Why Compliance Audits Are Becoming More Frequent and Risky
Audits aren’t new, but the intensity, frequency, and consequences have changed.
Recent analyses indicate a growing trend among states to enhance oversight of Medicaid Home and Community-Based Services (HCBS) providers, including the implementation of more frequent audits and increased enforcement of Electronic Visit Verification (EVV) requirements and caregiver training compliance.
According to a 2025 report by HHAeXchange, the Centers for Medicare & Medicaid Services (CMS) and the Office of Inspector General (OIG) may intensify audits to ensure continued compliance with EVV mandates. States like New York and Ohio have conducted audits highlighting the growing emphasis on adherence to EVV requirements.
Furthermore, a 2024 audit by the Ohio Department of Medicaid revealed that EVV was utilized for only 44% of provider-paid personal care services (PCS) and home health care services (HHCS) claims in 2022, indicating a need for increased enforcement and oversight.
These developments underscore the heightened focus on compliance and the necessity for HCBS providers to adopt robust systems and practices to meet evolving regulatory expectations.
What’s driving this uptick?
- Budget cuts mean states must recover improper payments to stay solvent.
- Federal pressure (via CMS and OIG) pushes for documentation precision.
- Public accountability demands more transparency in how Medicaid dollars are used.
Failing an audit can mean:
- Suspended reimbursements
- Plan of correction mandates
- Public reputational damage
- Potential loss of licensure
The Problem with Paper (and Semi-Digital) Systems
Many agencies still manage compliance with a blend of:
- Paper files
- Spreadsheets
- Email follow-ups
- Legacy learning systems that don’t integrate with HR or AMS tools
This creates what compliance experts call a “fractured audit trail.”
And that’s exactly what auditors look for: inconsistent documentation, training gaps, and hard-to-trace timelines.
Many home care agencies continue to rely on spreadsheets or paper-based training records, leading to challenges in retrieving complete documentation during audits.
What a Modern Compliance Culture Looks Like
Shifting from reactive compliance to proactive readiness requires more than a system. It requires a mindset.
Here’s what defines a modern compliance culture:
1. Real-Time Recordkeeping
Instead of pulling reports the night before an audit, data is continuously updated and accessible. Audit prep becomes an output, not a project.
Ask yourself: “If an auditor walked in today, how quickly could we provide every required training certificate?”
2. Centralized Data, Not Siloed Spreadsheets
All caregiver records — from onboarding to annual compliance records and annual CE’s — live in one digital environment, accessible by those who need it (and protected from those who don’t).
This eliminates “he said/she said” disputes and supports consistent internal standards.
3. Automated Alerts and Expiration Tracking
Credentialing, TB tests, training renewals — all automatically flagged before expiration, not after.
Proactive agencies build buffers into their compliance calendar, so deadlines are never a fire drill.
4. Multilingual, Mobile-Accessible Training
For agencies with high caregiver diversity and turnover, training systems must be accessible in multiple languages and via mobile devices — not just desktops in the back office.
Mobile-first training platforms enhance accessibility and flexibility, making it easier for caregivers with multiple jobs or irregular hours to complete their training.
The ROI of Being Audit-Ready Every Day
Shifting to a proactive compliance model delivers value across several measurable dimensions. Agencies that move from reactive, paper-based compliance to integrated, digital solutions are better able to:
- Track audit preparation time: Digital systems allow agencies to measure and reduce the hours spent gathering documentation and preparing for audits.
- Monitor audit success rates: Centralized compliance records make it easier to identify trends in audit outcomes and take corrective action if needed.
- Identify compliance violations: Automated alerts and reporting help agencies spot and address violations early, supporting more consistent compliance.
- Assess team stress and operational disruption: Streamlined processes decrease the stress and disruption often associated with last-minute audit preparation.
- Evaluate documentation retrieval rates: Agencies can track how efficiently they access required records, supporting faster and more reliable audit responses.
By routinely monitoring these metrics, agencies can quantify the benefits of their compliance strategy—demonstrating improvements in efficiency, regulatory outcomes, and staff satisfaction (HHAeXchange, 2025).
Almost every Nevvon customer who switches to centralized compliance tracking and automated reporting sees a significant improvement in audit preparation time. In some cases, agencies have reduced audit prep from weeks to just minutes with the click of a button, while also enhancing documentation accuracy and consistency.
How to Start the Shift: Strategic Steps for Compliance Leaders
- Map Your Current Audit Trail
Identify where your data lives — and where it breaks down.
- Talk to Your Frontline
Understand the pain points caregivers and managers face with current training and documentation systems.
- Calculate Your Compliance Cost
Consider staff time, audit risk, and turnover caused by missed certifications.
- Build a Business Case
A stronger compliance system doesn’t just avoid penalties — it supports growth, staffing, and operational efficiency.
The Future Is Continuous Readiness
In the coming Medicaid environment, audit preparation isn’t a quarterly sprint — it’s a continuous discipline.
Agencies that build systems and cultures around daily compliance will:
- Avoid audit stress
- Protect their licenses
- Safeguard their margins
- Move faster in a consolidating market
As scrutiny grows, trust becomes the currency of survival. And trust is built on precision, not paperwork.
