Thursday, August 23, 2007

In New York City, Medicaid spending on home health care aides totaled $1.3 billion last year.

Can you imagine what is going on in the rest of OUR country?

Cuomo, Investigating Medicaid Fraud, Issues Subpoenas to 59 Home Care Agencies
August 21, 2007


ALBANY, Aug. 20 - Attorney General Andrew M. Cuomo issued subpoenas on Monday to dozens of agencies that provide home health care aides to Medicaid patients in the New York City area, saying preliminary evidence suggested that the home aide industry was rife with fraud.

Fifty-nine such agencies were sent the subpoenas, representing nearly all of those operating in the metropolitan region. The subpoenas mark the latest stage of a two-year investigation into the industry, begun under Mr. Cuomo's predecessor, Gov. Eliot Spitzer. That investigation has until now focused primarily on schools that train and certify the aides, and on vendors who contract the aides' services out to the agencies.

Mr. Cuomo's investigators are now 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.

"We're finding increasingly that home health care seems to offer crooks many opportunities to exploit loopholes and oversights in the regulations," Mr. Cuomo said in a news release. "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, did not respond to calls seeking comment. A spokeswoman for another, Revival Home Health Care, said that the agency had not received a subpoena.

Aides to Mr. Cuomo said the investigation had already found evidence of significant fraud among the training schools and the roughly 1,000 vendor companies that link the schools' graduates with the agencies. That part of the investigation began with tips from three anonymous sources about two vendors based in New York City. Based on those tips, law enforcement officials arrested managers, nurses and more than 20 health aides associated with one of the vendors, Borina Home Care Inc., on criminal and civil charges last December.

That and subsequent investigations uncovered a variety of abuses, a Cuomo aide said. 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. Some aides received no-show jobs but later caused Medicaid to be billed for their services. One vendor hired marketers to identify individuals who would qualify for home health services paid by Medicaid, the aide said, and then split any Medicaid billings for those individuals with the marketer.

It was unclear on Monday whether the investigation had unearthed any cases in which patients were harmed as a result of the fraud, but the Cuomo aide said investigators believed the potential for such harm was high. Aspects of the investigation were reported in The New York Post on Monday.

The Cuomo aide declined to name other vendors and schools under Mr. Cuomo's microscope, saying it might compromise investigations that were at various stages. The attorney general's office expects to recover as much as $100 million in fraudulent Medicaid billing when the investigation is concluded, the aide said.

Under an agreement reached with federal officials in 2006, New York must recover $1.6 billion worth of fraudulent Medicaid dollars over five years to help qualify for hundreds of millions of dollars in federal financing.

The president of the Home Care Association of New York State, a trade association for the agencies and the vendors who supply them with home aides, said that the association supported Mr. Cuomo's efforts to uncover fraud but that there was a danger that investigators would "inadvertently characterize nonfraudulent activities as fraud."

"Last year's budget deal certainly has put incredible pressure on the state to recover Medicaid dollars under the auspices of fraud," said the association's president, Joanne Cunningham.

Home health care is a fast-growing segment of the health care industry, as 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.

The agencies and their vendors are certified by the state's Department of Health, which also certifies the schools that train aides. But the schools themselves certify the aides as having completed the required training. Because there is no central registry for those certifications, state officials do not know how many home health aides are working in the state at any given time.

The Blue Cross and Blue Shield Association Press Room

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