Auditors Identify Improper Payments and Operational Concerns in Medicaid Provider Examination



 

Columbus – Auditor of State Keith Faber’s Officer released the Medicaid compliance examination of Spectrum Home Health Care, LLC, a Medicare certified home health agency located in Cuyahoga County. The examination found improper payments totaling over $138,000 during the period of July 1, 2018 through June 30, 2019 and focused on home health aide and personal care aide services that were rendered to Medicaid recipients.

 

Auditors found that 66 percent of personal care aide services tested did not meet Medicaid requirements and identified an improper payment of $137,942 for these services and another an improper payment of $102.07 related to home health aide services. In total, with interest, $145,677.15 is due to the Ohio Department of Medicaid.

 

Auditors identified 36 individuals that rendered personal care aide services and were required to have first aid certifications. Two of the individuals had no first aid certificates and six were for on-line training only. The Medicaid rules in effect during this period clearly specified that the certification must be from a class that is not solely internet-based.

 

Of the remaining 28 first aid certificates, 68 percent of the certificates were not valid. Through contact with the American Red Cross and American Heart Association, auditors determined the certification numbers were not valid and/or the name on the certificate did not match the records of the issuing organization.

 

In all, only nine of the 36 aides tested had valid first aid certification for the services tested.  The Provider indicated that it is the employee’s responsibility to provide a copy of their certificate and that it was unaware of the invalid certificates.

 

Auditors also found that this agency had a change in ownership but had not informed the Ohio Department of Medicaid of this change as required. In addition, after purchasing Spectrum Home Health Care, LLC, the new owner continued to bill the Medicaid program using the same provider number and employer identification number.

 

In its response to the examination, Spectrum Home Health Care, LLC outlined steps to address the results of the examination including changes to training of new hires, notifying the Ohio Department of Medicaid of the change in ownership and initiating the application process for a new employer identification number.

 

A full copy of this report is available online.

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