Review of Personal Care Services in Westchester County Under the New York State Medicaid Program

EXECUTIVE SUMMARY:

Personal care involves services provided in the home to a recipient who requires varying degrees of assistance with activities of daily living such as hygiene, dressing, and feeding. New York spent Medicaid funds totaling $1.4 billion in 1990 on personal care services. Our audit report points out significant weaknesses with respect to documentation and billing of services rendered and the authorization of personal care services. For example, we found services billed by providers but not rendered and physicians prescribing services without current knowledge of the recipient's medical condition. These weaknesses raise serious questions as to the adequacy and appropriateness of care rendered to recipients. We also found that the State had not effectively monitored the program in Westchester County. We made recommendations to improve internal controls over the program and financial adjustments. Regional Health Care Financing Administration officials concurred with our findings and recommendations.