Stay Informed
of New Reports
Twitter
Where To Report Waste
Fraud, Abuse, Or Retaliation
Where To Report Waste Fraud, Abuse, Or Retaliation

Iowa Inadequately Monitored Its Medicaid Health Home Providers, Resulting in Tens of Millions in Improperly Claimed Reimbursement

Submitting OIG: 
Department of Health & Human Services OIG
Report Description: 
The Medicaid "health home" option allows States to create programs that provide care coordination and care management for Medicaid beneficiaries with chronic health conditions. Health homes are not physical spaces. Rather, they are a healthcare model based on the idea that several providers can work together to coordinate and manage beneficiaries' care and, in doing so, provide quality care at a reasonable cost.
Date Issued: 
Tuesday, April 7, 2020
Agency Reviewed / Investigated: 
Department of Health & Human Services
Submitting OIG-Specific Report Number: 
A-07-18-04109
Component, if applicable: 
Centers for Medicare & Medicaid Services
External entity, if applicable: 
State of Iowa
Location(s): 
IA
United States
Type of Report: 
Audit
Questioned Costs: 
$37,132,109
Funds for Better Use: 
$0
Number of Recommendations: 
4
View Document: 
AttachmentSize
PDF icon 71804109.pdf1.94 MB
Additional Details Link: 
https://oig.hhs.gov/oas/reports/region7/71804109.asp

Related Open Recommendations

Recommendation Number Recommendation Status Significant Recommendation Additional Details
268543 Open No
We recommend that the Iowa Department of Human Services, Iowa Medicaid Enterprise refund $37,132,109 to the Federal Government.
268544 Open No
We recommend that the Iowa Department of Human Services, Iowa Medicaid Enterprise improve its monitoring of the health home program to ensure that health home providers comply with Federal and State requirements for maintaining documentation to support the services for which the providers billed and received PMPM payments.
268545 Open No
We recommend that the Iowa Department of Human Services, Iowa Medicaid Enterprise revise the State plan to define the documentation requirements that health home providers must follow to bill and receive the higher IHH PMPM payments for intense IHH services, and educate providers on these requirements.
268546 Open No
We recommend that the Iowa Department of Human Services, Iowa Medicaid Enterprise revise the State plan to define the documentation requirements that health home providers must follow to bill and receive IHH PMPM payments for outreach services, and educate providers on these requirements.
Displaying 4 of 4 Recommendations