Saturday, June 12, 2010

New Emphasis On Prosecuting Fraud In IHHS, Med-Cal And CalWorks Programs: 9 Arrested In Los Angeles County

In Los Angeles County and California, there have been increased prosecutions for public benefits fraud. The Department of Health Services and the District Attorney's Office have targeted the In-Home Supportive Services (IHSS) Program since it is perceived that there is a significant amount of fraud by both the recipients (in failing to report all income) and the providers (many of whom are often family members or friends). CalWorks and Medi-Cal programs have also been targeted. The District Attorney's Office has a Public Assistance Fraud Division which specializes in these cases.

What is IHHS? IHSS provides services to persons who are over age 65, blind or have a disability to enable them to remain safely in their home.  IHSS lets family members and others to become providers and get paid for providing basic services (cleaning, cooking, laundry, shopping, etc.) to individuals who cannot safely perform their services themselves due to physical or mental incapacity.  Cal. Welf. & Inst. Code § 12300(a).  Basically, IHSS is an alternative for individuals who might otherwise be placed in a facility when they are unable to care for themselves in their own home.This is an excellent program which saves the state money in the long run since it is much less expensive to keep individuals in their own home than to pay for nursing homes.

Last year, there were grand juries in six California counties which pointed out the lack of safeguards to protect against fraud. In 2009, Governor Schwarzenegger contended that 25% of the IHSS program was fraud even though there were no real statistics to back up that claim. This has created a political climate where these programs will be targeted for fraud investigations. While no one endorses fraud, the government should be careful not to single out Californians who need assistance to live at home and the people who help them stay safe and healthy.

Recent Los Angeles County District Arrests

During the week of May 24, 2010, nine people were charged by the Los Angeles County District Attorney's Office as a result of investigations by the District Attorney’s Office, the Department of Health Services and the Los Angeles County Department of Public Social Services. Two of the cases involved alleged losses of $45,000 and $395,000 while the remaining seven cases were much smaller with losses ranging from approximately $700 and $15,500. Most of the smaller seven cases involved alleged IHHS fraud.

(1) Ms. Alicia Garcia, age 51 of Los Angeles was charged in case LASC Case No. BA370996 with (i) one count of false statements to receive healthcare, (ii) three counts of aid by misrepresentation and (iii) four counts of perjury by false application for aid. It is alleged that Ms. Garcia received more than $136,000 in welfare benefits from January 2002 to April 2010. During the aided period, Ms. Garcia allegedly failed to report her true income, ownership of property, vehicles and bank accounts and also failed to report a spouse in the home.

Ms. Garcia's bail was initially set at $45,000. It is the D.A.'s Office practice to initially set bail at the amount of the loss in a fraud case. The maximum punishment for these offenses is a maximum state prison term of nine years although sentences in these type of cases are generally much lower and probation is available even if there is a guilty plea. 

(2) Ms. Tangela Ridgeway, age 35 of Cerritos, allegedly received more than $60,000 in public assistance benefits from June 2004 to March 2010, and is accused of failing to disclose that she owned a business, property and several vehicles. Ms. Ridgeway allegedly failed to report employment, underreported income and failed to disclose bank accounts. In LASC Case No. BA371480, Ms. Ridgeway is charged with (i) one count of aid by misrepresentation, (ii) one count of perjury by false application for aid, and (iii) 14 counts of perjury by declaration. Ms. Ridgeway's bail was initially set at $395,000 - indicating a larger loss amount - and she faces a maximum term of 19 years in state prison which again is subject to negotiation between defense counsel and prosecutors.

In Ms. Ridgeway's case, the D.A.'s Office may have 1099 statements from employers and banks to substantiate its claims. For over 7 years, there was a lawsuit which precluded the County from receiving 1099 and W-2 information from the Franchise Tax Board in order to conduct audits. This issue was decided in favor of the County approximately two years ago and there are a number of audits being conducted to compare the 1099s and W-2 reports to what applicants reported to programs such as CalWorks, Medi-Cal and IHHS.

The loss attributed to the seven others charged ranges between approximately $700 and $15,500 from such public assistance programs as In Home Supportive Services and CalWorks. The majority of those arrested were participants in the IHSS system which permits providers to receive money for services to elderly or dependent adults.

Attorney Thoughts

If you or a family member are audited or asked to come in for an interview with any government program, you should consult a public assistance fraud attorney. If one receives assistance, there are a number of documents that are signed over time under the penalty of perjury. Similarly, if one is an IHHS provider, there are a number of timesheets that are completed over time. Even if you have received benefits, you still have your rights under the Fifth Amendment not to incriminate yourself. You should understand your rights and analyze whether there is any exposure before you meet voluntarily with government investigators.

Posted by Tracy Green, Esq.  Any questions should be directed to Tracy Green, a very experienced IHHS fraud attorney, Medi-Cal fraud attorney and California public benefits fraud attorney. You can email her at or call her at 213-233-2261.

The firm focuses its practice on the representation of licensed professionals, individuals and businesses in civil, business, administrative and criminal proceedings. They have a specialty in representing health care providers  in health care fraud and other types of fraud and overbilling allegations in California and throughout the country. Their website is:


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