State to pay back federal funds for Medicaid program
West Virginia health care officials have agreed to refund $360,000 to the U.S. government following a federal audit.
The audit found the state's Medicaid program doesn't properly oversee a multimillion-dollar effort to provide personal care to elderly and disabled West Virginians.
The effort provides home health care to people who need help to "perform activities of daily living," including bathing, eating and dressing.
From summer 2008 to summer 2010, the personal care program provided more than 100,000 months of benefits to people at a cost of $83 million. About $67 million of that money was federal.
The U.S. Department of Health and Human Services' Office of Inspector General estimated the federal government paid between $360,000 and $3 million in services that it should not have because of improper oversight by West Virginia officials.
The government asked the state to pay back $360,539.
The state DHHR contracted with the Bureau for Senior Services to operate the program. The bureau reports directly to the Governor's Office, according to DHHR.
The sprawling Medicaid program provides government-backed insurance to some 420,000 low-income West Virginians. The personal care program is just a part of the Medicaid operation.
The federal audit, released earlier this month, reviewed a random sample of 100 of the more than 100,000 "beneficiary-months" between 2008 and 2010.
"Of the 100 beneficiary-months in our sample, 82 complied with federal and state requirements, but 18 did not," the audit said.
There were two particularly pronounced problems in the sample.
The audit found that 10 percent of the time, the government was paying for undocumented services.
Home health care companies contract with the state to provide care to Medicaid recipients.
In half of those months with problematic documentation, the home health care companies were billing the state for more hours of work than their own records showed they had provided to Medicaid recipients.
In the other half of those months, the home health care companies billed the state for particular services that records did not show had been rendered.
Seven percent of the time, the state was paying for services the state itself had not authorized.
The auditing sample also included one time when a person providing care wasn't qualified to do so; that the person receiving the care wasn't qualified for the services; or that the person receiving the care was in a nursing home and not actually in his or her own home.
State Medicaid Commissioner Nancy Atkins told federal auditor Stephen Virbitsky that DHHR concurred with his findings.
In a Sept. 12 letter to the auditor, Atkins said the state will "improve its monitoring" to ensure compliance with federal and state requirements.
Among other things, the state will do more to make sure it has the proper documentation.