Consumers urged to look for signs of fraud
The Alaska Department of Health and Social Services Senior and Disabilities Services Division has placed a six month moratorium on certifying new agencies which provide personal care assistant (PCA) services funded by Medicaid.
Lynne Keilman-Cruiz, Director of Quality for the Division, emphasizes that the moratorium does not affect individuals seeking to enter the program for the first time as personal care assistants. Nor does it affect recipients – clients who are currently receiving PCA services from or through an established agency. Or who are seeking these services.
The moratorium does not apply to established agencies, a list of which is available from the division. According to Keilman-Cruiz, the reason for the moratorium is three-fold and includes efforts to conclude ongoing investigations into Medicaid fraud; to provide technical assistance to existing agencies; and to review internal policies and regulations.
If the agency that administers a recipient’s PCA service were to be decertified or suspended for allegations of fraud, the division would send each recipient a letter advising them that if they wanted Medicaid payments to continue, they should choose from a list of providers which have current certification.
For someone who is using the services of a PCA already or who is considering hiring such a service for the first time, it is essential that the choice of an agency provider is made solely by the recipient. In addition, recipients should read and understand any documents they are asked to sign, including the timesheets that are completed by their PCA.
Fraud warning signs
Danger signs of potential fraud, according to Keilman-Cruiz, include:
• a PCA who asks the recipient to use an agency selected by the PCA
• a timesheet from the PCA which lists hours and days on which the PCA did not actually work
• and situations where the recipient is asked to make payments directly to the PCA in return for tasks which are not approved by the recipient’s plan of service.
On a national basis, 5 percent to 10 percent of all Medicaid service charges are found to be fraudulent. The PCA program in Alaska, which is only one type of Medicaid service, costs the state about $230 million. According to an Alaska Department of Law press release last month, Alaska spends roughly $1.5 billion on Medicaid each year.
In 2012 the state’s Medicaid Fraud Unit increased from three to six enforcement officers and targeting Medicaid fraud became a state priority, according to Andrew Peterson, Director of the Unit.
Information about cases filed by the unit can be found at http://law.alaska.gov/department/criminal/mfcu.html.
