What do auditors look for in a Medicaid home care audit?
They check that every paid visit has proof: a service authorized in the plan, a worker with documented qualifications, a visit record showing time and place, and a note of what was done. Federal reviews have found missing worker qualification papers and no record of services. Match claim to chart to plan.
Auditors work backward from the claim. They pick a paid visit and ask for the paper trail.
Expect them to look for:
- The authorization and plan of care that allowed the service.
- The worker’s qualifications: background check, training, age, and other state requirements.
- Proof the visit happened: EVV time and place.
- A note of what was done, matching the plan.
- Supervisory visits and nurse sign-offs.
- Incident reports and follow-up.
What the evidence shows: a federal review of personal care claims found about 18 percent were improper because attendant qualifications were not documented, and about 2 percent were tied to workers who said they had no record of serving the client. Background checks were the most often missing item.
Georgia lists falsifying records and refusing state staff access to records as grounds for adverse action.
Practice: pick five paid visits at random each month and trace each one from claim to proof. If you can’t, fix the gap.
How CareBravo® helps
Each paid shift traces back to a checked visit, a plan and a signed clinical field, so the proof is already in one place.
Sources
- Inappropriate Payments for Medicaid Personal Care Services (OEI-07-08-00430) · HHS Office of Inspector General
- EDWP: CCSP and SOURCE General Services manual (Q3 July 2026) · Georgia DCH / GAMMIS
- MFCUs: Investigation and Prosecution of Fraud and Beneficiary Abuse in Medicaid Personal Care Services · HHS Office of Inspector General
Reviewed by Beth Bledsoe, Care Business Advisor®, 28 Oct 2026. Rules change. Confirm with your state Medicaid agency before you act.
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