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In-Home Care Program Fraud Claims Don’t Add Up

Audio

Aired 9/28/09

Thousands of disabled, blind and elderly people in San Diego County will no longer have help to cook their meals, bathe, change their sheets or take their medicine. Gov. Schwarzenegger cut In-Home Supportive Services to help resolve the state budget crisis. But in slashing the program he also alleged massive fraud.

Thousands of disabled, blind and elderly people in San Diego County will no longer have help to cook their meals, bathe, change their sheets or take their medicine. Governor Schwarzenegger cut In-Home Supportive Services to help resolve the state budget crisis. But in slashing the program he also alleged massive fraud.

Before Gov. Schwarzenegger eliminated more than a quarter billion dollars from In Home Supportive Services this summer, he met with a group of district attorneys to talk about fraud.

"And there's no program than where there's more of that (sic) than with In Home Support Services. And just so you do know of how much money is being spent it's between $4 billion and $5 billion. Some people say there's 25 percent fraud and that will be a billion dollars right there."

To Doug Moore sitting in his San Diego office, those were fighting words.

"I was livid. I wanted to bring him in this room and take him on one on one," says Moore.

Moore runs the union that represents people who work in In-Home Supportive Services also known as IHSS.

"There's not massive fraud like the governor has said in this program. The statistics do not back these claims up."

There are about 460,000 people in the program statewide. From July 2005 through November 2008, there were 5,000 fraud complaints against IHSS. Fifteen-hundred were substantiated. That's a fraud rate of less than 5 percent.

In San Diego County where there are 25,000 seniors, blind and disabled people in IHSS, there were 42 complaints and 14 prosecutions. That's a fraud rate of less than 1 percent.

But investigators say these numbers don't tell the full story.

"The way the system is set up now, the program is ripe for fraud," says Andrew Freshwater, the head investigator of the economic crimes unit in the San Diego's DA's office.

Freshwater says most of the people in IHSS are taken care of by friends and family. If there's collusion, fraud detection is difficult.

"Are you going to fudge a timesheet because your son didn't show up today?"

In recent years, the DA's office has prosecuted two cases of IHSS fraud with losses of over 100 thousand dollars and one case over two hundred thousand dollars. There are instances when people don't show up for work but claim they did by forging their clients' signatures on timesheets.

Along with cuts to the program, the governor put in place new rules to prevent fraud. They include requiring IHSS providers and recipients to put their fingerprints on timesheets and more random visits by social workers.

San Diego prosecutor Michael Groch says the new requirements will likely increase the rate of fraud prosecutions.

"What's really been lacking in the program is the ability to hold people accountable and to investigate these people and to turn them into prosecutable cases which is why we've seen the disparity between the amount of fraud that we know and believe is in the system and the number of cases of prosecution for them."

"There is a political move on the part of some districts attorneys to pad their budgets to create more investigation."

Lee Collins is director of the San Luis Obispo County Department of Social Services.

"I have no doubt that there is some fraud in every program including the In Home Supportive services but there is nothing to suggest that this program compared to any other program is particularly ripe for fraudulent intent. In the absence of data, it's simply trumpeting at a ghost."

Collins accused state officials of making cuts on dishonest grounds.

"But what they've tried to do is to have their cake and eat it too which is to say that we're cutting the program because we think there's a lot of fraud. I think it is its own brand of fraud and the worst most cynical ugly kind of politics because of who they're targeting. it's too easy a target to pick on folks who don't have the ability to fight back."

But one woman is speaking out. She stands to lose funding to take care of her autistic sister and elderly mother.

"I know that I'm fighting for a cause. And I'm fighting not for myself but for all others who cannot talk, who cannot express."

Comments

Avatar for user 'zafiro'

zafiro | October 3, 2009 at 11:30 a.m. ― 4 years, 6 months ago

There is fraud - it is prevalent. There are 2 level of people receiving care
One group is family member caring for family member - it's rife with problems but is something that would be hard to validate .
Seniors alone without family support are the most vulnerable. They have extreme difficulty with utilizing or being able to utilize IHSS because of the complexity in: locating , finding , interviewing, checking references, hiring, employment process paperwork, instructing, supervising and authorizing work time.
The IHSS program as I see it is riddled with inefficiencies and has unrealistic expectations of the vulnerable senior in securing a competent, caring homemaker. Many of these seniors are living with self neglect, and impaired physical and mental capacity. Their situation places them at increased risk for victimization, and abuse.

Vulnerable seniors who can remain at home with support but find it impossible to manage this complex program.

Seniors are frequently being victimized of actual work time versus reported time authorized/paid – ( can’t see reported hours on a complex, small time card, afraid to disagree; feel somebody is better than nobody).

Seniors are frequently robbed of personal effects as well as money.

IHSS SW staffing is frequently changing – lack of ability to establish a rapport/history to measure increase/decrease in client’s cognitive and functional capacity. Client doesn’t know who to call. Case Loads for the IHSS SW’s – are excessive. Most seniors are not savvy enough to take it to a higher level for intervention.

Communication is frequently difficult. Staff with accents; difficult for client to hear and understand.

The cuts the governor is making are harsh - Better they improve the system - If you look at the Grand Jury Report: "San Diego County Elder Care Program - Golden Years in Crisis" http://www.sdcounty.ca.gov/grandjury/reports/2006_2007/eldercare.pdf
and than look at the County's response which was something akin to - we are doing the job as dictated by the mandates - there isn't enough funding.
http://www.nctimes.com/news/local/article_44bda8ef-9f8c-55e9-b4e2-131baf261250.html

I'm happy to hear they are doing better background checks and they are requiring fingerprints to be affixed to time sheets
I am sad to see that probably the most vulnerable group -seniors without family will probably be affected the most. Frequently the hours of service they receive are for help with housekeeping, shopping etc -

The State and County don't want to be the employer and take the responsibility because of fear of liability - They make the patient/client the employer - State and County are the middleman to authorize the service ( eligibility and time allocation), State pays the bill.
The issue is complex - slashing the budget is not the answer - it is a much needed program - it needs better over-site and supervision.

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