Review of New Mexico Medicaid Personal Care Services Provided by Heritage Home Healthcare

For the period October 1, 2006, through September 30, 2008, we estimated that New Mexico paid Heritage Home Healthcare (Heritage) approximately $4.5 million for personal care services claims that did not always comply with certain Federal and State requirements. Of the 100 claims in our random sample, 36 did not comply with these requirements. The deficiencies included insufficient attendant training, missing prior approval for services, and unsupported units of service claimed.

We recommended that the State (1) refund to the Federal Government the $4.5 million paid to Heritage for unallowable personal care services and (2) ensure that personal care services providers maintain evidence that they comply with Federal and State requirements. Heritage disagreed with almost all of our findings, and the State disagreed with our recommended refund amount paid to Heritage for improper claims submitted for the audit period.