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Medicaid Provider Owes $74K for Unqualified Employees, Documentation Errors
Columbus – Several employees of a Medicaid provider in Meigs County administered home health aide services even though they had no first aid certification, according to a report released today by Auditor of State Dave Yost.
The findings were among 92 errors auditors identified in a sample of 735 services provided by Elite Home Nursing Services LLC from 2013 through 2014, resulting in Medicaid overpayments totaling $67,760. With interest, the provider owes the Ohio Department of Medicaid $74,006. The provider was paid $694,974 for 6,826 aide and nursing services during the period.
Auditors discovered that five of 32 personal care aides tested never obtained first aid certification during the review period. An additional four aides provided services prior to obtaining first aid certification.
The owner of the agency, formerly known as Ohio Valley Home Nursing Services LLC, told auditors that she assumed the Basic Life Support (BLS) course completed by the aides had included first aid. However, auditors verified that first aid was not part of the BLS course curriculum.
“Mistake or not, these employees weren’t qualified to care for patients,” Auditor Yost said. “Now that the provider is fully aware of the state’s requirements, I trust that she will take every step necessary to remain compliant.”
The review also determined that two of 24 personal care aides tested for compliance with competency evaluation requirements provided services before they completed their evaluations.
In a separate finding, auditors noted that supporting documentation for 14 services lacked legitimate signatures from the recipient or an authorized representative. The recipient signature is required to verify that the service was delivered. Instead, it appeared that the aides who completed the documentation added the recipient’s initials or signature.
Other findings in the report include:
- The units reimbursed for seven services exceeded those listed on service documentation;
- No service documentation was available to support two services;
- Five services were submitted for reimbursement before the provider obtained a physician’s signature on a plan of care to authorize the services; and
- Two plans of care were signed by a certified nurse practitioner instead of the certifying physician.
A full copy of this report is available online.
The Auditor of State’s office, one of five independently elected statewide offices in Ohio, is responsible for auditing more than 5,900 state and local government agencies. Under the direction of Auditor Dave Yost, the office also provides financial services to local governments, investigates and prevents fraud in public agencies and promotes transparency in government.
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