A Report by UDW Homecare Providers Union
April 2011

Also See: UDW Response Letter to CDSS

Background

In July 2009, then-Gov. Arnold Schwarzenegger, joined by several county District Attorneys and staff from the Department of Social Services, held a press briefing in Sacramento. During the briefing, Gov. Schwarzenegger declared that there was a fraud epidemic in the In Home Supportive Services (IHSS) program and that the rate of fraud in the program was 25 percent or more. Following the press briefing, the Sacramento Bee accused the governor of: “Spouting misleading rhetoric about waste and fraud”, while the San Jose Mercury-News called his allegations: “phantom claims.”

Up until that time, every reputable study–including the governor’s own California Performance Review in 2007–had shown the rate of fraud in the program to be no more than one to two percent.

For example, in March, 2009, the California Senate Office of Oversight and Outcomes issued a report citing selected state and county statistics on numbers of fraud allegations reviewed and the amount of money recouped. These statistics typically revealed that only a small percentage of such allegations result in recovery of significant overpayments and relatively few result in substantiated fraud. For example, the OOO Report notes that, of 298 IHSS fraud referrals in Sacramento County over a several month period, only seven resulted in substantiated fraud, only two were sent to the district attorney, and no overpayments were recovered. In Fresno County, for the same period, the County “reviewed” 639 cases, only 58 of which were sent to the district attorney, with $106,000 recouped. It was not clear how much of the amount recouped was the result of “fraud” versus overpayments not due to intentional deception or misrepresentation.

Nonetheless, the governor was able to force the State Legislature to appropriate more than $10 million in the 2010-2011 state budget for an IHSS “anti-fraud” program. This included mandatory fingerprinting of all IHSS recipients and providers, unannounced home visits by fraud investigators, and an orientation video for providers that looks more like something from “America’s Most Wanted” than vital information for caregivers.

In the months that followed, counties were given the opportunity to request anti-fraud funds from the state. While not all counties submitted proposals for anti-fraud programs, several–such as San Diego, Stanislaus and Sacramento–unveiled ambitious initiatives. Stanislaus, for example, created its own Special Investigations Unit to target IHSS fraud in that county. It is important to note that these counties started their programs even though the state protocols and guidelines required for these programs under the state’s anti-fraud law have never been established.

Since that time, UDW and other organizations representing IHSS recipients and providers have received reports of harassment, intimidation, threats and other examples of abuse toward elderly and disabled individuals by anti-fraud investigators. These incidents were similar in at least two respects: 1) many investigators carried firearms and/or wore bullet-proof vests; and 2) investigators treated recipients as if they had already been proven guilty and repeatedly threatened to cut off their IHSS services even though no proof of fraud had been found. (We believe it is no accident that many of the worst abuses have taken place in counties that launched anti-fraud programs without the proper protocols and guidelines.)

Examples of Abuse

Testimony by IHSS provider before Assembly Budget Committee, January 2010:

Michael Condon, a quadriplegic Vietnam veteran from San Diego, was “randomly selected” for a fraud investigation in October 2009. His provider of more than 25 years, Nancy Jo Riley, testified before the Assembly Budget Committee in January 2010 that Mr. Condon was threatened with termination from IHSS unless he met “immediately” with a fraud investigator from the state Department of Health Care Services.

Ms. Riley said that the investigator asked her and Mr. Condon a long series of “humiliating” questions. He then said that he could not understand why people with a severe disability like Mr. Condon should be subject to a fraud investigation in the first place. He also said that Mr. Condon, whose hands are frozen in a fist-like position because of his disability, would “probably” be exempted from new fingerprint requirements for IHSS recipients.

Then-Assembly Budget Committee Chair Noreen Evans declared that the visit to Mr. Condon by the fraud investigator was “unwarranted and premature,” noting that no protocols or guidelines for such home visits had been set up.

