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How Low We Have Sunk

by: stevefromsacto

Thu Jan 28, 2010 at 12:50:39 PM PST

(Steve's work with IHSS providers is critical for California's disabled. - promoted by Brian Leubitz)

A homecare provider from San Diego told legislators yesterday how she and her client--a qaudriplegic Vietnam veteran--were threatened and harrassed by a fraud investigator from the state.

Nancy Jo Riley of San Diego testified that she and her client were "randomly selected" for a fraud investigation last October as part of a new "anti-fraud" initiative by the state. According to Ms. Riley, the agent from the Department of Health Care Services (DCHS) first threatened in a phone call to cut off all IHSS unless she and her client met with him immediately. At the subsequent meeting, the investigator asked her and her client a long series of "humiliating" questions. He then said he could not understand why a person with a severe disability like his should be subject to a fraud investigation in the first place.  He also said that her client, whose hands are frozen in a fist-like position because of his disability, would "probably" be exempted from new fingerprint requirements for homecare consumers.

Several legislators expressed outrage over this intrusion, which Ms. Riley described as a "raid" and a violation of her Fourth Amendment rights against unreasonable searches and seizures. Her testimony came shortly after a representative from DCHS had denied at the same hearing that his department was conducting fraud investigations.

stevefromsacto :: How Low We Have Sunk
Committee chair Assembly Member Noreen Evans (D-7th) declared that no protocols or guidelines have been established for such anti-fraud investigations and that this home visit was possibly unwarranted and premature. She promisd a full committee investigation.

Ms. Evans also warned that without proper safeguards, individuals posing as fraud investigators could easily target elderly and disabled IHSS recipients for fraud and abuse.

The requirements for background checks for the nearly 400,000 IHSS homecare providers, fingerprinting for 450,000 elderly, blind and disabled homecare consumers, unannounced home visits by state and county agents, and other new regulations were enacted last July as part of the 2009-10 state budget agreement.  

The multi-million-dollar anti-fraud initiative resulted from claims by Gov. Schwarzenegger and his allies that fraud in the program was as high as 25 percent, even though every reputable study of the program has shown fraud rates of no more than one to two percent.

The Sacramento County District Attorney, who received more than $3 million from the state for anti-fraud efforts, reported last week that after four months her office had uncovered a total of 19 cases of fraud out of more than 42,000 homecare clients in the County.

We raid the homes of our most vulnerable citizens; we brand thousands of low-wage homecare providers as "fraud criminals"; we waste tens of millions of dollars to investigate widespread fraud that doesn't exist. All the while, white collar crimnals and crooked government contractors run free.

How low we have sunk!

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Acts like these (0.00 / 0)
Keep the fraud investigators out of the hair of corporations warehousing patients in deplorable conditions to maximize profits.

Great way to save money /snark

fraud (0.00 / 0)
I've done fraud investigations and background checks (It's kinda like muckraking journalism, except you get paid). So it's a jobs bill from my perspective at least.

That said, rule of thumb is about 3% of cases (and this is under condtions of regular investigation and auditing) are fraudulent. Which means for every scheme you uncover, you've bothered 32 random people. And some of those people are crazy protective of their privacy, or expected to be taken at their word.

On the other hand, only way to find that one scheme is to bother the 32. And with open-ended, to-the-grave outlays, that one fraud can cost in the 6 to 7 figures. So as unneighborly it might be, you figure that averaged out, hassling each person saves $15,000 or so, looks a bit more reasonable. Especially when the "hassle" basically consists of asking people questions about the free money they're requesting.

Disclosure: I'm awesome.

4th Amendment, Anyone? (0.00 / 0)
While I'm glad Teralloy put the fraud rate at 3 percent (that may still be high, but it's a helluva lot more accurate than Arnold's 25 percent), I think he's just a wee bit insentitive.

First of all, threatening a quadriplegic Vietnam Vet with the loss of his IHSS benefits is just a wee bit worse than "bothering" him, wouldn't you say?

Second, the 4th Amendment to the Constitution proects people against "unreasonable searches or seizures." So if you have a homecare client for which there is absolutely no probable cause that the person is defrauding the program, is it not "unreasonable" to demand entrance to that person's home?  Seems to me the 4th Amendment should protect homecare recipients against such "random" raids, when no probable cause exists.

Maybe the governor's anti-fraud scheme will turn out to be a "jobs program" for lawyers, eh?

[ Parent ]
the hinge is *unreasonable* (0.00 / 0)
@stevefromsacto -

That 3% figure was for programs that are investigated and audited - for a program that had gone without oversight up until this initiative, 25% is believable. For example, in the absence of auditing or oversight, the Long Island Railroad disability pension program had near 100% fraud, for example.

The sole saving grace there is that fraud on that level tends to be institutionalized - there are touts and crooked docs and ringleaders that need to maintain some visibility to keep drawing people into the scheme, so when you finally dedicate yourself to weeding it out you can go for a decapitation strike. But it's not a nice place to find yourself in in the first place.

And yes, the 4th amendment does bar unreasonable searches and seizures, but that certainly allows for reasonable ones, as prescribed by law, and I maintain that when someone who applies for free money on the basis that they are X, conditioning the money on their proving that they are in fact X is reasonable. (Case law agrees. There were some moves in the mid-20th century towards treating welfare and other benefit-granting programs more like you envision, with the government bearing more of the burden of proof. This was widely referred to as "The New Property" and was mostly walked back, largely because no one could figure out how to effectively prevent widespread fraud and abuse under those terms.)

Basically, this one guy's probably an asshole but honest. Most likely a guy who's been though an evaluation process before and expected that to settle things forever, who thinks of his condition as obvious and hasn't experience just how far dedicated fraudsters will go to maintain their fraud. Most likely found by a well-connected lawyer who wanted to challenge the program and went fishing for a sympathetic client who'll look good in court/press releases. (After all, look at you - it worked.)

Maybe there even is a way to accommodate him without accommodating fraudsters, by taking previous VA or workers comp determinations as dispositive (though for understandable incentive reasons, the VA tends to err against approving claims, and workers comp systems err according to which of a dozen stakeholders has the upper hand at the moment...) or whatnot. But just taking people at their word is an absolutely wretched idea; taking people at their word so long as they present at first glance as sufficiently noble, or pitiable, or otherwise "good people" is perhaps even worse.

(And yeah, he'll be exempted from fingerprinting if he can't, $50 says the case worker didn't have the protocol for that memorized and just defaulted to bureaucratic noncommittal.)

Disclosure: I'm awesome.

[ Parent ]
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