Electronic Visit Verification Compliance Signals Heightened Oversight

According to an article by Geoffrey R. Kaiser of Rivkin Radler, electronic visit verification (EVV) requirements under the 21st Century Cures Act are moving from implementation to enforcement. The Act required states to adopt electronic visit verification systems for Medicaid-funded personal care services by 2020 and for home health care services by 2023, citing long-standing concerns about fraud, waste, and abuse identified by the Centers for Medicare and Medicaid Services. Despite statutory compliance, recent findings suggest that oversight failures remain significant.

According to Kaiser, a November 2024 audit by the New York State Comptroller reported that New York paid $14.5 billion for Medicaid-funded personal care services without the required electronic visit verification. During a 26-month audit period covering more than $31 billion in Medicaid payments, auditors identified billions in claims lacking matching verification records, payments for visits too short to be billable, and services billed while patients were hospitalized. 

The Comptroller attributed these issues to insufficient monitoring and oversight of electronic visit verification data and recommended that the Department of Health establish a formal compliance program, deny improper claims, and recoup overpayments. The audit also raised concerns about data integrity, where providers can manually adjust verification records without state visibility.

Kaiser further notes that federal scrutiny is increasing. CMS is evaluating how states use electronic visit verification data for program integrity, with a report expected in 2026. Providers should view this as a clear indicator of sustained enforcement interest rather than a one-time audit cycle.

As Kaiser explains, providers of personal care and home health care services should expect intensified scrutiny of electronic visit verification submissions, with repayment demands and potential False Claims Act (FCA) exposure if overpayments are identified. Proactive audits of historical and current records, conducted with counsel where appropriate, can help organizations assess risk and prepare a defensible compliance response.