OIG Report on Personal Care Services

The Office of Inspector General’s (OIG) published a report examining Medicaid Personal Care Services (PCS), and found significant and persistent compliance, payment and fraud vulnerabilities that demonstrate the need for Centers for Medicare & Medicaid Services (CMS) to take a more active role with States to combat these issues. OIG has published numerous reports on PCS and fraud over the years; the latest report is an OIG Portfolio entitled Personal Care Services: Trends, Vulnerabilities, and Recommendations for Improvement, which offers new and comprehensive recommendations to address vulnerabilities.
 

In 2011, Medicaid costs for PCS totaled approximately $12.7 billion, a 35-percent increase since 2005. Several federal court decisions and Department of Health and Human Services policy initiatives aimed at providing more home and community-based options to Medicaid beneficiaries contribute to the increase in PCS use. As the move for state Medicaid programs to continue to explore home care options like PCS, it is critical that adequate safeguards exist to monitor and prevent improper payments, controls to ensure appropriate payment and quality of care.

Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871