Review of Personal Care Services Claimed by The Center for Living and Working, Inc.

EXECUTIVE SUMMARY:

Our objective was to determine whether the Center for Living and Working, Inc., (the Center) claimed personal care services in accordance with Medicaid rules and regulations.  The Center did not always claim personal care services in accordance with Medicaid rules and regulations from October 2003 through September 2005.  From our sample of reimbursed claims for 100 beneficiary payment years, we found errors totaling $20,552 ($10,704 Federal share) for services that were provided by personal-care attendants on dates when the beneficiaries were hospital inpatient and for services that were either insufficiently documented or unauthorized.  Based on the sample results, we estimate that the Center received overpayments of $493,777 ($256,366 Federal share).

We recommended that the Center refund to the State agency $493,777 ($256,366 Federal share) and strengthen procedures to ensure that it claims personal care services in accordance with Medicaid rules and regulations.  The Center disagreed in part with our findings and recommendations.

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