Audit of Medicaid Provider Triggers $150,000 in Medicaid Findings

Tuesday, November 22, 2011


The Auditor of State’s office issued more than $150,000 in Medicaid findings against Virginia K. Collins, LPN, due to faulty documentation and unauthorized Medicaid charges in an audit released today by Auditor Dave Yost.

“The heart of Medicaid services is a doctor’s decision that those services are necessary,” Auditor Yost said. “Too many times we find lax records of that decision, and this faulty paper trail puts taxpayer dollars at risk.”

The scope of this audit was limited to claims for which Collins provided services to Ohio Medicaid patients and received payment during the period of July 1, 2006 to June 30, 2009.

 Among the amounts found not reimbursable by the state, auditors identified $82,163.86 in billed services that were not specified in a doctor-issued plan of care. Private duty nursing services not specified in a plan of care are not reimbursable under Ohio Medicaid rules.

An additional $31,283.01 in billed services was charged for periods when plans of care had not been re-certified during the required 60-day certification period. Smaller amounts of billed services were found to be not reimbursable for exceeding amounts authorized in plans of care or otherwise failing to comply with Medicaid rules.

After November 22, 2011, additional interest will accrue at the rate of $27.70 per day until the findings and interest are paid in full to the Ohio Department of Job and Family Services.

The Auditor of State’s office performs audits of Medicaid providers to ensure compliance with reimbursement rules and to confirm that services billed to Ohio Medicaid are properly documented and consistent with professional standards of care, medical necessity, and sound fiscal, business, or medical practices.

A full copy of this audit is available online at www.auditor.state.oh.us.

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The Auditor of State’s office, one of five independently elected statewide offices in Ohio, is responsible for auditing more than 5,600 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.