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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.

Los Angeles County Grand Jury • 2007-2008

In-Home Supportive Services Fraud: Problems and Opportunities

Published: May 29, 2008 24 pages
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Findings 16 findings

F1 Page 77
When a person obtains Supplemental Security Income (SSI) benefits, he or she is assumed eligible for IHSS assistance. The District Attorney contends that if the Department of Public Social Services determines that the person has assets which would make him/her ineligible for SSI, the DPSS caseworker does not notify the Social Security Administration of these findings. However, in the Grand Jury’s discussions with executive management from DPSS, we were advised that all sixty existing field offices do in fact have a liaison person who contacts the Social Security Administration and advises it of a recipient’s possible ineligibility for SSI and other issues of concern, to the extent allowed by current privacy laws. It should also be noted that SSI recipients must report their annual income at telephone number 1-800-772-1213. Reference can be made to Social Security Publication SSA-4926-SM (January 2008). Supplemental Security Income (SSI) is not the same as Social Security benefits paid to those age 62 and over.
F2 Page 77
DPSS collects time sheets which are supposed to be signed by the IHSS aid recipient and the aid provider. Information from that time sheet is forwarded to the State of California, and a state warrant, made payable to the aid provider, is prepared. DPSS keeps the time sheets, but has no filing system for easy retrieval of these important records, which are often required by the district attorney in the prosecution of fraud cases. DPSS executive management concedes this is a problem, due to the enormous amount of paperwork received per month (over 300,000 time sheets) by the Central Time Sheet Processing Operation, and the current system of filing, which is by manual batching. DPSS is holding off on a more efficient, automated approach to this filing - 69 - 2007-2008 Los Angeles County Civil Grand Jury Final Report system due to a pending upgrade to the state’s computer system, which will hopefully address some of the inefficiencies of manual processing.
F3 Page 78
When a person applies for IHSS assistance, a medical verification of the person’s physical/mental/medical condition is required to be prepared and signed by a medical doctor. Without validation, the process as it currently exists is subject to fraudulent use and/or signature forgery.
F4 Page 78
Cases have been identified by the district attorney wherein care providers are allegedly providing aid under different names and fraudulently collecting benefits. Cases have also been identified wherein aid recipients are allegedly receiving aid under different identities.
F5 Page 78
DPSS administers various federal and state-funded aid programs at the county level, including General Relief (welfare), CalWorks, Food Stamps, Medi-Cal, and IHSS. The district attorney has identified a number of cases where benefits from one program would reduce or eliminate eligibility for another program, and contends that DPSS computer databases do not “talk to” one another, so inter-program opportunities for fraud abound. - 70 - 2007-2008 Los Angeles County Civil Grand Jury Final Report
F6 Page 79
Neither the State of California nor the County of Los Angeles conducts a criminal background investigation on the provider of IHSS services. Since the recipient has carte blanche to choose a provider, but cannot conduct a background investigation, the county is in a position to do so on behalf of the recipient.
F7 Page 79
Reassessments of the recipient’s need for continuing IHSS care are not done in a timely and systematic manner.
F8 Page 80
Personnel of the Los Angeles County Department of Public Social Services (DPSS) are not always qualified to assess the kind and intensity of the care required, which is roughly analogous to Medicare’s definition of “custodial care.” Among the chief determining criteria for receiving IHSS is the requirement that but for this program, the recipient would require out-of-home placement. Quoting from the County Welfare Directors Association (CWDA) report entitled In-Home Supportive Services: Past, Present and Future, January 2003: “The IHSS program is based on a social model – one that relies on a social worker assessment rather than assessment based on medical criteria. As such, caregivers are not medical personnel, nor are the social workers and, obviously, the consumer… “Quality of care is dependent on the caregivers qualifications and job satisfaction and how accurately the social worker’s assessment of the consumer’s need comports with the consumer’s actual supportive service needs.” Recipient need assessments have a significant subjective component, influenced by the personal bias of the social worker, personality interactions, and the innate desire to be charitable. DPSS also realizes that the initial assessment home visit, reassessment visits and scheduled visits are sometimes stage-managed in order to draw the maximum benefit of the program. The attempted reassessment via repeated random visits, to a supposedly housebound recipient who is never home, should be a cause for concern.
F9 Page 80
As an alternative to personalized, in-home care, electronic home monitoring could be made available for those recipients who neither want nor require personal contact. - 72 - 2007-2008 Los Angeles County Civil Grand Jury Final Report
F10 Page 81
