Friday, April 18, 2008

“Medicaid fraud in all its forms remains a statewide problem, ....

ALBANY–The industry-wide Medicaid fraud probe of the home health care industry has expanded upstate with the issuance of 27 subpoenas to western and central New York home health care providers. In addition, the investigation, known as “Operation Home Alone,” has resulted in the conviction of a Buffalo area home health agency employee, Rochester area nurse, and Syracuse area licensed practical nurse.

“Operation Home Alone” is the Attorney General’s long-term and statewide investigation into fraud in the home health care industry, which is one of New York’s fastest growing industries. Thus far, “Operation Home Alone” has resulted in charges against more than 80 defendants, including patients, aides, nurses, instructors, and the administrators of licensed and certified home health agencies. Defendants convicted during the investigation have been ordered to repay nearly $14 million in restitution.

and my office will continue using effective approaches to weed it out in all corners of New York,” said Attorney General Andrew Cuomo. “My office’s ‘Operation Home Alone’ investigation into the home health care industry has led to prosecutions both downstate and up. Taxpayers throughout the State cannot continue to shoulder the burden of unscrupulous companies and individuals that put patients at risk and rip off all New Yorkers.” This week the Attorney General issued 27 subpoenas to certified home health agencies in the Buffalo, Rochester, and Syracuse regions. These subpoenas seek information about home health aides whose services were paid for by Medicaid, including personal information, verification of qualifications, and the names of the licensed home care service agencies that supplied the aides for which the certified agencies billed.

The subpoenas follow a series of enforcement actions in the three regions. In Buffalo, investigators from the Attorney General’s Medicaid Fraud Control Unit arrested Melody McKnight, 26, an employment recruiter for an in-home health care training and services company. Among other crimes, McKnight sold falsified Personal Care Aide (PCA) certificates and further offered to have sex with an undercover investigator for $200 at a Buffalo hotel.

On April 1, McKnight pleaded guilty to attempted forgery in the second degree and commercial bribe receiving in the second degree. She is scheduled to be sentenced on June 10.

The Attorney General’s Office recently convicted a Rochester area nurse, Adrian Clements, 39, of grand larceny in the fourth degree. As part of her plea, Clements admitted to submitting reimbursement claims that falsely represented that she provided home nursing services to 10 Medicaid recipients - including five children under the age of 10. These false claims allowed her to steal $70,785 from the Medicaid program. Clements was sentenced to five years’ probation, four months of weekend incarceration, and restitution in the amount of $70,785.

Also in Rochester, the Attorney General’s Office has convicted one nurse and brought related charges against three others. Suzan Sheldon, 41, along with licensed practical nurses Michele Schug, 33, and Monica Webster, 36, and registered nurse Anna Reid, 58, were arrested and charged with grand larceny for falsely billing Medicaid for the care of a young adult patient in Onondaga County.

At various times over a four-year period, all four defendants cared for the same patient, a young adult with cerebral degeneration and pulmonary collapse who requires around-the-clock home care nursing services. Although the patient’s parents provided up to 12 hours of care daily, the nurses routinely split up among themselves the billing for those hours. The investigation found nearly $250,000 in payments for services that were not rendered.

On April 11, Sheldon, pleaded guilty to grand larceny in the third degree. She is scheduled to be sentenced on June 20. Charges against Reid, Schug, and Webster are pending.

“In each of these cases we see a pattern of patients being subjected to deficient care and aides committing acts of fraud that rob taxpayers of their hard earned dollars,” said Cuomo. “My office is taking action to root out Medicaid Fraud in Buffalo, Rochester, Syracuse and across the entire state. I am committed to ensuring that New York’s seniors receive the care they need and preventing our tax dollars from being wasted by fraud.”

Because Medicaid reimbursement for home health services is very generous, the costs of the program are a serious taxpayer expense. Last year alone, Medicaid expended $33,513,547 in Erie County, $56,056,948 in Monroe County, and $17,071,458 in Onondaga County on home health care for Medicaid recipients. Every month, more than 150,000 New Yorkers receive some sort of Medicaid-funded home health services. In 2007, Medicaid spent approximately $3.8 billion on home health care statewide. Moreover, because these services are provided outside an institution and therefore cannot be supervised, the home health care program is particularly prone to fraud.

“Operation Home Alone” has so far exposed a statewide range of fraudulent practices and schemes in the home health care industry by home health and personal care aides, the schools that train them, and the agencies that recruit and employ them. The crimes and frauds include the sale and distribution of falsified certifications, aides working without proper training or certifications, no-show aides who split their payments with complicit patients, aides billing multiple agencies for a total of up to 36 hours in one day, and nurses and certified home health agencies billing Medicaid for services never provided.

Along with the rigorous enforcement of current laws through initiatives like “Operation Home Alone,” Cuomo has also called for a statewide registry of certified home health aides to be developed and maintained by the state Department of Health.

The registry would enhance the State’s ability to oversee the industry, provide potential employers with the ability to screen home health aides, and help to detect and deter fraud. A registry already exists for nurse aides that work in nursing homes. By creating a registry for home health aides, this bill would extend the same protections that exist in the nursing homes to care-dependent persons being cared for in their homes.

New Yorkers are urged to report cases of suspected fraud to the Attorney General’s toll-free Medicaid Fraud Hotline, at 1-866-NYS-FIGHT (697-3444). 4-17-08

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