OIG audit makes recommendations to prevent overpayments to DME provider

The OIG Audit and Inspections Division conducted an audit of Aveanna, a durable medical equipment (DME) and supplies provider in Houston. The audit evaluated whether there was valid authorization and evidence of delivery of fee-for-service DME and supplies associated with Medicaid claims submitted by and paid to Aveanna as required by state laws, rules, and guidelines.

During state fiscal year 2018, Aveanna processed 28,994 Medicaid fee-for-service claims for DME and supplies delivered to 1,521 Medicaid beneficiaries and received reimbursements of $1.9 million. The audit determined 87 percent were completed according to requirements. However, Aveanna did not always meet authorization requirements for DME and supplies, and Aveanna did not always maintain the appropriate proof of delivery documentation for Medicaid fee-for-service claims.

Based on issues identified in the audit, Aveanna owes the State of Texas $50,728. Aveanna indicated that it implemented improvements to its controls and processes designed to prevent future overpayments. Read the full details in the OIG’s audit.