APN — New York has spent billions of dollars in Medicaid funding on home care services without verifying whether the services were provided, according to a report from the state comptroller’s office.
An audit by New York State Comptroller Tom DiNapoli found that 44% of more than $14.5 billion in personal care claims for 82 million services lacked electronic visit verification records, as required by a 2021 state law designed to reduce fraud.
DiNapoli said the review identified oversight issues and noncompliance with verification requirements by state health officials who manage home care programs.
“Medicaid’s home care services are vital and allow many New Yorkers to remain in their homes and communities,” DiNapoli said in a statement. “We need to know that Medicaid recipients and New York state are getting the services that were paid for. The state Department of Health must improve its oversight to safeguard Medicaid funds.”
New York implemented electronic visit verification to confirm the delivery of Medicaid-funded personal care services in 2021 and home health care services in 2023. The system requires providers to log visits through a mobile app, landline phone, or fixed device in the patient’s home to validate service delivery and prevent improper charges.
The audit, which examined payments from January 2021 through March 2023, found that the state Department of Health paid providers more than $31 billion for personal care and home health care services, including medical assistance and help with housekeeping, meals, bathing, and toileting.
The report also found that nearly 90% of more than $97.6 million in home health care claims lacked matching electronic visit records. Additionally, $11.6 million in claims were for visits lasting less than eight minutes, below the threshold for billable services under Medicaid rules, and $9.7 million was paid for home care services when the patient was hospitalized.
The audit made 14 recommendations, including reviewing Medicaid payments flagged for verification issues and creating a compliance program to deny or recoup improper claims.
In response, Johanne E. Morne, the Department of Health’s executive deputy commissioner, said the absence of verification data does not necessarily indicate that a claim was inappropriate. She cited a review by the Office of the Medicaid Inspector General that suggested $2.7 billion in claims flagged by the audit should not have been included in the findings.