What do auditors look for in a home care agency, and what happens if Medicaid audits me?

Georgia’s DCH Office of Inspector General says its work is to detect fraud, waste and abuse. Its December 2025 audit update lists a CMS home and community based services assessment and a state performance audit of the NOW and COMP waivers among current audits.

What auditors often find: in a 2010 HHS Inspector General review of Medicaid personal care in 10 states, about 18 percent of sampled paid claims (about $724 million) were inappropriate because caregiver qualifications were not documented. The most common missing items were background checks, age, and literacy or education. About 2 percent of claims had no record that the named client was ever served.

CMS also lists these common errors: billed units that do not match documented units, units above what the plan authorizes, and service logs missing the name of who gave the service, dates, time or activities.

What to keep ready for every claim:

1. The authorization or plan of care
2. A visit record with date, times, caregiver and tasks
3. A caregiver file with background check, training, TB screening and license where needed
4. A signed service log or note

If you receive an audit letter, note the deadline, collect the records and ask a health care attorney or your state agency how to respond.