Mike Foley, Auditor of Public Accounts
Nebraska State Auditor Mike Foley says providers billed the state for impossible or questionable amounts of work through a program serving elderly Nebraskans and people with disabilities.
The findings are detailed in a 34-page examination of the Nebraska Department of Health and Human Services’ Aged and Disabled Waiver program released Monday.
The Medicaid-funded program provides services to help eligible Nebraskans remain in their homes and communities rather than move into institutional care. Eligibility generally requires a person to be over 65 or have a disability, receive Medicaid and meet a nursing-facility level of care. DHHS describes the waiver and its services on its website.
According to Foley’s office, the program has grown from approximately $64 million a decade ago to $434 million—a nearly sevenfold increase. Spending increased almost 65% during the past two years.
More than 8,600 people now receive assistance through approximately 2,000 providers.
“A major challenge in controlling surging costs is eradicating fraudulent billing by unscrupulous providers who exploit the program’s current administrative weaknesses,” Foley said.
The auditor’s examination identified several examples of what it characterized as highly questionable billing:
* Providers billed for more than 24 hours of services in one day. One provider submitted claims totaling 47 hours.
* Auditors identified 15 providers who received waiver payments for times when they were working elsewhere.
* Some providers allegedly bypassed controls in the Electronic Visit Verification system by dividing consecutive service hours between two days.
* Providers could increase their billable time after their hours had been electronically verified. One agency added 434.5 billable hours during a single month.
* Providers submitted claims exceeding the number of service hours participants were authorized to receive. Auditors found that problem in a test involving 17 participants.
Electronic Visit Verification requires in-home service providers to use a smartphone or other electronic system to record when and where services begin and end. DHHS says federal law requires the system for certain Medicaid-funded in-home services. [The department provides EVV information for waiver providers online](https://dhhs.ne.gov/Pages/AD-Provider.aspx).
Higher hourly rates questioned
Auditors also questioned some hourly reimbursement rates approved by DHHS.
The guardians of one participant were allowed to negotiate wages for four providers. Those providers were paid $23.50, $28.45, $54.02 and $57.69 an hour, while Foley’s office said most independent providers receive approximately $15 an hour.
The participant’s brother received the $23.50 rate, while the participant’s mother was paid $28.45 an hour.
Agencies are normally allowed to charge higher rates because of their additional operating expenses. However, auditors identified four agencies they believe may have been structured specifically to qualify for enhanced reimbursements. In each instance, the caregiver was both the owner and sole employee, and the agency served only one participant.
“The people receiving assistance through the AD Waiver program deserve our full support, and honest service providers are entitled to fair compensation,” Foley said. “At the same time, DHHS must be able to account for every dollar spent on this program.”
Foley said he was encouraged that DHHS had begun implementing additional measures intended to identify dishonest providers.
“With nearly 2,000 providers to watch, this is no small task,” Foley said. “Hopefully, those controls will prove sufficient to prevent further deceptive billing and the resulting theft of public funds.”
The auditor’s findings identify questionable claims and control weaknesses; they do not, by themselves, establish that every cited provider committed fraud. The complete report is available through the Nebraska Auditor of Public Accounts.