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Franklin County Medicaid Provider Owes More Than $2.1 Million
Columbus – Shifo Healthcare Services, LLC (Franklin County) employed aides with no first aid certification, contributing to more than $2.1 million in recoverable findings – the largest amount identified in a Medicaid examination since Auditor of State Dave Yost took office in 2011.
“What is most upsetting about what our auditors found is that people in central Ohio are not getting the quality of care they deserve – and that taxpayers are paying for,” Auditor Yost said. “It is alarming that this business repeatedly sent untrained and uncertified workers to care for those in desperate need of quality care. That’s why they should not be paid for these services.”
The audit found that 75 percent of the services examined for the period between July 1, 2011 and June 30, 2014 had errors, resulting in an overpayment of $2,055,555.14 – two-thirds of the total amount reimbursed to the provider during the period. With interest in the amount of $109,817.33, Shifo Healthcare Services, LLC owes the Ohio Department of Medicaid $2,165,372.47.
Auditors tested six personal care aides for compliance with first aid certification and determined that none were properly certified. Based on these results, auditors tested an additional 12 aides and found that none were compliant. Auditors confirmed with the provider’s human resources director that first aid certification was not a company requirement for aides. The audit identified a total of 524 services provided by aides that were deemed ineligible. The audit also discovered that five aides failed to complete the required 12 hours of in-service continuing education in 2012, and five aides failed to do so in 2013.
A review of service documentation noted 253 services that had no supporting documentation. Auditors also determined that the units billed for 67 services did not did not match supporting documentation. Additionally, the audit found that the provider billed for 54 Healthchek services that either had no certification form or were not authorized.
In addition, a statistical sample of 505 state plan home health services provided during the period identified the following errors:
- 220 services submitted for reimbursement prior to the physician authorizing the service by signing the plans of care;
- 35 services in which the physician’s signature on the plan of care was not dated;
- 25 services with no plan of care to cover the service; and
- 13 services in which the plan of care did not authorize the home health service.
A full copy of this report may be accessed online.
Director of Communications