WASHINGTON, DC - The Subcommittee on Oversight and Investigations, chaired by Rep. Tim Murphy (R-PA), today held a hearing examining waste, fraud, and abuse in Medicaid’s Personal Care Services (PCS) program. In recent months, both the Department of Health and Human Services (HHS) Office of Inspector General (OIG) and the Government Accountability Office (GAO) have issued reports highlighting fraud schemes, poor program integrity, and mismanagement that have harmed beneficiaries.
There has been rapid growth in the PCS program. Ms. Katherine Iritani, Director, Health Care, GAO, spoke to the anticipated continued growth, saying, “As a result of the aging of the nation’s population and increased opportunities for aged and disabled individuals to live in their homes instead of institutions, the demand for and spending on HCBS [home- and community-based services] and personal care services is expected to increase."
Recent reports have raised questions about the Centers for Medicare and Medicaid Services’ (CMS) effectiveness in administering the PCS program and have suggested changes to better safeguard vulnerable beneficiaries.
Ms. Christi Grimm, Chief of Staff, OIG HHS testified, “In the last five years, OIG has opened more than 200 investigations involving fraud and patient harm and neglect in the PCS program across the country. Sadly some of these cases have involved loss of life and serious harm to Medicaid beneficiaries who are especially vulnerable. These include cases like the elderly woman in Idaho who was hospitalized to treat malnutrition and dehydration because the caregiver failed to provide water and food. When investigators served a search warrant suspecting she was a victim of neglect, they found that she had been living in filth despite the fact that Medicaid was paying a PCS attendant to care for her everyday needs."
Full committee Chairman Greg Walden (R-OR) highlighted a recent GAO report on beneficiary safeguards in four states including Oregon. GAO recommended CMS harmonize requirements to make it easier to improve oversight of PCS.
Among that outstanding work is getting better data on the programs. “Without complete and up-to-date data those who are tasked with rooting out waste, fraud, and abuse in this program are hamstrung," added Chairman Walden.
#SubOversight Chairman Murphy highlighted a new tool in our arsenal to help curb fraud within the program - the use of an electronic visit verification (EVV) system for home health services. “…Congress acted in the Helping Families in Mental Health Crisis Act of 2016 to require the use of an electronic visit verification system for Medicaid-provided PCS and home health services. This became law as part of 21st Century Cures, and, when implemented, will help ensure that information regarding the services provided are verified," explained Chairman Murphy.
See Also
* Combating Waste, Fraud, and Abuse in Medicaid’s Personal Care Services Program
