Indiana Wants $198 Million Back From Medicaid Home-Care Providers — But Even the State Won’t Call It Fraud.
Indiana’s Family and Social Services Administration says a statistically valid audit of five home-care agencies found $198,031,230.18 in improperly billed Medicaid claims — errors turned up in all but a handful of the claims its auditors pulled from a program meant to keep older and disabled Hoosiers cared for at home instead of in a nursing facility.
FSSA’s own deputy chief of staff won’t call it fraud. “What we are saying is they improperly billed for services — so it’s misuse of funds,” Marcus Barlow told reporters, leaving any fraud determination to law enforcement. That distinction — improper payment, not proven fraud — is a legal one, and it matters.
The audit covers claims filed between January 2022 and March 2025 — years when the underlying program’s spending nearly quadrupled under Gov. Eric Holcomb’s (R) FSSA. It is Gov. Mike Braun’s (R) FSSA, under new leadership, that ordered the audit and is now trying to claw the money back.
- $198,031,230.18 — extrapolated improper Medicaid payments, including interest, found across 625 sampled claim lines — Indiana FSSA
- 5 — attendant-care agencies audited — Guardian Care, Healing Hands, Help at Home, Tendercare Home Health, Team Select Home Care
- $317,000,000 → $1,400,000,000 — Indiana's attendant-care program spending, 2022 to a projected 2024 — roughly a fourfold increase
- Jan. 2022 – Mar. 2025 — the audit's claims-review period, spanning two governors' administrations
FSSA’s program-integrity unit pulled a statistically valid random sample of 625 claim lines from Indiana’s five largest attendant-care providers — Guardian Care, Healing Hands Personal Services, Help at Home, Tendercare Home Health, and Team Select Home Care — then extrapolated the error rate across the full population of claims those agencies billed to Medicaid between January 1, 2022, and March 31, 2025. The result, per HHS-standard sampling methodology, was $198,031,230.18 in projected improper payments, including interest.
The violations auditors documented were not one recurring clerical slip. They found caregivers who never activated the electronic visit verification system Indiana requires to timestamp and geo-locate a visit; services billed as delivered somewhere other than the beneficiary’s own home; consent forms and service plans that were missing, blank, or didn’t match what was actually billed; missing criminal-background checks for caregivers; and claims for clinical services the attendant-care program isn’t structured to cover at all.
FSSA Secretary E. Mitchell (Mitch) Roob Jr. framed the volume of violations as evidence of something more systemic than a paperwork backlog.
“These audits reveal not just mistakes, but a wholesale abandonment of the rules that protect vulnerable Hoosiers. ... Taxpayers are done subsidizing negligence.”
E. Mitchell (Mitch) Roob Jr. · Secretary, Indiana FSSA
The word FSSA has been careful not to use is “fraud.” This is a civil program-integrity audit — conducted by FSSA’s own auditors, not by the state Board of Accounts, the federal Centers for Medicare & Medicaid Services, or the HHS Office of Inspector General — and it has produced no criminal referral. Deputy chief of staff Marcus Barlow put the distinction plainly: “What we are saying is they improperly billed for services — so it’s misuse of funds,” he told reporters, adding that any determination of actual fraud would be up to law enforcement, not FSSA.
FSSA is pursuing civil recoupment and an administrative process, not prosecution, and the five providers retain reconsideration and appeal rights. One of them, Tendercare Home Health, is doing exactly that. President and CEO Eric Deitchman disputes the audit’s findings and says the agency was named publicly before that process played out: “I’m surprised we got listed publicly while we are working on our appeal.”
For context, not comparison: CMS’s most recent national Medicaid improper-payment audit put the country-wide rate at 2.30% for 2025, down sharply from 5.09% in 2024 and 8.58% in 2023. Indiana’s own statewide improper-payment rate has never been disclosed in connection with this audit, and this piece does not estimate one — the $198 million figure applies only to the five attendant-care providers reviewed, not to Indiana Medicaid as a whole.
FSSA says the audits began because the numbers stopped making sense. Attendant-care claims jumped by roughly $150,000,000 between 2021 and 2022 alone — a spike Roob says “could not be explained by changes in member need or program structure.” That spike traces to a March 2022 FSSA bulletin, issued under then-Gov. Eric Holcomb’s administration, that expanded eligibility for family members to be paid as attendant-care workers for their own relatives. From there, the attendant-care line item — known internally as ATTC — grew from roughly $317,000,000 in 2022 to a projected $1,400,000,000 in 2024, contributing to a swing of roughly $900 million to $1 billion in Indiana’s overall Medicaid budget.
The governor when spending expanded — Eric Holcomb (R), whose FSSA approved the March 2022 bulletin that opened attendant-care eligibility to family caregivers, the policy shift that preceded the spending surge this audit reviews. Nothing here alleges Holcomb personally authorized improper billing; the audit reviews claims practices at five private agencies, not gubernatorial conduct.
The governor auditing it — Mike Braun (R), sworn in January 13, 2025, whose FSSA ordered the review and announced its results.
The agency — the Indiana Family and Social Services Administration, led by Secretary E. Mitchell (Mitch) Roob Jr., a Braun appointee.
Braun has framed the recoupment effort as a matter of taxpayer trust rather than a partisan cleanup job.
“This conduct undermined the trust of the taxpayers who fund this program and the Hoosiers who rely on it. ... Indiana will protect its people and its dollars with absolute resolve.”
Gov. Mike Braun (R-IN)
Statehouse Democrats have questioned both the audit’s methodology and its timing. State Rep. Victoria Garcia Wilburn (D-Fishers) called the recoupment push “a step towards clawing back funds on the backs of Hoosiers and the needy.” State Rep. Ed DeLaney (D-Indianapolis) separately raised doubts about how the sample was drawn and what problem the audit was really built to solve, and State Rep. Gregory Porter (D-Indianapolis) has criticized a related Braun-administration push to cap Medicaid program growth at 2% annually, arguing the audit and the cap are two pieces of the same cost-cutting agenda. FSSA says it is moving forward regardless — expanding audits to additional attendant-care providers and shifting flagged agencies to prepayment review before new claims are ever paid out.
None of that is the same as what Attorney General Todd Rokita (R) has been building through his Medicaid Fraud Control Unit, which is a genuinely criminal track running in parallel. Rokita’s office touted $100,000,000 in Medicaid provider-fraud recoveries in February 2026, and on July 20, 2026, it filed charges in an unrelated $10,900,000 attendant-care fraud scheme tied to Senior Home Care Agency, naming defendants Alexander Byrnes and Faith Casas. That case involves actual criminal charges and defendants who, like anyone charged, are presumed innocent until proven otherwise in court. The $198 million audit at the center of this story involves neither — no charges, no defendants, just five agencies now working through a civil appeals process while FSSA tries to get the money back.
Indiana’s Medicaid attendant-care program nearly quadrupled in spending after a 2022 eligibility expansion under Gov. Eric Holcomb’s (R) FSSA, and a statistically valid audit under Gov. Mike Braun’s (R) FSSA now says $198 million of what got billed during that stretch shouldn’t have been paid. FSSA’s own spokesman calls it misuse, not fraud, and the five providers involved are appealing through a civil process, not defending against criminal charges — that distinction is real, and Attorney General Todd Rokita’s separate, genuinely criminal $10.9 million case against Senior Home Care Agency shows what an actual fraud charge in this same corner of Medicaid looks like when prosecutors bring one.
