Background Checks, Data Analysis Required to Limit Fraud in Personal Care Services, OIG Says

October 21, 2016 | Aging Services Risk, Quality, & Safety Guidance

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​Personal care services—Medicaid-covered nonmedical services provided to the elderly or people with disabilities so that they can remain in their homes rather than entering institutional settings—are rife with opportunities for fraud, and risks are only increasing as Medicaid expands, according to an investigative advisory from the U.S. Department for Health and Human Services' Office of Inspector General (OIG). OIG first warned about fraud in personal care services in 2012; since that time, it has investigated more than 200 criminal fraud investigations in this area. Common allegations include claims submitted for services that were unnecessary or never provided, but these may not be uncovered by examining documentation for individual beneficiaries.

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