Columbus – A Columbus-based home health agency was overpaid to the tune of $573,000 because it provided services with unqualified aides and billed the state before obtaining proper service authorization.

A review of 1,833 services provided by P.E. Miller & Associate, Inc. from July 1, 2011 through June 30, 2014 found 308 errors, resulting in Medicaid overpayments totaling $573,184. The provider received $4.8 million in reimbursements for 92,436 home health services during the period. With $38,839 in interest, the provider owes the Ohio Department of Medicaid $612,023.

Auditors tested 15 aides for compliance with Medicaid requirements and found one lacked first aid certification, making her ineligible during the entire review period. Another nine aides were ineligible at some point during the period due to lapses in the certification. The examination identified a total of 104 services provided by ineligible aides.  

“It usually takes just a few hours every two years to obtain or renew first aid certification,” Auditor Yost said. “I’d say that’s a pretty reasonable requirement when it comes to ensuring the well-being of patients.”

During a review of service authorization, auditors noted 148 errors, including 107 services submitted for reimbursement before the provider obtained approved plans of care. Auditors determined the units billed for another 41 services were either not authorized or exceeded the authorized limit. 

The examination also found 17 services lacked supporting documentation, and the documentation for 14 other services was not signed by the recipient or authorized representative.

Earlier this month, an examination of another Franklin County provider found similar noncompliance issues, which contributed to a $4.9 million overpayment. That overpayment is the largest amount identified in a Medicaid examination since Auditor Yost took office in 2011.

A full copy of this report is available online.

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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 5,900 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.

Contact:
Ben Marrison
Director of Communications
614-644-1111