(Bloomberg) -- New York state spent $14.5 billion on home health care services for low-income residents without required proof they took place, an audit by state Comptroller Thomas DiNapoli found.
Claims for 82 million personal care services like housekeeping, meals and bathing didn’t have a matching electronic visit verification record, or EVV, according to an audit covering January 2021 through March 2023.
“We need to know that Medicaid recipients and New York state are getting the services that were paid for,” DiNapoli said in a news release on Thursday. “The state Department of Health needs to do a better job of protecting the integrity of those services and safeguard Medicaid funds.”
The audit included the consumer directed personal assistance program, known as CDPAP, which Governor Kathy Hochul said this summer was one of “the most abused programs in the entire history of the state of New York.”
The state implemented EVV for personal and home health care services in 2021 and 2023, respectively, to validate service delivery and reduce improper charges by allowing entities to match EVV information to Medicaid claims to identify improper services charged to Medicaid. Home health workers submit information about their visits using a smartphone app, tablet or landline.
DiNapoli’s audit found a lack of oversight and monitoring of EVV records for in-home services contributed to the high number of payments that didn’t have matches.
The state Department of Health disputed the audit’s tally of unverified claims noting that about $2.7 billion of claims should not have been included in the report.
The agency said it is planning to implement a program to increase providers’ compliance with electronic verification and is reviewing current procedures to improve oversight.
--With assistance from Laura Nahmias.
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