Congress seeks solutions for fraud in home care for seniors, disabled
Painkiller diversion, visits that were never made, and, in a few cases, deadly neglect have been underwritten by taxpayers, House members heard Tuesday at a hearing on how to improve oversight of Medicaid's personal-care services spending.
Personal services spending helps with the activities of daily living—bathing, dressing and meal preparation, for instance. People who do this work don't need to have any training, and in some states, don't undergo background checks.
Christi Grimm, chief of staff in HHS' Office of Inspector General, told the Energy and Commerce Committee's Oversight and Investigations Subcommittee that Medicaid spent $14.5 billion on personal services for 3.2 million beneficiaries during fiscal 2014.
She said one-third of investigations by Medicaid fraud control units at the state level involve these services, and that for eight years, the OIG has suggested that program integrity should be a top management concern.
Katherine Iritani, director of Government Accountability Office's healthcare division, told lawmakers that her agency has repeatedly found that states are not reporting claims for personal services in a way that would allow the CMS to effectively oversee program delivery or track whether federal matching funds are proper.
Only 35 states are participating in the Transformed Medicaid Statistical Information System, which shares claim data with the federal government in a more complete fashion than the former reporting system. Timothy Hill, acting director of the Center for Medicaid and CHIP Services, told the subcommittee that the CMS would be ready to accept the other 15 states' enhanced data by the end of the summer, but he wasn't sure if the states would have transitioned to T-MSIS by then. He said he was hopeful they'd be done by year-end.
Rep. Susan Brooks (R-Ind.) asked Hill: "You might, after five years, consider setting a deadline?"
Hill said he doesn't have the authority to do that, but he will bring that suggestion up with officials above him at HHS.
In addition to better data, the GAO suggests that HHS require audits and monitor service delivery for services from people hired directly by recipients. It currently does so in some programs, but not others. Also, Grimm testified that the OIG would like HHS to require that states perform background checks on all care providers and require that they undergo some kind of training.