You’ve probably seen the news about Medicaid fraud investigations increasing across the country.
When that happens, states respond the same way:
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 Medicaid Audits Increasing?
State Medicaid programs are under pressure to:
- Reduce fraud
- Make sure visits actually happened
- Confirm billing matches services
- Enforce EVV (Electronic Visit Verification) rules
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.
What Is a Manual Check-In?
A manual check-in happens when:
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:
- Visits weren’t properly verified
- EVV rules are being bypassed
- Staff aren’t following compliance procedures
And that can trigger an audit.
How Many Manual Check-Ins Are Too Many?
CMS generally recommends keeping manual check-ins below 15%.
However, this varies by state.
Because manual check-ins are know 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.
How to Prepare for Medicaid Audits
You don’t need a complicated system. You need consistency.
Here’s what every agency should be doing:
1. Keep All Your Documentation in One Organized Folder
If the state asks for records, you should be able to find them immediately.
Keep:
- Care plans
- Authorizations
- EVV visit logs
- Timesheets
- Supervisory notes
- Any communication about care
If it happened, save it.
2. If It Has a Signature, KEEP IT
Auditors love signatures.
Missing signatures are one of the easiest ways to lose money in an audit.
Keep:
- Caregiver signatures
- Client signatures
- Supervisor approvals
- Plan of care signatures
No signature? That can mean no payment.
3. Watch Your Manual Check-In Rate Weekly
Don’t wait for the state to notice.
Track:
- Total visits
- Manual entries
- Your manual percentage
- Caregivers with repeated manual issues
Often, one or two caregivers cause most of the problem. That’s a training issue, not a system issue.
4. Train Caregivers on EVV
Many manual check-ins happen because:
- Caregivers forget
- They think the office will fix it
- They weren’t trained properly
- They don’t know offline mode exists
Training reduces audit risk.
Simple as that.
GEOH has weekly caregiver training! If your agency uses GEOH, make sure you are sending caregivers to be trained!
5. Sign Up for Provider Newsletters
Stay informed by subscribing to:
- Your State Medicaid site
- Your Managed Care Organizations
- GEOH provider updates, click here to sign-up for your GEOH newsletter!
Rules change. Staying informed keeps you protected.
The Bottom Line
Audits are increasing.
That doesn’t mean you’re doing anything wrong. It means oversight is tighter.
The agencies that stay safe:
- Keep documentation organized
- Keep every signed document
- Lower their manual check-in rate
- Monitor compliance weekly
- Train their caregivers consistently
Compliance isn’t just paperwork. It protects your agency.
Disclaimer
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.
