INDIANAPOLIS — The Indiana Family and Social Services Administration (FSSA) today announced findings from comprehensive audits of five Home- and Community-Based Services Attendant Care (ATTC) providers. The audits identified $198,031,230.18 in extrapolated improper payments (including interest) and systemic compliance failures across the review period of January 1, 2022, through March 31, 2025.
The audits were initiated after ATTC program expenditures increased by more than $150 million between 2021 and 2022 — a spike not supported by changes in member need or program structure. Using Statistically Valid Random Sampling (SVRS) aligned with HHS regulations, auditors reviewed 625 claim lines across the five highest risk providers.
Nearly all reviewed claims had multiple findings, including missing criminal background checks, non-covered clinical tasks, insufficient documentation, misaligned authorizations, and other significant regulatory noncompliance.
Governor Braun issued a warning to any providers who misuse taxpayer funds, “This conduct undermined the trust of the taxpayers who fund this program and the Hoosiers who rely on it. Providers who don’t follow the rules should understand clearly: Indiana will protect its people and its dollars with absolute resolve.”
FSSA Secretary Mitch Roob had this to say about the findings, “These audits reveal not just mistakes, but a wholesale abandonment of the rules that protect vulnerable Hoosiers. When a provider neglects to perform the required criminal background checks and bills for services without documentation, that is not an ‘oversight’, it is a reckless disregard for safety and an abuse of trust. Taxpayers are done subsidizing negligence, and we will pursue full recovery and accountability.”
Phase 2: Expanded Oversight Now Underway
FSSA’s efforts to identify and address fraud, waste, and abuse across the Medicaid program are ongoing. The Agency will continue to apply the same SVRS claims audit methodology that drove this review to additional high-risk providers across both Fee-for-Service and Managed Care claims.
Actions underway include:
- Targeted and continuous post-payment audits
- Prepayment review for offenders
- Enhanced electronic visit verification (EVV) reviews
- Strengthened provider education on ATTC requirements
Attendant Care provides nonmedical, hands-on support with daily living activities such as bathing, dressing, hygiene, eating, mobility, and community participation. It does not cover clinical interventions or medical tasks, which remain prohibited under program rules.
FSSA will continue working with providers, managed care partners, and federal partners to ensure program integrity while supporting access for eligible Hoosiers. Providers retain reconsideration and appeal rights throughout the audit process.
