Electronic Visit Verification Audit Ohio Department of Medicaid
Learn how the AI-generated research projects were createdOverall Conclusion
The audit identified significant gaps in EVV utilization and matching, with only 44% of claims supported by EVV data in 2022. The Department has made efforts to implement EVV but faces challenges including low provider compliance, technical issues, and stakeholder engagement. The report recommends enhanced communication, monitoring, and enforcement strategies to improve EVV adoption and effectiveness.
Source Document
Audit Scope
The audit analyzed EVV data for the period January 1, 2022, through December 31, 2022, focusing on Medicaid personal care services (PCS) and home health care services (HHCS) in Ohio, including claims paid during this period totaling approximately $2 billion, to assess compliance with EVV implementation and identify barriers to its effective use.
Key Findings Summary
EVV was utilized for 44 percent of provider paid PCS and HHCS claims in 2022.
Approximately 56 percent of all paid services were not processed in the EVV system, indicating they were not matched to a verified EVV entry.
37 of 100 providers in the sample did not submit any EVV data at all.
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AI-Assisted
AI Scope Summary
The primary objective of this audit was to evaluate the Ohio Department of Medicaid's compliance with federal EVV requirements, assess the extent of EVV utilization in supporting Medicaid claims, and identify barriers to effective EVV implementation to improve oversight and reduce fraud in home health services.
AI-Generated Insight
The audit underscores the importance of robust EVV systems in reducing fraud and ensuring service verification in Medicaid home health services. Despite progress, significant barriers remain, highlighting the need for strategic stakeholder engagement, technological improvements, and policy enforcement to realize the full benefits of EVV.