Columbus – A home health agency in Hamilton County owes the state $4.51 million for Medicaid overpayments and interest stemming, in part, from patient care provided by nearly 80 unqualified employees. 

Personal Touch Home Care of Ohio was reimbursed $9.46 million by the Ohio Department of Medicaid from 2012 through 2014 for providing home health services. State auditors determined that $4.25 million of that amount was overpayment based on 773 errors in a sample of 1,728 services. 

The overpayment is the second largest amount in a Medicaid examination since Auditor Yost took office in 2011, surpassing the $3.72 million overpayment auditors tied to a Montgomery County provider in September. 

Widespread noncompliance with the state’s requirement of first aid certification for aides was one of several causes of the overpayments. An initial sample of 17 personal care aides who provided services revealed that 16 were not certified. The remaining employee had a lapse in the certification but continued to care for patients. 

The extent of the noncompliance prompted auditors to expand the review to include all personal care aides who administered services. Of an additional 63 aides tested, 60 lacked certification and one had a lapse. In total, 273 services were provided by aides who were ineligible on the dates of service.

The provider claimed to be unaware of the first aid requirement but told auditors that aides completed a one-hour in-service course entitled “Basic First Aid Tips.” This consisted of reading a 15-page packet of material and answering a 10-question multiple-choice and true-or-false quiz at the end. The training lacked hands-on work and was not taught by a certified instructor, both requirements of Medicaid-approved courses. 

“Circling answers on a test cannot fully prepare someone for the daunting task of providing life-saving care,” Auditor Yost said. “The best way – and the only approved way – to effectively train someone is through hands-on practice led by a certified instructor.”

The review also flagged 254 errors in service authorization, including 221 services submitted for reimbursement before the provider obtained a physician’s authorization to provide the services. 

Among another 246 errors in the provider’s service documentation, the records for 181 services were not signed by the recipient or an authorized representative as required. No service documentation was available to support 45 more services. 

“The Provider should implement a quality review process to ensure that documentation is complete and accurate prior to submitting claims for reimbursement,” auditors wrote.

The Auditor’s office received a letter from the provider disputing the report’s findings. A full copy of the report, including the provider’s response, 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.

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Beth Gianforcaro
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614-644-1111