The IHSS program is an excellent program in that it allows care to be provided at home and ultimately saves the State significant sums in hospital and nursing home costs. However, the programs which are administered by local counties -- even though funded by Medi-Cal -- are being more aggressive on combatting fraud and billing for services not provided. Audits of these programs have criticized IHSS for being an open door for fraud and abuse. Since most caregivers are family members, friends or someone known to the beneficiary this increases the risk for fraud.
We have had a number of cases where billing was done for the Medi-Cal beneficiaries while the beneficiaries were out of the United States. Sometimes those cases were referred to the County by Social Security because the beneficiaries collected SSI while outside of the United States. Other times the issues were raised by on-site visits or care provided by family members who worked full-time at other jobs. We have also had cases where the person providing the IHSS services were out of the country while the services were provided. Other cases have involved the IHSS provider collecting the funds and hiring someone else to perform the services. And other cases involved claims that the total hours billed were not provided.
There are a number of ways that the County can refer a case criminally but the case often begins with an investigation. In those cases, it is important to find legal counsel before any interviews or incriminating statements are made. We have prevented a number of cases from being filed when involved at the beginning of the investigation. There are times, for example, when the billing errors were a result of not understanding the rules of the program. There are other times when there are suspicions but the government does not have any evidence of the wrongdoing and will not unless there is a confession by the caregiver. Other types of cases with difficult facts can be handled better if there is a strategy at the beginning rather than the time of an arrest. The city council member in the case referenced above resigned from his position due to this arrest and the charges are still pending with an arraignment scheduled for October 7.
Posted by Tracy Green, Green and Associates, Attorneys at Law
213-233-2260; Email: tgreen@greenassoc.com
