Myths vs. Facts in Social Service Programs

MYTH: “Grand juries in six counties have found that the program has no safeguard against fraud. Care providers are able to collect state checks under aliases, and some providers bill the state for far more hours than they worked – with no oversight.” (Op Ed, 7/3/09)

FACT:

The IHSS Program has numerous safeguards against fraud, including a state and county-level IHSS Quality Assurance (QA) Initiative enacted in a bi-partisan agreement in 2004. Counties have dedicated QA staff performing desk reviews and home visits of recipients and providers, according to state-established guidelines, looking specifically for potential fraudulent activity and adequacy and quality of care issues. In addition to these reviews, the counties perform more in-depth or “targeted” case reviews that focus on specific issues or cases which may be problematic or signal potential fraud.
In addition to the QA activities, IHSS providers must complete an enrollment process that requires the provider to submit a valid social security number and in some cases undergo a criminal background check for enrollment as a registry provider. Timesheets are signed by both the consumer and the provider verifying that services were rendered. The service hours can never exceed the amount authorized by an IHSS social worker to meet the client’s needs for care. Additional efforts to combat fraud through the use of technology are planned with the release of CMIPS II, beginning in Spring 2010.

MYTH: “Requiring background checks of providers and hiring more fraud investigators could save the state hundreds of millions of dollars this year alone.” (Op Ed, 7/3/09)

FACT:

This statement is wrong. The Administration’s own May Revision estimates savings to be $100 million, and even this figure is grossly overstated.
The incidence of IHSS fraud is overstated. According to 2007-08 results of state/county QA efforts, of the nearly 24,000 total cases reviewed, only 523 were referred for further investigation for potential fraud – just 2%. County data of actual fraud referrals shows even fewer potentially fraudulent cases, including Los Angeles County with less than 1% of cases over a three-year period referred for fraud.
The Governor’s proposal would add a new bureaucratic layer to state government at a taxpayer cost of over $3.4 million to combat an exaggerated problem . Building on successful current efforts and investing into local QA programs is a more cost-effective and efficient way to enhance program integrity.

MYTH: The IHSS Program pays unscrupulous people to provide substandard care, endangering clients, even leading to death. “In San Luis Obispo County, a 20-year-old drug abuser who was the sole caretaker for his seriously disabled father provided such poor care that, according to the grand jury in that county, the father frequently had bedsores, he was not properly cleaned, adult protective services had to be called in and, ultimately, he died before he was 60 years old. Incredibly, the son was being paid by the state, through the In-Home Supportive Services Program, for this substandard care.” (Op Ed, 7/3/09)

FACT:

Catching unscrupulous providers in the IHSS program requires good case management by trained social workers. Unfortunately, the Governor has consistently grossly underfunded the case management oversight in the program throughout his tenure. His budgets fund less than the bare minimum of case oversight — just over 8 hours per year per client to perform a number of activities, including client intake, assessment, provider enrollment, timesheet processing, and overall case monitoring. IHSS social workers often can’t get out to see their clients more than once a year. To make matters worse, the Governor permanently cut county IHSS budgets by another $15 million in 2008-09.
Elder and dependent adult abuse is a crime and is not tolerated in the IHSS Program. IHSS staff works closely with county Adult Protective Services (APS) programs to help keep elderly and disabled adults safe. However, county APS programs are critically depleted, and the Governor has made the situation worse . APS was never fully-funded, and despite the fact that reports of abuse and neglect have grown by nearly 40% since 2000, The Governor has never increased the funding to keep up with the workload. He has vetoed legislative augmentations to the program, slashing another $11.4 million in 2008-09.