The OIG has issued an “Investigative Advisory on Medicaid Fraud and Patient Harm Involving Personal Care Services” that identifies various “fraud schemes” it has encountered involving personal care services (PCS) — nonmedical assistance typically provided by an attendant working for a personal care agency.  PCS is an optional Medicaid benefit offered in certain states.  According to the advisory, the OIG has opened more than 200 investigations involving PCS program fraud and patient harm and neglect since 2012, including cases involving:  payments for PCS that were unnecessary or not provided; the abuse or neglect of beneficiaries by PCS attendants that have resulted in deaths, hospitalizations, and other patient harm; and attendants caring for beneficiaries while impaired.

The OIG urges CMS to establish regulatory safeguards for the PCS program, including:

  • Minimum federal qualifications and screening standards for PCS workers, including background checks.
  • A requirement that states enroll or register all PCS attendants and assign them unique numbers.
  • A requirement that PCS claims identify the dates of service and the PCS attendant who provided the service.
  • Other controls to ensure that PCS are allowed under program rules and are provided.