Excerpt from Modesto Bee news story, Sept. 1, 2010:

“In testimony before the Stanislaus County Board of Supervisors, Linda Ibrahim of Modesto and daughter Holly Yonan described a relative with Down’s syndrome who became terrified after he was awakened by agents who ‘stormed in’ and searched his bedroom, Yonan said. The 51-year-old man urinated on himself, then locked himself in a bathroom, wouldn’t come out for hours and now awakes in fear at all times of night and is afraid to leave the house, they said….’It was a horrible experience,’ Ibrahim said. “We’re not criminals. We’re decent people…”

Report by UDW Homecare Providers Union of Complaints against Stanislaus County Fraud Investigators, October 2010: 

“Lilly Sarkizi from Turlock is a care provider who takes care of her mother, her stepfather and another gentleman who was referred to her by a friend. She testified that she and her clients have been investigated four times by members of the Stanislaus County Special Investigations Unit. Investigators called her a ‘liar’ and said she and her clients were “cheating the government”. Lilly stated that her mother has breast cancer and is a diabetic. Even though her mother cannot raise her arm because of her cancer, an investigator demanded that she raise her arm over her head. Because her mother uses a walker to get around, an investigator told her that she does not need assistance and can do her own work…. She also testified about another IHSS recipient, an 86-year old man who the investigators also accused of cheating the government and threatened with jail. He was subsequently hospitalized because he was peeing blood, she said.”

“Roney George of Riverbank provides care for both his parents. He testified that in the past 18 months, his parents had their IHSS hours reduced five times, only to have them restored prior to the appeal hearing. He said that SIU investigators contacted his neighbors and asked them what Mr. George did for a living. When the investigators spoke to Mr. George, they first said that they were making a “random” visit. However, they later told him that he had been referred to the unit because of alleged fraud. The hours for Mr. George’s parents were subsequently reduced again and he appealed again. At the hearing, the hours were restored because, according to Mr. George, the judge found the evidence given by the SIU investigator and the social worker to be false.”

“Ron Halseth of Hughson testified that his client was told by SIU investigators that they “had the authority to put him in a nursing home.”

“Donald Smith of Modesto is an IHSS recipient. He has sclerosis of the liver (and is on the liver donor list) as well as severe arthritis in his hands and toes. He has had five knee surgeries. His doctors have told him that he must get some exercise. However, because of the activities of the Special Investigations Unit, he stated that he and his wife (who is his caregiver) are afraid that he will lose his IHSS services if he is seen exercising.”

“In addition to these complaints of abuse, these unannounced SIU raids have also resulted in the arbitrary reduction of homecare service hours based on claims of “fraud” as defined by the county. Administrative law judges have subsequently overturned some of these hour reductions due to lack of evidence or improper procedures. Many others are being appealed. Under the law, IHSS hours can only be reduced after an independent evaluation by a trained social worker. Fraud investigators cannot arbitrarily reduce IHSS hours.”

Summary by UDW Regional Director Yesenia Decasaus of discussions of Kern County IHSS fraud investigations at labor/management meetings between UDW and Kern County officials, October-December 2010:

“Kern County officials explained that the county’s IHSS anti-fraud task unit includes two investigators, one of whom is armed. Two of the methods of investigation being used are unannounced visits (referred to as ‘routine checks’ by the county) and secret surveillance. Officials confirmed that IHSS recipients and providers are being secretly watched. However, they did not provide details on how cases were selected for investigation.

“UDW stated that it has received calls from Kern County providers claiming that county officers are parked outside their houses conducting surveillance. County officials refused to explain how they target individuals for surveillance or how they document such surveillance. They did say, however, that any allegations of fraud are referred to the anti-fraud unit and that cases will be submitted for criminal prosecution at the discretion of the anti-fraud unit.

“County officials defended their methods by pointing out that the new state anti-fraud law required ‘surprise visits’ to IHSS recipients and providers. UDW responded by noting that 1) secret surveillance is not mandated by the new state law; 2) unannounced visits are authorized but are not required under the new law; and 3) the new law requires that county programs be run according to state anti-fraud protocols, which have not yet been issued.

“UDW argued that it is intrusive to conduct secret surveillance of providers when they are not working and that a due process procedure is necessary if a provider is involved in an investigation or being accused of fraud.

“Kern County claimed that UDW providers are not entitled to Weingarten Rights in these investigations; UDW strongly disagreed.”

Statement of Sana Hanna, IHSS recipient from El Cajon, CA. Ms. Hanna is a paraplegic; she was shot during an attempted robbery and carjacking: 

“On Wednesday, Aug 12^th, 2009, Eileen Bogard, Public Assistance Investigator with the office of San Diego County District Attorney Bonnie M. Dumanis, came to my home with two other people.

