Last February, an Illinois woman was convicted in federal court of scamming a Medicaid program designed to care for the elderly in their own homes.
The woman, Ann Marie Sheppard, 55, of O’Fallon, Illinois, billed Medicaid for $35,168 worth of services that she never provided to her clients over a nearly two-year period, according to the U.S. Attorney for the Southern District of Illinois. Sheppard spent part of that time vacationing in Costa Rica and taking a Caribbean cruise.
As it turns out, this sort of rip-off of the multi-billion-dollar Medicaid Personal Care Services program administered by the states is fairly common, according to a recent Department of Health and Human Services Inspector General’s advisory report.
Indeed, the Inspector General’s office investigated more than 200 cases of fraud and abuse of the program since 2012 and came up with some alarming findings. In a home care industry that operates with little government oversight, the possibilities for cutting corners or outright fraud are great.
For instance, more than 50 people employed by a medical assistance agency in Anchorage, Alaska, took part in a conspiracy to bilk Medicaid out of millions of dollars by filing bogus time sheets for services not provided to elderly Medicaid beneficiaries. In some cases, they claimed payment for assisting deceased patients.
The owner of the agency, Agnes Francisco, 56, was sentenced to three years in prison and fined $1.5 million last December while many of her employees were hit with stiff penalties as well, according to media reports.
“With Medicaid growing rapidly and individuals increasingly receiving care in their communities rather than in institutional settings, effective administration of [personal care services] takes on heightened urgency,” the Inspector General said in the latest report. The IG said a lack of internal controls is an important issue, and that fraud will likely continue to be a problem.
The report doesn’t specifically quantify the extent of the fraud, and a spokesperson for the IG said she was unable to immediately provide an accurate figure. But it likely involves many hundreds of millions of dollars or more in a program that, according to Kaiser Health News, spent more than $14.5 billion in fiscal 2014.
As Baby Boomers continue to retire and attempt to remain in their homes for as long as possible, the demand for personal care assistants will grow by 26 percent or more over the coming decade, according to the Bureau of Labor Statistics. There are currently about 1.8 million caregivers who earn a median income of $20,980 a year providing seniors with such daily tasks as bathing, cleaning and cooking.
The inspector general’s office has repeatedly documented fraudulent activities in the program and has renewed its call for tougher standards, training and regulations of personal care assistants. A previous report by the IG released back in 2010 cited cases of fraud totaling $724 million.
The Obama administration for years has been wrestling with the problem of widespread Medicaid and Medicare fraud, which drains the government coffers of billions of dollars annually. But beyond the massive loss of revenue to unscrupulous health care providers, widespread fraud in the elderly home care program has also led to serious cases of negligence and abuse of the elderly.
The IG report documents numerous cases of seniors neglected by care givers and allowed to go hungry or lie in their own excrement. In some cases, seniors were neglected by their own children, who assumed responsibility as caretakers and billed Medicaid for their services.
In one case, a personal care provider in Vermont submitted bogus claims for 456 hours of service to an elderly man and then secretly split the payments with the patient’s wife in return for access to her husband’s prescription pain killers. An Idaho woman was hospitalized because of severe dehydration and malnourishment after her son, who had signed on as her caretaker, neglected her.
David Ceron, a special agent for the inspector general’s office in Washington, told Kaiser Health News that “it’s fairly common” for family members to be the ones neglecting or abusing seniors and the ones committing the fraud. KHN was the first to report on the IG’s latest findings.