This disturbing story from Kaiser Health news...
An Alaska man developed gangrenous toes. A Philadelphia woman froze to death on the street. An Illinois woman died emaciated, covered in excrement.
These individuals suffered as their government -paid caretakers neglected them, collecting paychecks under a Medicaid program that gives people who are elderly and those with disabilities non-medical assistance at home. In some cases, the caretakers convicted of neglect were the victims' own family members.
The Personal Care Services program, which exceeded $14.5 billion in 2014, is rife with financial scams, some of which threaten patient safety, according to a recent report from the Office of Inspector General at the U.S. Department of Health and Human Services.
The OIG has investigated over 200 cases of fraud and abuse since 2012 in the program, which is paid for by the federal government and administered by each state. These caretakers, often untrained and largely unregulated, are paid an average of $10 an hour to help vulnerable people with daily tasks like bathing, cleaning and cooking.
The report exposes vulnerabilities in a system that more people will rely on as baby boomers age. Demand for personal care assistants is projected to grow by 26 percent over the next 10years- an increase of roughly half a million workers- according to the U.S. Department of Labor.
The risks increase because the car takes place out of view in people's homes, and because neglected patients may not advocate for their own care.The OIG report describes a range of rip-offs, some of which involve caretakers caught up in the nation's opioid epidemic. In one Illinois case, a woman whose nursing license had been suspended for allegedly stealing drugs at work signed up as a caretaker. She billed Medicaid for $34,000 in caretaking services she didn't provide-including charges made while she was on a Caribbean vacation. In Vermont, a caretaker on probation for drug possession split her paychecks with the patient's wife- in exchange for stealing the patient's prescription painkillers, while he lay in visible discomfort.
In other cases, Medicaid beneficiaries colluded in hoaxes, faking disability so they could hire unneeded help.
In the worst cases, patients got hurt, sometimes fatally.
In Philadelphia, a 37-year-old woman with severe autism, froze to death on the street after her caretaker lost her in a crowded department store five miles away.
In some cases, elderly patients were neglected by their own children, who signed up for caretakers payments. In Idaho, a woman was hospitalized for severe dehydration and malnourishment after her son and caretaker neglected her. Investigators found the home they shared littered with drug paraphernalia.
In Illinois, a woman was found incoherent and covered in feces after her daughter and caretaker failed to show up for over a week. The patient, who lived crocheting and quilting, died seven months later at just 46.
Investigators provided no count of how many cases of fraud and abuse involved relatives, but it seems to be fairly common, said the OIG report.
In California, an investigation last year revealed widespread problems, as well as lack of training and oversight in the state's program, which is the largest in the U.S.In one disturbing Illinois case, a family member found a 62-year-old woman on the floor in her home- covered with feces, malnourished, with deep-bone ulcers and open wounds.
Her alleged caretaker, who herself had a disability, had billed Medicaid for six years using fraudulent names.
The negligence extended beyond the caregiver to the system, which failed to dig into the caretaker's criminal history. notice forged signatures or monitor the patient's well-being.
The inspector general's office, which has documented years of fraud and neglect in the program, urged federal action. The Centers for Medicare and Medicaid Services requires no standard training-nor background checks- for personal care attendants. Fraud can be hard to track, because many states don't register caretakers, or even identify the worker in Medicaid c;aims, the OIG report found.
In the report, the OIG called on CMS to establish national qualifications, including background checks, and ensure every claim identifies the worker and time of service. It also called on CMS to require states to enroll all personal assistants, so they can be tracked by unique numbers.
That's just what Alaska has done. It began requiring enrollment for personal care assistants in 2011 and now has 8,000 workers assigned unique identifying numbers, used with every claim.
The system helped investigators determine that Good Faith Services, a large home health care company in Alaska, was billing Medicaid for half a million dollar' worth of caretaker services never performed. Its workers made claims while they were out of the country, or after Medicaid benficiaries were dead. As part of a criminal prosecution that convicted 50 people, the company dissolved and its owner pleaded guilty to fraud. She was sentenced in 2015 to three years in prison, and ordered to pay $1.5 million in restitution and fines.
That case couldn't have been cracked without the state database of workers' identifying numbers. The system enabled the state to see that one caretaker billed over 24 hours of service in a day. Another caretaker purported to be in Anchorage caring for one patient, just two minutes after caring for another patient in a town an hour away.
In one case, investigators visited the home of a 63-year-old man with diabetes who had signed up to receive home help. The man told her that no help ever came- though a man would knock on his window and ask him to sign paperwork he didn't understand. Without a caretaker to bathe him, dress him and remind him to take medications, the man's diabetes intensified and he grew gangrene on his toes. The window=knocker, who had been falsifying time sheets, was later charged with fraud, as was his wife, who claimed to be the caregiver but never entered the home.
Alaska and Minnesota are among the states that now require caretaker enrollment . To detect impropriety, Illinois now requires personal assistants to call in at the beginning and end of each client visit; their phone calls are recorded in an electronic database.
Meanwhile, CMS is trying to strengthen the [program's integrity.Earlier in the year, CMS started training states to monitor fraud, waste and abuse. The agency also published a bulletin offering states several options, including creating a registry, where consumers could look up which caretakers meet state qualifications.
But disability groups have pushed back against stricter regulations, arguing they don't want to limit Medicaid beneficaries' access to caretakers. So CMS is treading lightly.
Instead of making background checks mandatory, CMS has granted $50 million to 26 states to set up background check programs.
And instead of requiring mandatory training, CMS has offered states the option of offering basic caretaker training-"without usurping beneficiary decisions on what skills are most appropriate for their business workers".
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