OIG Alleges Maryland Submitted $10.9 Million in Non-Compliant Claims for Personal Care Services
In April, the Office of the Inspector General of the Department of Health and Human Services (OIG HHS) released audit findings claiming that Maryland submitted non-compliant claims for personal care services under its home and community-based services (HCBS) waiver. Based on a sample size of one hundred claims, OIG HHS estimated that from July 1, 2008 through June 30, 2010, Maryland improperly claimed $10,864,195 out of a total amount of $67,248,404 in claims to the federal government.
Of the 100 claims in the sample size, OIG HHS found that 20 claims had errors. In total, there were 24 errors in the sample size, as some claims had multiple errors. Of the 24 errors, fifteen (15) had an unqualified personal care aid, four (4) had an unapproved or missing plan of care, four (4) had unauthorized services, and one (1) had undocumented services. Out of the 15 that had an unqualified personal care aid, eleven (11) did not have a CPR certification, ten (10) did not have a first aid certification, four (4) did not have a criminal background check, and in one (1) the aid performed nursing functions by administering medications but lacked medicine aid certification. OIG HHS also concluded that Maryland lacked sufficient ability to monitor local agencies and to submit solely allowable claims to the federal government.