She asked my niece and nephew “who are you?” They told her, “We’re from Michigan; we came to visit my aunt.” She looked at my sister and asked her the same thing. My sister said, “I’m here to visit my sister.”

She then entered my bedroom and asked me questions about my husband, asking if he was living here. I told her that he wasn’t—that he had left me.

She said, “I just came from the welfare department. Who fills out your monthly report?” I told her, “Anybody who can read and write will help me fill out the report because I can’t read or write.” She asked, “Who are these people who help you?” I told her there are different people that help me from time to time.

She asked me if she could look in the closet and I said yes. She and the other two looked in the closet. She asked me, “Whose clothes are these?” I said, “Mine.”

Then she asked me for the telephone number of my provider, and I gave her the number. She asked, “Where is he?” I said, “He’s not here–it’s 9 o’clock. He had something to do.”

Then she asked me again about my husband. “Your neighbor hasn’t seen your husband?” “No they haven’t,” I replied. Then she asked me about my son. She wanted to ask my son about my husband. She then said something to the other two people and I couldn’t hear what they were saying; I was so scared that I started to shake real bad. Finally, she said, “We’re leaving.”

She called me on Monday, August 17^th and asked me about my (IHSS) provider. “I want to see your provider—I can’t reach him. Where is your provider? I want to talk to him.” I told her, “My provider can’t speak English.” She said, “What language does he speak?” “Chaldean,” I told her

She came over at 10:43am. She came to my bedroom again, by herself this time, and didn’t bring an interpreter. The man I was interviewing to be my new provider was in the room talking to me in Chaldean. She was very angry. She asked him if he was Muhamad, my provider. I said, “No he’s not—I’m interviewing him to be my future provider.” She asked him for his ID. He didn’t understand what she was saying because he doesn’t speak English. So I spoke to him in Chaldean and he said he doesn’t want to give the ID to her because, “I’m only here to help Sana”. She told me to tell him that if he didn’t show me his ID, she was going to take him to the police and put him in jail.

He then told me that he wasn’t going to do the job (of being a provider for me) because he was too scared. “She wants to take me to jail—why does she want to take me to jail?” he asked me. So I asked her, “Why do you want to take him to jail?” She replied: “I’m not going to answer any questions unless I have his ID.”

“Are you going to do something to him?” I asked. She said she was going to check with immigration for his identification. She asked me to ask him for his social security number, if he’s married, where he lives and how many kids he had. I was shaking so badly. I kept telling her that he was just here to be interviewed to be my future provider. She wrote down the information.

My new provider tried to go to the bathroom, but she wouldn’t let him past her. She pointed to his pants and said, “You have something here—it’s your wallet. Open your wallet right now.” . She still wouldn’t let him go until he opened his wallet. She wrote down the information from what was in his wallet.

She told me over and over again that I was a liar and that she didn’t believe me. I was so scared that it felt like I was having a heart attack. She was very mad and disrespectful and intimidating. The reason I’m in this wheelchair is that I was shot from an attempted robbery and carjacking. This whole situation has been very stressful to me.

Statement by Richard Lawrence, union representative for IHSS home care provider Miriam Infante of San Diego, who witnessed a visit by fraud investigators to Ms. Infante’s home:

Miriam Infante is a provider on the registry with two clients. The investigators had previously investigated one of her clients for possible fraud. Miriam had received a letter from the registry removing her from the list of eligible providers. She contacted me and we filed a grievance to reinstate her to the registry. After we filed the grievance, the Public Authority informed me that she was being investigated. Miriam received notification that the investigators were coming to her home to ask questions.

I was present the day the investigators came to her home. The investigators were very intimidating upon entering her home. They told her that the interview was with her and they did not want a union representative there. At this point I asked if she had a right to have someone there. They allowed me to sit in, but told me I could not say anything. They proceeded to bombard her with questions, showing her pictures, accusing her of fraud by claiming hours she did not work, neglect, and not reporting abuse. Miriam was very upset and was on the brink of tears when I interrupted the interview as her union representative. After much arguing between me and the investigators, they concluded the interview and said that they would file a report. Approximately a month later, Miriam received a letter from the Public Authority reinstating her to the registry and clearing her of any wrongdoing.

