Homemaker and Home Health Aide Program: Most Claims Paid Correctly, but Opportunities Exist to Improve Services to Veterans

The Veterans Health Administration’s (VHA) homemaker and home health aide program offers personal care and related services to help frail or disabled veterans with daily activities. The OIG examined whether veterans received intended program services and VHA accurately processed program claims. The team conducted this audit because of the large number of veterans in the program; its high cost; the risks experienced by older veterans, such as poor health and social isolation; and the volume and nature of hotline complaints about the program. The OIG found that VHA could not be certain that veterans received services from home health agencies that were licensed or certified, or met criteria for exemption, for about 546,000 of 1.1 million claims approved for payment between September 2018 and February 2019. Consequently, VHA may have made up to $145.4 million in improper payments. Medical facilities also applied program policies differently, or inconsistently prioritized veterans on the program’s waiting lists. The team also found variances in how some facility personnel addressed veterans who were difficult to place because of prior inappropriate behavior towards aides. These differences resulted in some facilities providing inconsistent access to services for some veterans and were partly caused by limited budget resources. VHA paid more than half of program claims within 30 days and nearly always accurately. However, it could further reduce risks of paying inadequately supported claims or claims for services not preauthorized. Based on a random sample of 200 program claims, the OIG estimated VHA improperly paid at least $8.5 million to home health agencies, with at least $5.5 million potentially recoverable. VHA concurred with the OIG’s eight recommendations on program policies and practices, controls for service agencies’ licensing and certification, program demand tracking, procedures for hard-to-place veterans, timeliness and claim payment monitoring, and a review of identified claim errors.