Federal audit: Missouri must refund $34.2M for bad Medicaid reimbursements

(The Center Square) – The U.S. Department of Health and Human Services’ inspector general found the state of Missouri must refund $34.2 million to the federal government due to unqualified reimbursements for personal care assistance.

A 36-page audit by the HHS’ inspector general found Missouri didn’t always ensure consumer-directed personal care assistance services complied with federal and state Medicaid reimbursement requirements. The audit reviewed fiscal years 2018 and 2019.

The audit found 17 of a sample of 150 items had a variety of errors. The problems included timesheets that weren’t provided or lacked details, charges for services that exceeded the amount authorized, and lack of documentation that attendants were registered, screened and employable. The audit also found unsigned care plans.

“Based on our sample results, we estimated that Missouri claimed at least $52.5 million ($34.2 million in federal funds) for unallowable consumer-directed personal care assistance services during fiscal years 2018 and 2019,” the report stated. “In addition, timesheets for 46 of the 150 sampled items did not identify the specific services that were performed in accordance with the plans of care.”

The Missouri Department of Social Service responded with a six-page letter. Missouri disagreed with the federal government’s recommendation to recoup funds if the state couldn’t provide all 10 requested documents for each of the 150 claims in the sample. The state said it’s required to consider at least six factors in determining a sanction imposed against a provider, according to Missouri’s code of state regulations. Missouri DSS noted five errors in the federal government’s audit and analysis.

The audit also found Missouri didn’t have established pandemic emergency preparedness standards and protocols within the consumer-directed personal care assistance program.

“Most providers for the sampled items did not have any emergency preparedness documentation for a pandemic response,” the report stated.

The audit said Missouri disagreed with most of the findings and recommendations and provided additional documentation. After a review of Missouri’s comments and the documentation, the number of sampled items in error was revised from 18 to 17. One procedural recommendation was removed.

“We maintain that our findings and recommendations, as revised, are valid,” the report said.

The audit stated $918 million ($597 million in federal funds) in Medicaid payments for consumer-directed personal care assistance services were provided and paid for in Missouri during the two fiscal years in question. The random sample of 150 claims of $25 or more determined whether the services provided were allowable and adequately documented.

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