The Indiana Family and Social Services Administration is seeking $200 million in improper payments from Indiana’s five largest attendant care providers after an audit of Medicaid claims found errors in nearly all claims reviewed.

FSSA Secretary Mitch Roob said the audits, which reviewed claims submitted to Medicaid between Jan. 1, 2022 and March 31, 2025, were initiated following a $150 million surge in Medicaid claims submitted between 2021 and 2022 he says could not be explained by changes in member need or program structure.

“If you bill taxpayers, you must be accurate,” Roob said.

At least one provider reached Thursday pushed back on the allegations.

“I’m surprised we got listed publicly while we are working on our appeal,” said Tendercare Home Health President and CEO Eric Deitchman. “They said our care plans weren’t up to par. We did a clinical review and feel we have extensive care plans for all our patients. We asked for more detail on what’s missing or wrong.”

Audit finds improper payments, missing background checks

The agency used statistically valid random sampling to review 625 claim lines submitted to Medicaid by Guardian Care, Healing Hands Personal Services, Help at Home, Tendercare Home Health and Team Select Home Care, according to FSSA.

The companies employ attendant caregivers, who provide non-medical services like bathing, dressing and cooking for senior and disabled Hoosiers, throughout the state.

The audit uncovered errors in nearly all claims reviewed, Roob said.

The cabinet secretary described instances of attendant care providers failing to activate electronic verification or providing services outside a patient’s location.

Other alleged errors include missing or incomplete consent forms and service plans — including one alleged instance in which the chief operating officer was listed as the patient — blank service plans, and incomplete or missing visit notes.

Roob said the agency found instances of the companies billing for services like physical therapy, which attendant care providers are not authorized to perform.

More concerning to the cabinet secretary were the instances of incomplete, missing, undated or late background checks for attendant caregivers.

“That’s not just a compliance issue,” Roob said. “It’s a direct threat to safety and represents a complete breakdown of the most basic protections we owe the people we serve. When combined with those safety failures, the $200 million in improper payments, missing documentation, prohibited tasks and service plans that didn’t match the services bill — you see a system that is being misused at a staggering scale.”

FSSA expands oversight, seeks full recovery

The agency sent a letter to the providers Wednesday seeking the return of improper payments, though the providers are likely to appeal.

Roob said FSSA will expand audits to other attendant care providers and begin prepayment reviews for offenders to prevent improper payments from Medicaid.

The agency intends to enhance electronic visit verification reviews and provider education on the rules for attendant care as well.

“For every dollar that is improperly claimed, we will seek full recovery,” Roob told reporters Thursday morning.

“This conduct undermined the trust of taxpayers who fund this program and the Hoosiers who rely on it,” Gov. Mike Braun said in a statement. “Providers who don’t follow the rules should understand clearly: Indiana will protect its people and its dollars with absolute resolve.”

Provider vows appeal

Deitchman told the Indiana Capital Chronicle he intends to appeal FSSA’s decision.

The company provided FSSA 150 pages of documentation for each patient, as well as electronic verification on all patient visits, he said.

“We’ve gone above and beyond to prevent fraud, and we actually call fraud out on a regular basis,” Deitchman said.

The second-generation family-owned company employs 650 people across the state, with offices in Indianapolis and Lawrenceburg.

Attendant care comprises only a “small part” of the business, originating as a solution to the nursing shortage, Deitchman said.

The 350 families receiving care from Tendercare include medically complex children, he said.

Deitchman said the company’s Medicaid audits have been free of deficiencies since the home health agency opened in 1994.

“We want to be good stewards of Medicaid money,” he said. “I am glad (FSSA does) these audits. We are preparing our appeal and think we will be fine.”

Still, Deitchman said initiating prepayment review could be difficult for his business — “if it takes a month to get payment and I have to pay my employees every two weeks.”

Roob acknowledged possible cash flow issues but said “but with 100% error rate I don’t know that we really have an option.”

Should FSSA recoup three years of Medicaid payments from the company, Deitchman said “it would be a significant operating issue for us.”

Braun administration pushes reform

The audits are part of a broader push by the Braun administration to curtail waste, fraud and abuse within Indiana’s Medicaid system.

The agency stopped advertising Medicaid on Braun’s first day in office and has since removed 400,000 Hoosiers from Medicaid rolls through eligibility checks, Roob said.

Still, he said these actions did not result in a commensurate decline in costs, because the sickest patients remain insured through Medicaid.

More Hoosiers may lose access to Medicaid on Jan. 1 when the state’s work requirements take effect.

FSSA is also examining autism behavior analysis costs for similar irregularities.

The audits follow earlier FSSA reforms of attendant care transitioning parents of medically fragile children to a different program, known as Structured Family Caregiving, amid a $1 billion Medicaid shortfall.

The state had previously paid the families of 1,600 children for unskilled care, but did not include guardrails restricting how many hours or parents could bill the state for basic care.

Roob told reporters Thursday the change did not cut down on waste, fraud and abuse.

“If anything, it’s increased,” he said, alleging people continue to take advantage of “loose” rules.

Parents of medically fragile children praised FSSA’s audit of attendant care providers in a statement Thursday calling on the agency to eliminate policies “allowing providers to capitalize on the health and welfare of our children — the state’s sickest Hoosiers,” mothers Sarah Saylor and Renee Case said.

“The legislature and FSSA must work together to adequately fund Indiana’s attendant care program so families like ours can continue to care for our kids at home instead of expensive and preventative hospital stays.”

Indiana Capital Chronicle is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Indiana Capital Chronicle maintains editorial independence. Contact Editor Niki Kelly for questions: info@indianacapitalchronicle.com.