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Extracted from Consolidated Report

This investigation was originally published as part of a larger consolidated report containing multiple investigations. View the consolidated PDF for the complete document.

Fresno County Grand Jury • 2004-2005

The In-Home Supportive Services Program

Published: June 23, 2005 7 pages
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Findings 25 findings

F1 Page 66
Sweeping, dishwashing, changing bed linens
F2 Page 66
Meal preparation, laundry, grocery shopping
F3 Page 66
Paramedical services ordered by a licensed health care professional
F4 Page 66
Non-medical personal care
F5 Page 66
Assistance with transportation
F6
Protective supervision C. Services IHSS does not pay for:
F7 Page 66
24-Hour care and supervision
F8 Page 66
Routine outdoor work or gardening
F9 Page 66
Clean-up after pets, visitors and family members
F10 Page 66
Moving or lifting heavy furniture, etc.
F11
Mileage D. Until the formation of the IPW, RP services could be domestic only and performed only by a parent of a minor child or a spouse. PCSP services could not be domestic only nor performed by the parent of a minor child or a spouse E. With the passage of the IPW, the PCSP will now cover domestic services only and/or protective supervision services only when these services are not provided by a parent of a minor child or a spouse. F. There are numerous serious problems with the PCSP program which need addressing.
F12 Page 66
The number of hours worked by providers; as reported on the time card, cannot be verified by IHSS
F13 Page 66
Social worker approved services performed by the provider cannot be verified
F14 Page 66
Providers and recipients may not fully understand the consequences of fraud 47
F15 Page 67
IHSS time cards do not address fraud and its consequences
F16 Page 67
There is no county registry of providers or recipients convicted of fraud
F17 Page 67
Providers convicted of fraud are removed from the program, whereas recipients are allowed to remain in the program with no consequences
F18 Page 67
There has been limited training of social workers to detect fraud
F19 Page 67
The commission of fraud is still unchecked in the PCSP within IHSS system G. Since its inception in July 2003, the newly formed fraud unit in the District Attorney’s Office has had 401 cases referred for investigation for fraud, with 166 cases completed. Of these, 113 cases were referred for prosecution resulting in 60 convictions for restitution. H. In this same time frame:
F20 Page 67
There has been an estimated $713,219 in losses resulting from fraud
F21 Page 67
$432,205 has been ordered to be paid in restitution I. There are only two investigators assigned to handle IHSS fraud. J. Investigators lack adequate surveillance equipment. K. The first training session for social workers to better detect fraud, held in March of this year, had an immediate result of 85 cases being referred to the fraud unit of the District Attorney’s Office. L. The doctor’s referral/evaluation form does not address the specific needs of the recipient. M. There are 55 social workers in the PCSP. Of these, 42 are assigned to monitor the 11,839 recipients and 13 social workers are assigned to intake services. N. Social workers are only required to visit assigned recipients once a year according to state regulations. O. Social worker’s ability to make unannounced visits is limited by a heavy caseload P. The cost of providing in-home services is projected to increase 21% annually in Fresno County. Q. The statewide cost of IHSS for PCSP’s initial year (1993/1994) was $232 million. The cost for PCSP in 2003/2004 was $1.4 billion. R. The cost in Fresno County for the first six months of the current fiscal year was budgeted for $52 million and the actual money spent was $63 million. An increase of 21% over budget. S. Fresno County authorities estimate that fraud is committed by 30% to 35% of the recipients/providers in the program. T. Providers are not required to be trained to meet the specific needs of the recipient. U. The Fresno County Board of Supervisors established the Public Authority in 2002, in accordance with Assembly Bill 1682 passed in 1999. The purpose of the Public Authority is to:
F22 Page 68
Serve as the provider’s employer of record for wage negotiations and benefits
F23 Page 68
Furnish a provider registry
F24 Page 68
Offer provider and recipient access to training
F25
Perform provider background checks V. Recipients are not required to use Public Authority trained providers. Providers are not required to be registered with the Public Authority. W. Recipients select and employ the provider of their choice, making them the employer of record. X. There are approximately 10,000 IHSS providers in Fresno County with less than 10% having been hired through the Public Authority process. Y. The State of California’s primary function is to disburse payments to the providers for services rendered. Z. According to IHSS statistics, over 60% of care providers are relatives. AA. Neither the State of California nor Fresno County require criminal background checks for providers. BB. The Public Authority is the only entity that performs background checks on providers, and does so without State funding. CC. A medical doctor’s statement of the medical and/or physical needs of a recipient is not required for a social worker’s assessment of the recipient. DD. Many of the recommendations made by the 2003/2004 Fresno County Grand Jury, relative to fraud, were not adopted by Fresno County on the premise that they were not required by the State of California. CONCLUSIONS A. The use of timecards in the In-Home Supportive Services (IHSS) program lacks adequate oversight and leads to fraud. B. IHSS forms, including time cards, are not specific to enable the detection of fraud. C. There is no admonition on the time cards relative to the consequences of fraud. D. Social workers only recently have received training to better detect fraud. E. The first training session for social workers to detect fraud had immediate positive results with 85 referrals being made to the fraud unit. F. Providers and recipients need to be given training addressing fraud and its consequences. G. Until tighter controls are implemented in the PCSP, fraud will continue at the expense of the taxpayers. H. Social worker’s heavy caseloads limit their ability to visit recipients more than once each year and to properly monitor recipients continuing and changing needs. I. Social workers are limited in their ability to make unannounced visits to recipients. J. There is an insufficient number of fraud investigators assigned to the IHSS. K. Fraud investigators lack sufficient surveillance equipment to carry out fraud investigations. L. The commission of fraud continues to be prevalent in Fresno County. M. Specialized training of care providers is not required by State law and County ordinance. N. Recipients are not required to employ Public Authority trained providers. O. The State of California and Fresno County does not require background checks of providers. P. The Public Authority is the only public entity that requires and provides criminal background checks on all registered providers. Q. There needs to be a County master registry of IHSS providers or recipients convicted of fraud. R. The medical doctor’s referral/evaluation form needs to address the specific needs of the recipient to be performed by the provider. S. The fraud unit in the District Attorney’s Office is a valuable tool that will begin to pay for itself and the monies recovered in restitution.

Recommendations 13