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By James Swann
A relatively new Medicaid health homes program has caught the eye of a health-care watchdog, with a report expected by fiscal year 2019.The Health and Human Services Office of Inspector General will review an optional Medicaid benefit that creates health homes for beneficiaries with chronic health conditions. The new review was announced in a Sept. 15 update to the OIG’s work plan.States participating in the program receive higher payments from the federal government for the first eight quarters of the program, and the review will make sure the money is being used appropriately and in compliance with federal and state requirements.While the OIG audit is focused on the operations of the new program, the OIG is certain to keep in mind its experiences with some of the inherent problems in Medicaid’s home care services, Ellyn Sternfield, a health-care attorney with Mintz, Levin, Cohn, Ferris, Glovsky and Popeo PC in Washington, told Bloomberg BNA Sept. 19.Traditional Medicaid home health services have been plagued by hundreds of cases every year involving unscrupulous individuals conspiring with friends or family members to secure Medicaid payments for unnecessary or never-provided home care services, Sternfield said.
The health homes program was created by the Affordable Care Act and helps beneficiaries coordinate their care.As of May, 21 states and the District of Columbia have health home programs, with more than 1 million beneficiaries enrolled.
Prior to the health homes program, many state Medicaid programs secured federal funding for waiver home care services, Sternfield said. Previous home health initiatives didn’t offer medical services, and instead provided help to disabled Medicaid beneficiaries in the form of activities such as meal preparation and bathing.“These programs were often delegated to be overseen at the county level, and overworked county social workers frequently relied on the Medicaid recipients to locate willing care providers,” Sternfield said. Care providers often lacked a health-care background, education, or training, Sternfield said.The Centers for Medicare & Medicaid Services has adopted several internal controls to manage fraud in Medicaid home health, including requiring background screening for providers and requiring recertification of a beneficiary’s need for care, Sternfield said. However, these anti-fraud measures require increased manpower and infrastructure at a time when state and local social services are being asked to reduce their administrative overhead, Sternfield said.
OIG didn’t respond to requests for comment.
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