Missouri Claimed Federal Medicaid Reimbursement for Tens of Millions in Consumer-Directed Personal Care Assistance Services That Did Not Comply With Federal and State Requirements

Date Issued

Thursday, February 23, 2023

Submitting OIG

Department of Health & Human Services OIG

Other Participating OIGs

Department of Health & Human Services OIG

Agencies Reviewed/Investigated

Department of Health & Human Services

Components

Centers for Medicare and Medicaid Services

Report Number

A-07-20-03243

Report Type

Audit

Number of Recommendations

Questioned Costs

$3,742,833

Funds for Better Use

External Entity

Missouri Department of Social Services

Open Recommendations

This report has 5 open recommendations.

Recommendation Number	Significant Recommendation	Recommended Questioned Costs	Recommended Funds for Better Use
23-A-07-044.01	No	$34,171,397	$0
We recommend that the Missouri Department of Social Services refund $34,171,397 (Federal share) in overpayments to the Federal Government.
23-A-07-044.02	No	$87,018,594	$0
We recommend that the Missouri Department of Social Services work with CMS to determine the allowability of $87,018,594 (Federal share) that we have set aside, and refund to the Federal Government any amount that is determined to be unallowable.
23-A-07-044.03	No	$0	$0
We recommend that the Missouri Department of Social Services monitor consumer-directed PCA providers to ensure compliance with the State agency's established policies and procedures such that timesheets are completed and the tasks performed are described accurately and in sufficient detail; units of service charged on timesheets do not exceed the units allowable on the recipients' plans of care; consumer-directed PCA providers maintain documentation showing that attendants are registered, screened, and employable pursuant to the FCSR; and plans of care are signed.
23-A-07-044.04	No	$0	$0
We recommend that the Missouri Department of Social Services establish policies and procedures to ensure that timesheets include fully accurate and complete details on the specific tasks performed.
23-A-07-044.05	No	$0	$0
We recommend that the Missouri Department of Social Services establish and implement policies and procedures to specify what consumer-directed PCA providers must include in their emergency backup plans for recipients and require development of pandemic preparedness plans and implement training to educate consumer-directed PCA providers on these plans.