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OIG cites fraud, other issues in Medicaid home healthcare

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The Office of Inspector General of the U.S. Department of Health & Human Services has reported that there are continuing serious compliance, payment and fraud issues in the Medicaid home healthcare program for disabled and elderly people.

The OIG said that since 2012, it has investigated more than 200 cases involving fraud, patient harm and neglect in the  program.

Among OIG’s observations:

“From OIG’s experience, PCS {personal care service} providers, including agencies and individual attendants, have commonly used aggressive tactics when recruiting Medicaid beneficiaries to participate in PCS fraud schemes. Likewise, OIG has observed Medicaid beneficiaries voluntarily participating in such schemes,” the  office wrote.

The OIG  asked that CMS improve monitoring of PCS programs, including  establishing minimum federal qualifications and screening standards for PCS workers, including background checks, and requiring that PCS claims list the dates of service and the names of PCS people who provided services.

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