A Medicaid home health provider in Bellaire, Texas, failed to comply with certain electronic visit verification (EVV) visit maintenance requirements, leading to more than $15,000 in possible overbilling, according to the Texas Health and Humans Services Office of Inspector General (OIG).
Visit maintenance occurs when the EVV device doesn’t automatically capture required data elements, which can occur due to a shift in scheduled service times, according to an OIG release Sept. 26, 2022. To maintain proper records, designated staff for the provider can edit data elements to reflect service delivery and avoid billing errors.
Of the 14,912 transactions reviewed, 12,136 were missing required information and documentation. In total, 263 transactions were missing clock in and out times with no supporting documentation, leading to $15,353 in overpayment for services not provided.
Auditors recommended the provider should:
- Strengthen controls over the visit maintenance process to ensure transactions missing service delivery times include the required data elements in the free text field.
- Repay the state of Texas a total of $15,353 for EVV transactions that did not contain the required information to verify the delivery of personal care services.