Oakland Tribune
The in-home care program funded by Medi-Cal and administered by Alameda County is so fractured, unsupervised and poorly managed that a registered sex offender was able to work as a caretaker, while another woman offered to pay for a fake address so she could pretend her husband qualified for benefits, according to a recent grand jury report.
The June Alameda County grand jury report on the problems in the In-Home Support Services program shines a spotlight on a system that affects every county in the state and roughly 441,000 elderly and disabled Californians who rely on the IHSS program for nonmedical in-home care. Of those, 43,000 are in Alameda, Contra Costa and Santa Clara counties, whose IHSS programs have all been scrutinized by grand juries in the past decade. "Wherever there is welfare money, there is a potential for fraud," said Santa Clara County IHSS program manager Jim Ramoni.
IHSS is designed to help aged, blind and disabled adults on Medi-Cal stay in their homes. A division in each county called the Public Authority is supposed to keep a registry of vetted caregivers, who are hired by the IHSS clients to provide nonmedical services such as bathing, feeding, laundry, shopping and transportation to doctor appointments. Many are family members.
The idea behind the program is to save the state and federal governments money by keeping people out of expensive nursing homes, which can cost as much as $55,000 per person a year compared to $12,000 per IHSS recipient.
Former Gov. Arnold Schwarzenegger sparked an anti-fraud rallying cry against the IHSS program, which he threatened to eliminate. He said costs could be cut by 25 percent, a figure his administration lowered to 10 percent -- or $162 million. The Legislative Analyst's Office in Sacramento later put the number at no more than $40 million.
Gov. Jerry Brown carried on the anti-fraud crusade. He signed a bill in March requiring IHSS recipients to have a doctor certification that they need in-home services, which he claimed would save the state $120 million annually and cut caseloads by nearly 37,000.
Advocates like Karen Keeslar, executive director of the California Association of Public Authorities for IHSS, estimated fraud amounts to no more than 2 percent of cases. Keeslar, like county IHSS administrators, said that problems will only get worse if the state lets claims of fraud drive budget decisions and hurt the people who need IHSS services the most.
The stakeholders all recognize that the unsteady balancing act with counties and states at opposite ends has come to a tipping point -- especially with millions of baby boomers poised to reach retirement age in the midst of tough economic times.
"It's a lot to balance," Alameda County Supervisor Keith Carson said.
Blatant fraud
The most blatant example of fraud cited by the Alameda County grand jury was an ad on Craigslist placed by a woman willing to pay someone $100 a month for use of an address in Alameda County so she could fool a case worker. She said she would make it appear her husband lived at the fake address. "The worker doesn't ask anything about your personal information or financial arrangements," the woman wrote in the advertisement.
In another case, a registered sex offender billed the program for taking care of a woman while she was hospitalized. The man was being investigated as a suspect in numerous sex crimes while he was sending in faked timecards. Meanwhile, timecards were being bundled and stored in boxes held by the payroll clerks instead of being processed, the grand jury reported.
Fraud could be prevented by better organization and stepping up oversight by social workers, which IHSS managers call their "first line of defense," according to a June 2009 report by the State Senate Office of Oversight and Outcomes. Current state law only requires a social worker visit every 12 to 18 months. They may never meet the caregivers, setting the stage for abuse and manipulation.
Counties have stepped up training so clients will learn how to obtain and manage their caregivers, who are required to fill out an application, provide references, submit fingerprints and may take a three-hour orientation training class. But some clients have severe developmental disabilities and many are elderly. As one woman told the Oversight and Outcomes investigators, "I've been pressured to sign fraudulent timecards by people bigger and stronger than me. I am not empowered just because you call me the employer."
Conversely, intrusive oversight worries advocates like Esperanza Diaz-Alvarez, of the Community Resources for Independent Living, a Hayward-based nonprofit group that assists disabled adults. She agreed that social workers can help by taking an active roll in IHSS clients care as long as it doesn't come at the cost of clients' independence. "We have to find a better way of keeping up, monitoring the program and monitor the effect."
Red-flagging offenders
The state began offering money for anti-fraud efforts in 2009. The Contra Costa County Department of Social Services put together a team, which meets monthly to review fraud referrals. The team compares timesheets with hospital rolls and looks for "red flags," like a woman who billed 433 hours of work in a single month for several clients in Alameda and Contra Costa counties.
The state Department of Social Services has to stretch funds to make sure providers are compensated and the needs of the most vulnerable people are met. The state sets policies, cuts IHSS worker checks and contributes about 30 percent -- or $1.38 billion -- to the $5 billion program. Counties chip in about 17.5 percent and are in charge of assessing the number of hours recipients need and following up on any questionable payments. "We want to make sure the money is going to the people who need it the most," said spokesman Michael Weston. "That's a continuing process."
More information: www.acgov.org/grandju
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