-home personal care services. ACI claimed to have provided in-home personal care services after two clients were deceased, and after others were hospitalized, from September 2009 through November 2012.
Of the total $149,414 owed, ACI will pay $38,971.59 to the state for its fraudulent billings, $77.743.18 in damages, $25,000 in penalties, and over $7,000 to cover the costs of the state’s investigation.
Also on April 25, two Massachusetts residents were charged with billing Medicaid in Rhode Island for personal care attendant services not rendered. The false claims alleged span November 24, 2012 to January 1, 2013, and total $5,712. The Massachusetts residents allegedly billed the state for personal care attendant services when the beneficiary was hospitalized.
To combat Medicaid fraud and promote program integrity, Rhode Island Attorney General Peter F. Kilmartin has submitted legislation that, if passed, would require all personal care attendants to have a background check and a licensing procedure. Kilmartin stated that as “especially as the home care field continues to expand, it is imperative that we regulate businesses and workers in this field.” In addition, Arkansas, California, Minnesota, and Oklahoma are all considering legislation requiring background checks for direct care workers.
To see the Missouri news release from the Attorney General’s office, click here, as well as an article on the matter here.
To see the full story in Rhode Island, click here and here.
Home health providers should be aware that despite increased enforcement efforts, providers and direct care workers continue to face allegations of Medicaid fraud, primarily focused on billing for services not rendered. Stakeholders should be aware of a movement to require background checks for caregivers, and should actively engage in that process through the forums or state advocacy. Also, to the extent that the alleged false billings relate to services where no documentation exists to support the billing, providers need to redouble efforts in that regard. Home health providers are encouraged to keep abreast of program integrity initiatives in their states, and to contact NAHC with any questions or concerns.