Review of Provider’s Medicaid Services Finds Nearly $128K in Improper Payments
Columbus – A state review of a Scioto County Medicaid provider uncovered almost $128,000 in improper payments stemming from errors in service documentation and a lack of first aid training.
The report released today shows that personal care aide Joseph Poole claimed reimbursement for 2,046 services and was subsequently paid $158,000 by the Ohio Department of Medicaid (ODM) from 2013 through 2015. All of the claims identified the same recipient, who is a relative of Poole.
Auditors tested 499 services for compliance with Medicaid requirements and determined Poole was ineligible to receive $127,901 (81%) of the reimbursement amount. The improper payments resulted entirely from non-compliance in personal care aide services, which accounted for 449 of the tested services.
According to the report, records for all waiver aide services were missing the required signature of the recipient or an authorized representative. The forms were instead signed by a family member who was not a legal guardian or authorized representative.
The report also points to 178 aide services that Poole administered without first aid certification, even though records show he was aware of the training requirement at the time. In another finding, auditors noted the activities performed during 108 aide services did not meet the criteria for that type of service.
With interest, Poole owes $139,130 to ODM. 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.