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Claims of harassment surround in-home care fraud investigations
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The Stanislaus County Board of Supervisors on Tuesday unanimously approved expanding a program intended to catch those defrauding the system that pays people who provide in-home care for the elderly or disabled, though providers say the fraud investigators have traumatized patients.

The In-Home Supportive Services program, since its establishment in 1973, has paid providers to supply in-home care to aged, blind, and disabled persons so they do not have to live in care homes. The program is only available to those with income at or below $845 per month, with no more in $2,000 in assets – $3,000 for married couples – excluding vehicles and homes.

“Stanislaus County is strongly supportive of providing IHSS to eligible persons,” said county CEO Rick Robinson. “The county is adamantly opposed to people fraudulently receiving funds.”

IHSS is a $5 billion program statewide, with a county budget of approximately $60 million annually – up drastically from a $32 million price tag in the 03-04 fiscal year.

The program is funded 42 percent by federal Medicaid funding, 33 percent by state dollars, and the county pays the remaining 18 percent. That county share has started to impact the general fund in recent years, as realignment sales tax – the normal source of IHSS funding – has decreased.

In 2004, the state took over IHSS fraud investigations, but in last year’s state budget the onus was shifted back to the counties. A Stanislaus County IHSS fraud investigation program, run through the Special Investigation Unit, kicked off early this year.

The pilot program, running from January through June, completed investigations in 187 cases. Of those cases, 142 were determined to have some sort of fraudulent activity, including 79 percent of cases referred to SIU by social workers and 62 percent of random checks.

“They’re not based on misunderstandings, they’re clear and intentional fraud,” said Elizabeth Beck, chief investigator of the SIU

In 54 percent of cases, someone was entirely overstating their disability. In 21 percent, disabilities were partly overstated. Household compositions were misrepresented in 18 percent of cases.

In almost half of cases both providers and recipients were terminated from the program. Benefits were reduced for the 21 percent whose disabilities were overstated, and in 28 percent of cases providers were terminated while recipients remained eligible for IHSS.

Beck related three stories of fraud discovered by her unit, ranging from a provider who came one time for 10 minutes over the course of an entire month, to an individual who failed to report a husband capable of providing care. The SIU is preparing its first two fraud cases against violators, including a $17,000 claim against the woman whose husband could have cared for her.

While members of the audience agreed that fraud prevention was a worthwhile goal, the 20 speakers all disagreed with the way they said the SIU handles its investigations as they wielded signs reading “SIU – Stop Intimidating Us,” “Care not Scare,” and “Needing Homecare is not a Crime.”

Holly Yonan, who helps care for her mentally-disabled 51-year-old uncle, told of investigators who woke her uncle at 8:30 in the morning to interrogate him. They went through all of his possessions, she said, including his underwear drawer.

The ordeal was horrifying for the uncle, who locked himself in a restroom for four hours. Even today, he won’t go outside anymore for fear the investigators are hiding in the trees to take him away.

“This is a very unjust thing that they’ve done and they’ve punished him and they’ve punished me as well,” Yonan said. “… They did more damage to him than he is born with, and that’s not fair.”

Yonan’s tale wasn’t the only story of investigations upsetting IHSS customers. Others told of a 70-year-old diabetic, on oxygen, who had undergone three heart surgeries, who was told by bulletproof vest-clad SIU investigators that she didn’t deserve the hours she had been allocated. More claims arose of investigators who threatened to place IHSS clients into care homes. One individual, who cares for his mother, said he was recorded without his consent.

“Some of the stories you’ve heard here, I can understand some people might be frightened, but I can assure you that’s not how our employees go in,” said Christine Applegate, director of the county's Community Services Agency which oversees IHSS.

Beck said her staff conducts investigations in a “professional and respectful manner” with “no coercion or force.” Beck said SIU employees ask permission to enter a residence and leave if they are asked, though some speakers said the investigators misrepresented their reason for visiting.

Beck said that investigators were thoroughly trained to do assessments, though providers questioned their aptitude. The providers argued that, though someone can appear fine at a glance, they still may not be capable of caring for themselves.

Investigators meet with social workers before terminating providers or recipients, Beck said, and an appeals process exists for those who believe they have been wronged.

“I have to disagree with this letter we received today that says the investigators are threatening and harassing the people in this program,” said Supervisor Jim DeMartini. “I’ve been out with the investigators two times and this just is not the case.”

Supervisor Vito Chiesa said he had also gone out with the SIU and witnessed nothing but professionalism, though he did admit that investigators may act differently without supervisors present.

Before the supervisors finished their comments, the majority of IHSS providers left the auditorium as one yelled out, “Liars with no compassion.” Robinson later thanked those who stayed to the end and admonished the conduct of those who left in anger.

“The fraud unit has to continue, because we have to root out the fraud,” said Supervisor Bill O’Brien. “But let’s do it in the most dignified manner we can.”

To contact Alex Cantatore, e-mail or call 634-9141 ext. 2005.