KFF Survey: States Exceed Federal Rules on Home Care Fraud Detection
In a new report, KFF finds that states administering Medicaid home care programs are going beyond federal requirements to detect fraud, including cross-checking billed claims against electronic visit verification (EVV) data and using AI-based monitoring tools. KFF surveyed Medicaid home care officials in all 50 states and D.C. between April and August 2026; Florida and South Carolina did not respond, and Minnesota skipped a program integrity question. All 48 responding states reported some program integrity protocols beyond EVV, and 21 states said they are using, piloting, or planning AI for fraud detection. The report's authors caution that added scrutiny, while reducing fraudulent spending, can create administrative burdens that limit provider participation and access to care.