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Review of New Mexico Medicaid Personal Care Services Provided by Clovis Homecare, Inc.

For the period October 1, 2008, to March 31, 2009, we estimated that New Mexico paid Clovis Homecare, Inc. (Clovis), at least $405,000 for personal care services claims that did not always comply with certain Federal and State requirements. Of the 100 claims in our random sample, 24 did not comply with these requirements. The deficiencies included inadequate attendant certifications, no documentation of supervisory visits, unsupported units of service claimed, no documentation of physician authorization, and lack of State agency approval for personal care services provided by the recipient's legal guardian or attorney-in-fact.

We recommended that the State agency (1) refund to the Federal Government the $405,000 paid to Clovis for unallowable personal care services and (2) ensure that personal care services providers maintain evidence that they comply with Federal and State requirements. Clovis disagreed with most of our findings, and the State agency disagreed with our recommended refund amount paid to Clovis for improper claims submitted for the audit period.

Filed under: Centers for Medicare and Medicaid Services