Independent Auditor’s Report on Compliance with Requirements of the Medicaid Program

One aide matched Office of Inspector General exclusion database and the Department's exclusion/suspension list, but identity could not be confirmed due to undelivered information request

Material noncompliance with service days when the recipient was inpatient in a hospital, lack of service documentation for nursing services, lack of plans of care or plans of care not signed by physician for nursing services, and lack of first aid certification for personal care aide services; provider failed to comply with electronic health record system review

Implied that all nursing licenses were current and valid; no licensure finding

There were improper Medicaid payments identified in the amount of $9,715.98, plus interest of $1,493.13, totaling $11,209.11

CarePlus should review Ohio Medicaid rules and ensure all provider qualifications fully comply before rendering direct care services or participating in the Medicaid program

CarePlus should ensure first aid certificates contain information necessary to confirm validity and duration of the certification

CarePlus should seek technical assistance from the Department to determine if first aid certification is appropriate for aides rendering MyCare Ohio waiver services

CarePlus should develop and implement procedures to ensure that all service documentation and billing practices fully comply with Ohio Medicaid rules

CarePlus should implement a quality review process to ensure documentation is complete and accurate prior to submitting claims for reimbursement

CarePlus should develop and implement controls to ensure all services billed are authorized by a signed plan of care prior to submitting claims

CarePlus should ensure plans of care contain an authentic signature from the recipient’s treating physician or allowed practitioner