Providers of in-home care complain that they are not getting paid by the recipients of in-home care. Conversely, recipients complain that the providers are not providing the level and/or quality of care for which they are being paid from IHSS funds. In some cases, time cards have been forged or altered.
F11 Page 81
Initial fraud referrals are supposed to be sent to DPSS headquarters. However, in some cases, DPSS employees attempting to report suspected IHSS fraud have been met with responses ranging from apathetic to hostile on the part of district office supervisors and managers. Reports of suspected fraud, forwarded to DPSS headquarters, are not followed up on with the employees who initiated the reports; in essence, a lack of feedback. Senate Bill (SB) 1104 grants jurisdiction for IHSS fraud investigations to the Department of Health Care Services (DHCS), formerly known as the Department of Health Services. Specific provisions contained in SB 1104 created fraud detection and quality assurance protocols, adherence to which is not optional.
F12 Page 81
An Affidavit of Support, U.S. Citizenship and Immigration Services Form I-864, must be submitted by those who are sponsoring foreign nationals under the family- - 73 - 2007-2008 Los Angeles County Civil Grand Jury Final Report based immigration system. Furthermore, the Affidavit of Support is required in certain employment-based immigration situations. Section 213a of the Immigration and Nationality Act (Title 8 CFRs) creates a legally enforceable contract between the sponsor(s) and the foreign national. The Act also creates a legally enforceable contract between the sponsor(s) and the federal agency or any state agency which may provide means-tested public benefits to the sponsored immigrant. Implemented in 1996 to ensure that foreigners do not become public charges after admittance to the U.S.A., the Affidavit of Support requirement must be satisfied in order for many foreigners to ultimately obtain legal permanent residence. The Affidavit of Support terminates once the sponsored immigrant “naturalizes” or when credited with 40 qualifying quarters of work as defined by the Social Security Act. Form I-864 and I- 864A data may be disclosed to other federal, state and local agencies providing means- tested public benefits for use in any civil action against the sponsor(s) for breach of contract. Social Security numbers may be verified with the Social Security Administration. It may also be disclosed as a matter of routine use to other federal, state, local and foreign law enforcement agencies to enable these entities to carry out their law enforcement responsibilities.
F13 Page 82
The Earned Income Tax Credit (EITC) is a refundable federal income tax credit for low- income working individuals and families. It is not a tax rebate, but rather a federal subsidy. In addition, the EITC has no effect on certain welfare benefits; the EITC will not be used to determine eligibility for Medicaid, SSI, Food Stamps, Section 8 housing or most payments of temporary assistance for needy families. The EITC is based on a past and an anticipated calendar year of income. Applicants must file a federal tax return and have a valid Social Security number. Full details are contained in IRS Notice 797 and Form W-5.
F14 Page 83
Although the Los Angeles County Civil Grand Jury cannot comment upon or review State of California operations, the successful and professional local administration of IHSS is dependent upon state databases. The state’s and Los Angeles County’s Department of Social Services computers and software must handshake and exchange data, primarily with the following: • State Medi-Cal Eligibility Data System (MEDS) • Income and Eligibility Verification System (IEVS) There is no longer a demarcation between county and state functions; we live in a virtual world. Even checking a person’s federal Supplemental Security Income (SSI) status requires DPSS to go through the state systems to obtain Social Security Administration data. Obviously, Los Angeles County DPSS is at the mercy, interest and competence of state agencies, particularly the California Department of Social Services (CDSS) and California Department of Health Care Services (DHCS). Providers and recipients of IHSS services sign and submit a biweekly timesheet which is ultimately processed by the state, the payment warrant is issued by the state, and fraud investigation is within the purview of the state. The acceptance of scrawled or absent signatures on the timesheet does not constitute good management of a multi- billion dollar program such as IHSS. Dual endorsement of the payment warrant would definitely be a good business practice.
F15 Page 83
The Advance Pay feature of IHSS is reportedly abused, particularly by the recipient receiving “advance pay” for weeks and months without submitting a time card in support of that pay.
F16 Page 84
A member of the 2007-2008 Civil Grand Jury, a past service provider in the IHSS program, was approached by an IHSS employee to sign up to take other recipients. All the member had to do was give the IHSS employee permission to re-use the member’s provider information, which was already in DPSS files, and periodically sign papers. For this, the member would keep one-half of each check / warrant, and yield the other half to an associate of the DPSS employee. The grand jury member was subsequently approached by someone who was not a county employee, but offering a similar scam. He told the member that “…lots of people are doing it.” Needless to say, the current grand jury member emphatically refused both offers.

Recommendations 16