Colorado Could Improve Its Electronic Visit Verification System and Claimed Federal Medicaid Reimbursement for Millions of Dollars in Personal Care Services That Did Not Comply With Federal and State Requirements

Why OIG Did This Audit

• As required by the 21st Century Cures Act, Colorado uses an Electronic Visit Verification (EVV) system to verify that a personal care services (PCS) attendant has arrived on the job and assisted a Medicaid enrollee with Medicaid-approved tasks.
• EVV was developed to address weaknesses in the PCS program that contribute to improper payments, questionable quality of care, and notable amounts of fraud.
• This audit examined whether Colorado implemented an EVV system in accordance with Federal and State requirements and complied with Federal and State requirements when claiming PCS.

What OIG Found

Colorado implemented an EVV system but did not verify that all PCS visits were recorded and verified in that system. Additionally, Colorado did not always comply with Federal and State requirements when claiming PCS. Specifically, of the 160 sampled PCS claims, we identified the following:

What OIG Recommends

We make six recommendations to Colorado related to its EVV system and provision of PCS, including that it refund $8.0 million (Federal share) in estimated overpayments to the Federal Government and that it work with CMS to determine the allowability of the estimated $45.7 million (Federal share) that we set aside. We also make procedural recommendations regarding system edits, improved monitoring of providers, and the establishment of policies and procedures. The full recommendations are in the report.

Colorado disagreed with most of our findings and recommendations.