The state of Iowa did not sufficiently monitor its health home care program providers for at least four years, resulting in tens of millions of dollars in improper reimbursement, the Office of Inspector General (OIG) found upon review.
The Medicaid health home care option allows states flexibility in creating programs that produce care coordination and care management plans for beneficiaries with chronic health issues.
The OIG — a part of the U.S. Department of Health and Human Services (HHS) — was alerted by Iowa’s unusually high reimbursement claims rate in 2016. That year, Iowa’s Medicaid home health claims accounted for 3% of the entire federal total.
Even if all states were created equal, Iowa’s 3% piece of the pie would be high. But for a state that accounts for less than 1% of the country’s population, it was especially alarming.
That led to the OIG investigation, which consisted of an audit that covered 795,000 payments made to Medicaid-backed home health providers in Iowa from 2013 to 2016. The OIG decided to randomly pick 130 payments out of that bunch to sample, seeing if providers followed state and federal requirements.
In the sample, the OIG found that 62 of the 130 payments were improper claims for federal Medicaid reimbursement by the state of Iowa. The improper payments primarily had deficiencies in regard to documentation, including Iowa home health providers not documenting core services, integrated home health outreach services, diagnoses and enrollment correctly.
“In addition, Iowa’s providers did not maintain documentation to support higher payments for intense integrated health home services and did not ensure that beneficiaries had full Medicaid benefits,” the OIG report read.
Therefore, the OIG ruled that the mishap was due to Iowa not adequately monitoring providers for compliance with both state and federal requirements.
The state improperly claimed at least $37.1 million in federal Medicaid reimbursement for payments made to home health providers, the report said.
While the OIG recommended that Iowa refund the $37.1 million, Iowa disagreed with most of the watchdog’s findings and has not yet agreed to pay that amount.
The state did agree, however, that it needed to improve its monitoring of the health home program and said that it was revising its state plan.