Medicaid Provider Owes Almost $141K for Ineligible Aides, Missing Records

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Thursday, September 21, 2017

Columbus – A Pickaway County Medicaid provider owes the state nearly $141,000 because it administered home health services with employees who let their first aid certification expire.

A report released today by Auditor of State Dave Yost cites more than a dozen aides employed at Constance Care Home Healthcare LLC who administered services in 2015 when they were unqualified by Medicaid standards. 

The company issued certificates to new employees for completing an in-house basic first aid program that was part of their new hire orientation. Employees were told the certificates were valid as long as they remained employed with the company. The industry standard, however, is that first aid certification is valid for a set period, usually two years.

Auditors determined that the company also gave in-house certificates to employees who had already obtained certification through the Red Cross even though they did not participate in the company’s orientation program. The in-house certificates issued to these employees listed the same effective date as their Red Cross certificates and lacked expiration dates.

“Aides have to maintain first aid certification by attending renewal courses to freshen their skills,” Auditor Yost said. “This company unwisely took a shortcut and gave some employees a free pass instead.” 

Of 30 aides tested, 13 let their Red Cross certification expire but subsequently administered a combined 101 services when they were ineligible to care for patients. 

In a separate finding, auditors discovered that 19 of 756 services tested had no supporting documentation. For two additional services in the sample, the units billed exceeded the documented durations of service. 

Based on the report’s findings, auditors concluded that the Ohio Department of Medicaid overpaid the provider $135,135. The department paid the company a total of $989,198 during 2015 for 19,643 billed services. With interest, the company owes the state $140,910.

A full copy of this report 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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