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Audit (A-09-09-00030)

Review of Medicaid Personal Care Services Claimed by Washington State

Executive Summary

Our review found that the State agency did not always claim Federal Medicaid reimbursement for personal care services in compliance with Federal and State requirements during the 2-year period October 1, 2006, through September 30, 2008. The State agency did not comply with Federal requirements for 50 of the 100 sampled beneficiary-months. For 26 beneficiary-months, providers did not comply or only partially complied with Federal and State timesheet or training requirements. Based on our sample results, we estimated that the State agency claimed $19.4 million in Federal Medicaid reimbursement for unallowable costs.

For the 24 remaining beneficiary-months, individual providers did not have timesheets supporting daily hours of service provided to the beneficiaries. We have set aside these services for resolution by CMS and the State agency because the providers may have followed State agency guidance and disposed of the timesheets after 2 years. We estimated that the State agency may have improperly claimed $30.3 million in Federal Medicaid reimbursement.

We recommended that the State agency (1) refund $19.4 million to the Federal Government, (2) work with CMS to resolve the $30.3 million that we set aside, (3) improve its monitoring of providers to ensure compliance with Federal and State requirements, and (4) revise its guidance to require providers to retain timesheets for 3 years. The State agency partially concurred with our recommendations.

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Office of Inspector General, U.S. Department of Health and Human Services | 330 Independence Avenue, SW, Washington, DC 20201