Fraud Rampant In U.S Home Care Health Industry

by Medindia Content Team on Aug 23 2007 3:50 PM

Stating that the home aide industry is rife with fraud, U.S Attorney General Andrew M. Cuomo has issued subpoenas to dozens of organizations providing the same to Medicaid patients.

Fifty-nine such agencies were sent the subpoenas, representing nearly all of those operating in the metropolitan region of New York. The subpoenas are the latest stage of a two-year investigation into the industry. These moves began with Cuomo’s predecessor, Gov. Eliot Spitzer. Up till now, the search has focused primarily on schools that train and certify the aides, as well as vendors who contract the aides’ services out to the agencies.

Currently, Cuomo’s investigators are seeking to verify the qualifications of aides for whose services the agencies billed Medicaid, as well as the schedules for the hours they billed and the names of the vendor companies that supplied their services. Says Cuomo: “We’re finding increasingly that home health care seems to offer crooks many opportunities to exploit loopholes and oversights in the regulations.

The early stages of our investigation showed us where to look and gave us an idea of what we’d find. We continue to press deeper into the corruption plaguing the home health care industry, and will continue to prosecute wrongdoers at all levels of these criminal operations.”

Several of the agencies named in the subpoenas, including Excellent Home Care Services, Girling Health Care of New York, and Personal Touch Home Aides of New York, are not responding to calls for comments.

According to Cuomo, the search has already unearthed evidence of significant fraud among the training schools and the roughly 1,000 vendor companies that link the schools’ graduates with the agencies. It was seen that some of the training schools sold home health aide certification to individuals with no training. Under state law, home health aides must go through 75 hours of training at a school and 16 hours of practical training with a registered nurse.

Coming to money matters, the attorney general’s office expects to recover as much as $100 million in fraudulent Medicaid billing when the investigation is concluded.

Home health care is a fast-growing segment of the health care industry. Federal and state officials seek to reduce health spending by providing care to elderly patients in their own homes rather than at institutions. In New York City, Medicaid spending on home health care aides totaled $1.3 billion last year. About 54,000 city residents receive some sort of Medicaid-financed home health services, from help getting dressed in the morning to dressing wounds and other kinds of care.

Christy Johnston, vice president of the state Association of Health Care Providers, an organization representing 500 agencies, says her group welcomes the effort to root out fraud.

"If there are bad actors in the system, that doesn't do anyone any good," she was quoted. At the same time, she contends that the problem "is not as widespread as it's being made out to be."