Colorado could owe the federal government at least $8 million for improperly documented care to people with disabilities, according to a new audit from the U.S. Department of Health and Human Services’ Office of the Inspector General.
The inspector general’s , released last month, alleged that Colorado didn’t process all information about personal care services covered by Medicaid through its electronic visit verification system.
Under the 21st Century Cures Act, all states had to adopt electronic visit verification, or risk losing part of their federal Medicaid funding. Colorado rolled it out in August 2020.
Most providers of home-based health services have to file a timesheet that also includes the name of the client and the provider, as well as the type of service and where it took place. They can submit that information through an app or web portal, or by calling it in.
The federal auditors took a sample of 160 Colorado reimbursement claims for one or more visits in fiscal year 2024, out of about 1.3 million.
The audit found , with the majority involving someone entering the information manually rather than using an app or calling it in. In a smaller number of cases, data was missing, providers billed for more than 24 hours of care in a day, or the state paid the higher Denver-specific rate in other parts of Colorado.
The report said the state shouldn’t have paid for about $15.7 million in care, with the federal share accounting for $8.1 million.
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The report also flagged about $45.7 million in federal spending on claims that didn’t include specific information about the services provided, and advised the state and the Centers for Medicare and Medicaid Services to figure out if Colorado should pay back any of that money.
The Department of Health Care Policy and Financing, which oversees Medicaid in Colorado, said the auditors used a sample that doesn’t represent the overall mix of providers, making its estimates unreliable.
The auditors didn’t say that any providers committed fraud or that patients didn’t receive care, but that they couldn’t verify everything happened correctly with the available data. They recommended Colorado make changes to its electronic systems to avoid paying claims that don’t follow the rules.
The Department of Health Care Policy and Financing described the findings as “isolated documentation issues.” Federal officials held Colorado up as a model for electronic visit verification, and the state has already corrected some of the problems the auditors found, the agency said.
“The audit does not demonstrate that payments were made for services that were not authorized and rendered, nor does it identify fraud or intentional misuse of Medicaid funds,” the department said in a statement.
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