Office of the Inspector General Report On Home Health Aides
In May 2015, the Office of the Inspector General (OIG) issued a report, "CMS's Reliance on New York Qualification Requirements Could Not Ensure the Quality of Care Provided to Medicaid Beneficiaries Receiving Home Health Services." The report concludes that some home health agencies did not meet certain State requirements for employee health screenings and training.
OIG limited their review of Medicaid home health service claims to the period of January 2007 through December 2009. They examined 150 claims out of 5,720,894 claims that were submitted during this time frame. They found out that of the 150 claims, home health aides associated with 135 claims met federal and State qualification requirements, and home health aides with 15 claims did not met the same requirements. Specifically they found agencies could not document:
- screening for tuberculosis and/or rubella;
- annual health assessments;
- inservice education requirements; and
- basic training requirements.
OIG extrapolated this sample findings to estimate that 572,089 of the 5,720,894 claims covered by their review, resulting in $27.9 million in federal Medicaid reimbursement that was associated with Home Health Agency (HHA) workers who did not meet selected federal and State requirements during their audit period.
OIG has proposed several suggestions to the Centers for Medicaid and Medicare Services (CMS):
- work with the Department of Health (DOH) to reinforce guidance to HHAs regarding worker qualification requirements; and
- direct DOH to improve its monitoring of HHAs to ensure compliance with worker qualification requirements.
Accordingly, DOH has described the actions they were taking to meet OIG recommendations, and CMS concurred with OIG's recommendations. Please note our previous article on the Dear Administrator letter, "Reminder for Home Care and Hospice on Health Screening & Training."
Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871