In the last two years, Onondaga County’s investigation of as many as 30 referrals to its consumer-directed home health services program uncovered fraud and abuse.
Although only $10 million was spent in New York on the consumer-directed home health services program in 2008, it’s the fastest growing Medicaid program and also the least supervised program the county operates, said Zachary Karmen, attorney for the county’s Department of Social Services.
Approximately 800 Medicaid beneficiaries out of approximately 50,000 beneficiaries in the county participate in the program, which is serviced by two local home health services agencies and some 490 home healthcare providers.
The program enables Medicaid beneficiaries to hire out aides. “Most do it honestly, but some people abuse the system,” Karmen said. The most common abuse is billing for services not rendered.
Surveillance is time-consuming and costly, he said. In response, Onondaga County has implemented a voice-recognition application from the Medical Management Technology Group (MMTG), which records the voices of aides for the two home health services agencies. Aides must call in and out from the beneficiaries’ homes.
Eventually, the agencies will phase out written timesheets and process claims and payroll using the application, he said.
While ROI will be difficult to quantify, Karmen said a drop in referrals would indicate the system is working. “The deterrent effect will produce the largest savings,” he said.
Jay Hamel, CEO of MMTG, estimated that New York spends approximately $4 billion annually on Medicaid-funded home health services. “We confidently estimate a 10-to-15-percent savings by usage of our system, which equates to about $400 million to $600 million in New York,” he said.
Medicaid fraud and abuse, as well as limited resources available to the Centers for Medicare & Medicaid Services to combat it, has been well documented by the Government Accountability Office.
CMS does not have any national data on home health services or consumer-directed personal care services, said CMS spokeswoman Mary Kahn.
“Over time, we hope to collect and develop data on these kinds of services both through our provider audit efforts and the national database that we will be developing over the next several years.”