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March 03, 2023

OIG Audit Finds Missouri Claimed Federal Medicaid Reimbursement for Tens of Millions of Dollars in Personal Care Services That Did Not Comply with Federal and State Requirements

In February 2023, OIG released a report finding that the State of Missouri had claimed federal Medicaid reimbursement for $52.5 million in consumer-directed personal care assistance (PCA) services that failed to comply with state and federal requirements. OIG conducted an audit of $918 million in Medicaid payments in FYs 2018 and 2019. OIG audited a sample of 150 consumer-directed PCA services and found that 17 were unallowable because of (1) errors related to time sheets, (2) lack of documentation, (3) services charged that exceeded the number authorized, and (4) recipients with unsigned care plans. OIG also found that 46 of the 150 consumer-directed PCA services sampled failed to have timesheets that identified the specific services that were performed. OIG left the resolution of the 46 claims (an estimated $133.8 million, with a federal share of $87 million) to CMS. Additionally, the OIG found Missouri did not establish and implement pandemic emergency preparedness standards and protocols within the consumer-directed PCA program.

Missouri disputed most of the OIG findings and provided additional documentation to the agency. After review, OIG made revisions that (1) reduced the number of sampled items that were unallowable from 18 to 17, (2) changed the statistical estimate and amount conveyed in their first recommendation, and (3) removed a procedural recommendation. However, OIG maintains that its findings as revised are valid. OIG recommended that Missouri refund the $34.2 million in overpayments to the federal government, work with CMS to evaluate the 46 claims where no specific service was identified, and refund any part of the $87 million in the federal share related to those claims if CMS makes a determination that they are not allowable.

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