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Medicaid Fraud is on the Rise – Protect Yourself

By October 14, 2023May 29th, 2024No Comments

Early Childhood programs are finding that the pressure is on to identify and prevent fraud. Medicaid audits have started in the Early Intervention community – something that was rarely, if ever, seen in the past. The arrests of nine therapists for stealing over $3 million from The New York State Early Intervention Program shows just how serious an issue this is, and how problematic Medicaid fraud has actually become. 

How could this happen? If your Agency doesn’t have the proper controls in place, it is easier than you might think. 

ProviderSoft has several features in place to help prevent fraudulent activity and protect your agency in the event of a Medicaid audit: 

Signature Capture Settings (Provider Deterrents)

  • Date/Time Stamp may be configured on signature fields to identify when a signature has been captured
  • Geolocation Stamp may be configured on signature fields to identify where a signature was captured

Session Posting Settings (Preventative Settings)

  • Hours of Operation may be configured to disallow posting of sessions outside of reasonable or preferred service hours
  • Overlap Prevention settings may be configured to disallow various session overlaps or the allowing of overlaps in specified scenarios (e.g., group services)

Agency Oversight Tools (Management)

  • Activity Summary and Service Delivery Ratio reports may be reviewed to determine reasonable mandate delivery
  • Provider Caseload screen/reports may be reviewed to determine reasonable caseload volume

Behind-the-Scenes Information Capture (Auditable upon request)

  • IP Address for System Users
  • Communication Trail for use of the Remote Signature Capture Tool to ensure Caregiver review and sign-off of documentation

If you already have ProviderSoft, we recommend checking in on your current settings to ensure that you have the best configuration possible.  See what one of our NYC clients has to say:

“ProviderSoft can be programmed to comply with stringent Medicaid requirements which is highly recommended since the first audit of an Early Intervention provider agency has commenced. Geolocation stamp, date time stamp, flattening of notes, ability to disable editing of notes after their creation, recording of changes to notes after they are saved and set up of required fields are some of the many options which can be employed to minimize Early Intervention provider agencies’ exposure to fraud and Medicaid noncompliance. 

We are happy to be working with ProviderSoft  – their expertise provides us with the ability to minimize incidents of fraud and maximize our compliance with Medicaid, NYSDOH BEI and NYCDOH BEI.”


ProviderSoft understands how important fraud protection is to your Agency. 

Contact us today to learn more about how we can help.