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Medicaid Provider Owes $119K for Unverifiable Services
Columbus – An Ashtabula County Medicaid provider owes the state more than $119,000 because she allegedly threw away records needed to support all of the services she was paid for during a three-year period.
A Medicaid examination by Auditor of State Dave Yost’s office found that Kimberlee Potts, a personal care aid, claimed reimbursement for 1,502 services and was subsequently paid $112,766 by the Ohio Department of Medicaid (ODM) from July 2013 through June 2016.
Most of the claims listed Potts’ mother as the service recipient. After her mother’s death, Potts said she grew distraught and disposed of all her service records.
In a response to the report, Potts wrote, “I was in such a state of shock, I just started cleaning my mom’s room and throwing stuff away.”
Along with the paperwork related to her mother, Potts said she discarded documentation supporting services for a second recipient, as well as proof that she was properly certified in first aid.
The state’s Medicaid rules require providers to maintain original service records for six years, in addition to a duplicate set at a separate location. Potts claimed she threw away these copies as well.
Auditors labeled the full amount reimbursed to Potts an overpayment because they could not substantiate any of her Medicaid claims. With interest, she owes ODM $119,121.
A full copy of the report, including the provider’s response, 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.