CMS Should Take More Active Role to Combat Personal Care Fraud, OIG Says

November 21, 2012 | Aging Services Risk, Quality, & Safety Guidance

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​The Centers for Medicare and Medicaid Services (CMS) should take a more active role with states to combat compliance, payment, and fraud involving personal care services, states a November 2012 portfolio from the U.S. Department of Health and Human Services' Office of Inspector General (OIG). Spurred by government policies that increasingly support home- and community-based services, Medicaid costs for personal care services—nonmedical services that support activities of daily living—totaled $12.7 billion in 2011, representing a 35% increase since 2005. OIG's past work, which includes 23 audit and evaluation reports on personal care services since 2006, has found "significant and persistent compliance, payment, and fraud vulnerabilities" in personal care services, the portfolio states.

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