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Review of New Mexico Medicaid Personal Care Services Provided by Ambercare Home Health

For the period October 1, 2006, through September 30, 2008, we estimated that New Mexico paid Ambercare Home Health (Ambercare) approximately $889,000 (Federal share) for personal care services claims that did not always comply with certain Federal and State requirements. Of the 100 claims in our random sample, 23 did not comply with these requirements. The deficiencies included lapses with attendant training, number of units claimed for attendant services, and prior approval for personal care services provided by a legal guardian.

We recommended that the State agency (1) refund to the Federal Government the $889,000 paid to Ambercare for unallowable personal care services and (2) ensure that personal care services providers maintain evidence that they comply with Federal and State requirements. Ambercare disagreed with our findings on billing records. The State agency generally agreed with our findings but disagreed with our recommended refund amount paid to Ambercare for improper claims submitted for the audit period.

Filed under: Centers for Medicare and Medicaid Services