This was my first experience in observing one of these investigations. I found the way the investigators approached Miriam to be very disturbing. They were very intimidating and very accusatory. I feel that if I had not been there, Miriam would have been reduced to tears and may have admitted to things she did not do because of the extreme pressure they had put on her.

Example of Wasted Resources

Purchase of military/security cameras for IHSS anti-fraud campaign:

In March 2010, the Schwarzenegger Administration announced plans to purchase up to $5 million worth of military/security camera systems to photograph IHSS recipients and providers. These “MorphoTrak” cameras have been used in Iraq and other military locations. According to their manufacturer, they are also recommended for, among other things, “border crossings, gang enforcement, and airport/maritime security.” The camera itself costs $4,200, plus hundreds of dollars more for docking stations and other equipment. http://www.morpho.com/MorphoTrak/MorphoTrak/mt_products.html

The State Legislature never authorized photographing recipients as part of the anti-fraud campaign, nor did the Administration prove how the photographs will help stop fraud. As the Sacramento Bee noted in an editorial slamming the camera purchase:

“In the welfare realm, fingerprints and photo IDs are used primarily to prevent duplicate fraud, cases in which aid recipients go to different counties and apply for welfare or food stamps under different names. IHSS services are delivered in recipients’ homes. It’s hard to conceive of an elderly frail or disabled IHSS recipient traveling from Sacramento to Yolo to apply for help bathing or feeding him- or herself at two different addresses.”

Despite sharp criticism from legislators, the media and the homecare community, the Administration borrowed several of these devices from the manufacturer and solicited Sacramento and San Diego Counties to use them in a pilot project beginning in April 2010. The District Attorneys in these two counties have been among the strongest proponents of the administration’s anti-fraud campaign.

Each $5,000 used to buy a “MorphoTrak” camera would purchase nearly 500 hours of IHSS homecare.

Putting IHSS Fraud in Context:

While Gov. Schwarzenegger’s political allies and some ambitious District Attorneys have continued to raise the specter of “massive” fraud in IHSS, there has never been proof of this.

Indeed, this excerpt from an analysis of Senate Bill 930 (Evans) released on April 26^th of this year helps put the issue in context:

“Because federal participation in the cost of IHSS services comes through the Medicaid program, and because DHCS is California’s single state agency for Medicaid, the unit charged with investigating reports of suspected fraud in the IHSS program is located within that department. Counties are instructed to refer cases of suspected fraud to DHCS for further investigation….

“DHCS reports that in June of 2010, there were 447,635 recipients of IHSS and 405,328 active providers in the program. During the fiscal year, the department:

• Received 2458 complaints (0.5 percent of the number of recipients)
• Made 347 unannounced home visits in response to complaints
• Opened 193 criminal investigations
• Closed 107 criminal investigations with no action
• Referred 51 complaints to the Department of Justice (0.01 percent of the number of recipients)
• Referred 577 complaints to other agencies (0.13 percent of the number of recipients)
• Initiated recovery of funds in 70 investigations

Similar results can be found at the local level. For example:

A report by the Sacramento County District Attorney’s Office last Fall claimed to have uncovered more than 60 cases of IHSS fraud, saving the county more than a million dollars. However, County Supervisor Roger Dickinson was not impressed. According to the Sacramento Bee, Dickinson “pointed out that the number of cases of fraud and the amount saved is miniscule when compared to the overall size of the program.” The money allegedly saved represents less than one percent of the total cost of the program, he said.

Dickinson said that the figures reported by the DA’s Office “would seem to refute the argument made by those who assail IHSS—often those on the right seeking to slash the program—which is that as much as 25 percent of the costs of the program go to fraud. These numbers don’t even start to scratch the surface of that figure,” he said.

Related:

• UDW Response Letter to CDSS
• Sacramento Bee: State should respect rights of IHSS clients
• Feedback from IHSS Fraud Stakeholder Meeting in Sacramento: Consumers and providers cite abuses by fraud investigators; demand a direct say in shaping anti-fraud protocols
• IHSS advocates push back on plans for unannounced home visits  
• UDW Blasts IHSS Anti-Fraud Program as Duplicative, Wasteful and Abusive 
• UDW Co-sponsors Repeal of Enrollment and Fingerprinting Requirements