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Officials say electronic visit verification can be bypassed; federal data challenge state explanations for spending rise
Summary
In questions after the announcements, officials said electronic visit verification (EVV) systems can be gamed (e.g., tapping an app or calling in) and rejected the idea that expanded legitimate home‑care programs since COVID fully explain spending surges, citing cross‑state comparisons and analytics.
During a question‑and‑answer period, audience members pressed officials on how defendants could apparently 'clock in' from prison and whether a post‑COVID expansion of home‑care programs explains the large increases in providers and payments.
Prosecutors and CMS representatives said some fraudsters bypass EVV safeguards by tapping an app, calling in or relying on a registered address rather than location services, and that EVV alone has not proven sufficient to prevent schemes. "If you don't have location services enabled, it doesn't necessarily track your location," one prosecutor said, adding that calls can be registered to a beneficiary's address.
Officials also said state comparisons suggest growth and per‑beneficiary payments in some states are anomalous and not solely explained by policies encouraging home care since the pandemic. CMS and DOJ officials said data analytics and revalidation are needed to determine where billing growth reflects legitimate demand and where it indicates exploitation.
