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Maryland Improperly Claimed Personal Care Services Provided Under Its Medicaid Home and Community-Based Services Waiver for Older Adults

Maryland did not always comply with Federal and State requirements when it claimed Federal Medicaid reimbursement for personal care service claims submitted under the waiver. Of the 100 sampled claims, 80 claims complied with Federal and State requirements; however, 20 claims did not. Some claims had more than one error. We estimate that the State agency claimed at least $10.9 million in unallowable costs. States may obtain a waiver to furnish services to Medicaid beneficiaries so that they can live in the community and avoid institutionalization.

Maryland did not ensure that the Department of Aging had sufficient controls to monitor the local agencies that coordinate care and to submit only allowable claims for reimbursement.

We recommended that Maryland (1) refund $10.9 million to the Federal Government and (2) work with the Department of Aging to improve its controls over claims for personal care services provided under the waiver to ensure compliance with Federal and State requirements. Maryland generally concurred with our findings.

Filed under: Center for Medicare and Medicaid Services