Indiana’s Medicaid auditors say they have uncovered a massive problem: state reviews of five attendant-care providers turned up an extrapolated $198,031,230.18 in improper payments. The audits covered claims filed from Jan. 1, 2022, through March 31, 2025, and relied on a statistically valid sample of 625 claim lines. Investigators documented widespread paperwork gaps and safety concerns, including missing criminal-background checks and bills for clinical care that the attendant-care program is not supposed to cover.
FSSA announcement and scope
The Family and Social Services Administration launched the reviews after attendant-care spending spiked by more than $150 million between 2021 and 2022. Officials say the nearly $198 million figure includes interest and extrapolated findings from the sample. According to the agency, the review used Statistically Valid Random Sampling that tracks with federal guidance, and FSSA plans to recover funds whenever an audit identifies an improper payment. Those details came from the agency’s public release, as reported by the Indiana Capital Chronicle.
What auditors found
Auditors reported that almost every claim in the sample had more than one problem. They cited missing or incomplete visit notes, service plans that were blank or did not match the billed care, and criminal-background checks for caregivers that were late or missing entirely. The reviews also found providers billing attendant-care codes for physical therapy and other clinical services that are not authorized under the waiver, raising red flags about both program integrity and patient safety. The agency’s description of those compliance failures was summarized by WBIW.
Which providers were reviewed
FSSA labeled five providers as highest risk in this round of audits: Guardian Care, Healing Hands Personal Services, Help at Home, Tendercare Home Health and Team Select Home Care. The agency says it has sent letters seeking repayment and that the companies can pursue reconsideration and appeals under state procedures, according to the Indiana Capital Chronicle. Tendercare’s president told reporters the company is preparing an appeal and has already turned over extensive documentation and electronic visit-verification records, Indiana Economic Digest reported.
Broader context and federal audits
FSSA has framed the attendant-care reviews as part of a broader push to shore up program integrity after a rapid run-up in spending that the agency says cannot be explained by changes in member needs or program rules. The state findings land on top of separate federal scrutiny: a December 2024 audit by the HHS Office of Inspector General found at least $56.6 million in improper fee-for-service Medicaid payments for applied behavior analysis in Indiana, highlighting wider worries about billing in home- and community-based services. Those federal findings are detailed in an HHS Office of Inspector General report, while state reporting has traced the attendant-care spending surge that helped trigger the latest audits.
FSSA response and provider pushback
The agency says it plans to ratchet up oversight, including more targeted post-payment audits, prepayment reviews for repeat problem providers, additional checks on electronic-visit-verification data and stronger education for agencies on what attendant care is actually allowed to cover. FSSA officials have pledged to pursue full recovery of improperly claimed dollars while also emphasizing the need to keep services available for eligible Hoosiers, according to Indiana Economic Digest. Providers, for their part, warn that large recoupments or payment holds could choke off cash flow and disrupt care for families that depend on in-home support.
What happens next
The five companies named in the audits can seek reconsideration and formally appeal FSSA’s findings. The state says it intends to extend the same audit approach to additional high-risk providers across both fee-for-service and managed-care claims. Advocates and families are urging the state to be precise, pushing for enforcement that claws back misspent money without unnecessarily cutting off needed services. Coverage of the initial announcement and the agency’s early moves was provided by FOX59.
