Concerns have been raised once again regarding the oversight of Medicaid spending in New York State, widely referred to as “the white card.” A report discussed by Rachel O’Brien, the deputy editor of the public policy research organization OpenTheBooks, reveals that the state has spent as much as $14.5 billion on home care services under Medicaid, yet has failed to sufficiently verify whether patients actually received the services in question.
According to O’Brien, federal regulations stipulate that home care services paid for by Medicaid must include corresponding Electronic Visit Verification (EVV) records to confirm that caregivers provided the services as reported. However, despite having the capability to intercept claims lacking matching verification records, New York State has not activated this crucial mechanism.
The findings from the state comptroller’s office indicate that within the home care services audited, just over half managed to obtain electronic record verification. O’Brien emphasizes that the absence of these verification records does not automatically imply that the $14.5 billion spent on services has been embezzled, nor does it necessarily prove that patients did not receive care. However, it does imply that the state government is unable to validate whether the services were actually provided.
She points out that while the state knows which services have been billed, it cannot confirm whether those services were indeed delivered to the patients.
The report additionally uncovers multiple suspicious payment scenarios, including nearly $10 million in home care costs paid for patients who were hospitalized, and close to $12 million for visits that lasted less than eight minutes. O’Brien argues that such brief visits should not qualify for billing.
Furthermore, the report reveals that New York State has paid approximately $1.2 billion in Medicaid premiums for individuals residing out of state. O’Brien notes that over $500 million of this amount is attributed to the addresses of 155,000 individuals who moved out of New York but whose information was not promptly updated by the state government. Another $375 million in expenditures was found to relate to the state health department’s failure to review federal matching data.
The issues surrounding Electronic Visit Verification and the oversight of Medicaid are not unique to New York State, as some governments have begun implementing stricter measures. For instance, Missouri has started to automatically deny certain claims lacking matching records since spring, while Texas utilizes systems to automatically reject applications that do not align with electronic verification records. Illinois has set a compliance target of 75% and has begun arranging mandatory training for service providers that fall short of this benchmark, which could potentially lead to penalties.
O’Brien states that federal regulations stipulate that all reimbursable Medicaid expenses must be matched with Electronic Visit Verification records. The possibility of reductions or eliminations in federal funding is encouraging states to strengthen their oversight, as “they do not want to bear the costs of Medicaid themselves.”
With escalating scrutiny of Medicaid expenses, it is imperative that effective measures be implemented to ensure that funds are spent appropriately and that patients receive the care they are entitled to. The ongoing revelations about Medicaid spending in New York highlight the urgent need for enhanced accountability and verification processes to protect both taxpayers and beneficiaries of these critical healthcare services.