GAO Notes Out of Sync Program Requirements Could be Leading to Waste and Improper Payments
WASHINGTON, DC – A new report from the nonpartisan Government Accountability Office (GAO) examining Medicaid personal care services found that the Centers for Medicare & Medicaid Services (CMS) could do more to ensure requirements across programs are in harmony.
According to GAO, their findings include:
- CMS has not collected useful state data on personal care services provided under two programs, although CMS stated that guidance for states to submit the reports is under development. Collecting these reports could improve oversight by providing CMS and Congress with information on programs’ effects on beneficiaries’ health and welfare.
- CMS’ program requirements have not addressed the significant differences across federal program requirements, specific to beneficiary safety and ensuring that billed services are provided. Consequently, beneficiary protections and oversight of billed services can vary by program.
“As the Medicaid program continues to grow, so too does reliance on in-home personal care services. Current law allows these programs to be offered by multiple services, with varying federal requirements,” said Energy and Commerce Committee Chairman Greg Walden (R-OR). “Maintaining flexibility for states and beneficiaries is key, but the GAO’s findings that data are lacking and that these program guidelines are not in sync raises questions about how CMS can better work with states to streamline requirements and ensure appropriate program integrity measures. In heeding the GAO’s recommendations, I hope CMS will work with states to make improvements to help address improper payments and other types of waste.”
In addition to GAO’s oversight, the HHS Office of the Inspector General has also warned the personal care services provided for Medicaid beneficiaries constitutes a growing part of the Medicaid program that deserves closer state and federal oversight. In recent months, HHS OIG issued an investigatory advisory on Medicaid fraud and patient harm involving personal care services. This serious advisory was a follow-up to numerous OIG efforts related to Medicaid personal care services in recent years.
Click HERE to read the GAO report.