On April 28, 2025, New Hampshire Attorney General John M. Formella announced a settlement with a home healthcare services company, resolving a dispute over the adequacy of the company’s documentation of home health aide services.
In May 2022, the Administrative Appeals Unit of the New Hampshire Department of Health and Human Services upheld an audit conducted by New Hampshire Healthy Families. The audit concluded that the company’s documentation was insufficient, resulting in an order to repay $28,269.50. The company did not seek judicial review of the decision and continued to use the same documentation methods that had been deemed inadequate.
To resolve the matter and avoid further legal proceedings, the company has agreed to pay an additional $100,000 to the state, in addition to the previously ordered repayment. It has also committed to improving compliance by enhancing its electronic visit verification (EVV) technology.
The investigation was conducted by the Attorney General’s Medicaid Fraud Control Unit, with assistance from the Program Integrity Unit of the Department of Health and Human Services.
Compliance Perspective
Issue
Providers that receive payment from Medicaid or other government programs are required to maintain accurate and complete records to support billed services. Missing, incomplete, or unclear records can result in repayment demands, compliance actions, or increased oversight. Documentation must reflect the services delivered and support the claims submitted.
Discussion Points
- Review policies and procedures related to documentation. Confirm that they clearly describe what information must be recorded, who is responsible for completing records, and how records are maintained.
- Provide training to staff responsible for documenting care. Training should cover what information is required, how it should be recorded, and the importance of accuracy and completeness in supporting billing and compliance.
- Conduct periodic audits to ensure records support claims submitted. Compare documentation to billing data to identify discrepancies or omissions. Use findings to address gaps and make any needed changes to policies or training.
*This news alert has been prepared by Med-Net Concepts, Inc. for informational purposes only and is not intended to provide legal advice.*