Are Medicaid Audits Increasing?
You’ve probably seen the news about Medicaid fraud investigations increasing across the country. And if you run a home care agency, you may be wondering: does this affect me?
The short answer is yes. As states invest more in EVV technology and data analytics, they audit more providers. If you run a home care agency, you should expect more oversight — even if you’ve done nothing wrong.
Many Medicaid audits are routine. But certain behaviors can increase your chances of being reviewed. The good news? Most audit problems are preventable. Let’s break this down in simple terms.
Why are audits increasing?
Because EVV collects detailed visit data, states can now spot patterns faster — especially red flags like high manual check-ins. That’s where many agencies get into trouble.
A caregiver does not clock in themselves, and someone in the office clocks them in instead. Sometimes this is necessary. But when it happens too often, it raises questions. From the state’s perspective, manual entries can look like falsified visit records, billing for services not rendered, and patterns of non-compliance — and that can trigger an audit.
What is GEOH’s standard for manual check-ins?
Because manual check-ins are known to trigger Medicaid audits, GEOH’s standard is stricter: less than 10%. If your agency’s manual rate is creeping higher than that, it’s time to correct it.
You don’t need a complicated system. You need consistency.
Steps to reduce your audit risk
Keep your documentation tight
If the state asks for records, you should be able to find them immediately. If it happened, save it. Auditors love signatures — missing signatures are one of the easiest ways to lose money in an audit. No signature? That can mean no payment. Don’t wait for the state to notice.
Identify problem caregivers early
Often, one or two caregivers cause most of the problem. That’s a training issue, not a system issue. Training reduces audit risk. Simple as that.
Take advantage of GEOH’s weekly caregiver training
GEOH has weekly caregiver training! If your agency uses GEOH, make sure you are sending caregivers to be trained.
Stay informed
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The bottom line
Audits are increasing. That doesn’t mean you’re doing anything wrong. It means oversight is tighter. Compliance isn’t just paperwork — it protects your agency.
This article is for informational purposes only and does not constitute legal, compliance, or regulatory advice. Medicaid audit requirements vary by state and by Managed Care Organization (MCO). Agencies should consult with a qualified healthcare attorney, compliance professional, or their state Medicaid office for guidance specific to their situation. GEOH does not guarantee audit outcomes or regulatory determinations. Always refer to your state’s official Medicaid guidelines and CMS regulations for the most current requirements.