HHS Has Its Eye on Medicaid Personal Care Service

Speaking at last week’s American Health Lawyers Association conference in Baltimore, Gregory Demske, chief counsel for the U.S. Department of Health and Human Services Office of Inspector General, stated that home health-related services currently are one of the two top anti-fraud priorities for his agency.

The government investigates home health agencies for a number of reasons, including improper billing, rendering unnecessary services or employing people who are not eligible to work in the health care field. A new area that is receiving increased scrutiny is the use of Medicaid personal care service (PCS), an optional program provided by states that increases the quality of life for certain Medicaid beneficiaries, but can be problematic for home health agencies. Indeed, the most recent statistics available, indicated that 31 percent of Medicaid Fraud Control Unit criminal cases involved PCS attendants or other home care aids during fiscal year 2015 — making PCS attendants or other home care aids the number one type of provider prosecuted and convicted of a crime.