States Go Beyond Federal Requirements to Fight Medicaid Home Care Fraud
A new KFF report finds states are exceeding federal requirements to detect Medicaid home care fraud by cross-checking billed services against electronic visit verifications and analyzing claims for patterns.
Key Facts
- Affected providers
- Home Health
States are going beyond federal requirements to detect fraud in Medicaid home care, cross-checking billed services against electronic visit verifications (EVVs) and analyzing claims for specific patterns, according to a new report from KFF, a nonpartisan health policy research organization.
KFF surveyed officials administering Medicaid home care programs in all 50 states and the District of Columbia between April and August 2026. All 48 responding states reported some form of program integrity protocol, and all maintained EVV data in machine-readable files and cross-checked billed claims against EVV data.
Twenty-one of the 48 responding states are using, piloting, or planning to use AI in program integrity and data monitoring tools, the report found, and most states listed program integrity among their top three priorities.
The 21st Century Cures Act of 2016 required states to use EVV for personal care services and home health services delivered in-home, automating timekeeping, attendance, and care plans that home care workers input at the point of care.
KFF report authors cautioned that while additional scrutiny and oversight may limit fraudulent or inappropriate Medicaid spending, added fraud-combat efforts can create administrative burdens and limit provider participation, potentially reducing access to care.
Sources & References
Attribution: HHH Newsroom by KDG summarizes and analyzes publicly available source material. Interpretations in this article are not statements of law. Always verify against the linked primary document.