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Medicaid Examination Cites Unsupported Services, Lapse in First Aid Certification
Columbus – A Medicaid provider in Cuyahoga County is on the hook for nearly $50,000 after state auditors discovered she billed the state for almost 150 aide services that could not be substantiated.
A review of Medicaid claims submitted to the state for reimbursement by Arlene Barkley, a personal care aide, identified 267 errors in a sample of 875 aide services provided from 2013 through 2015.
In total, 147 of the errors stemmed from services that lacked proper supporting documentation. When auditors questioned Barkley about the missing records, she claimed she could produce them but needed time to gather them from her cousin’s attic and the home of a service recipient.
Auditors complied with the request, scheduling a later time to review the records. But as the meeting neared, Barkley cancelled the appointment, saying the records were destroyed by a flood in her basement, where she allegedly kept them during her home renovations. She also was unable to supply a duplicate set of records, which providers are required to leave at the service recipient’s residence.
“The state’s Medicaid rules don’t make exceptions for flooded basements, assuming there even was one. And that still wouldn’t explain the lack of a backup set,” Auditor Yost said. “All providers are required to complete and safeguard accurate service records to ensure accountability for patients and taxpayers.”
In a separate finding, auditors found Barkley had a lapse in first aid certification lasting almost seven months, but she continued to provide 108 services anyway. Auditors also noted that the units Barkley billed for seven services exceeded those documented. In another five instances, recipient signatures were not included on service documentation.
The 267 errors resulted in in overpayments totaling $47,222, more than 32 percent of the $146,862 Barkley was paid during the period for providing 3,503 services. With interest, she owes the Ohio Department of Medicaid $49,654
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.