HHS comes off as an enabler. Some attendants were fraudulently paid while neglecting suffering patients as the department failed to implement years-old recommendations to correct the scandal, according to the OIG.
“Significant vulnerabilities,” the OIG said, “including a lack of internal controls” continue to plague the program.
Building on the OIG’s 2012 study, investigators found “significant and persistent compliance, payment, and fraud vulnerabilities” with the personal-care services (PCS) program. It was a $12.7 billion operation in 2011. In many cases, the attendants work for personal-care agencies that bill Medicaid for their services. States operate their own Medicaid programs under federal guidelines.
Since that six-year-old study was issued, the new review, first reported by CBS News, said the OIG has opened more than 200 investigations of possible fraud and patient harm and neglect in the PCS program across the country.
Because the federal government provides much of the funding, it has a responsibility to make sure that people are not harmed or ripped off. But the OIG says officials in the department’s Centers of Medicare and Medicaid Services (CMS) have not implemented previous recommendations that could have prevented some of the ongoing problems.
The OIG said it “continues to recommend” that CMS “take regulatory action to establish safeguards that will prevent fraudulent or abusive providers from enrolling or remaining as PCS attendants” and better protect against “fraud and patient harm and neglect.”
Examples from the report of that fraud, harm and neglect, in some cases by close relatives, are disgraceful:
- “In Illinois, a concerned neighbor who had been unable to reach a beneficiary for days found the beneficiary in an incoherent state, covered in dried excrement. The investigation revealed that the PCS attendant had not seen the beneficiary, her mother, for a week before the incident.” The attendant even submitted claims to be paid for the home care when the mother was hospitalized.
- “A PCS attendant in Vermont submitted claims for 456 hours of services that were not provided. . . . The attendant allegedly had an arrangement with the patient’s wife to evenly split the payments for services.” The wife also allegedly paid off the attendant with her husband’s prescription opioid painkillers “despite the patient appearing to be in significant discomfort and the attendant being on probation for drug possession.”
- “A beneficiary in Pennsylvania died of exposure to the cold while under the care of a PCS attendant who provided inadequate supervision. The beneficiary had a pervasive developmental disorder and a history of running away. . . . For an unexplained reason, the attendant took the beneficiary shopping in downtown Philadelphia. The attendant lost sight of the beneficiary in a crowded department store and then waited an hour to call authorities.”
- “A beneficiary in Idaho suffered from severe dehydration and malnourishment and was hospitalized after her son, who was employed as his mother’s PCS attendant, neglected her care. . . . While serving a search warrant at the home shared by the mother and son, investigators found the home filthy with drug paraphernalia, trash, and dog feces among the piles of clutter.”
- “On a sunny and hot July day, a PCS attendant in Maryland left a beneficiary with developmental disabilities in a locked car while shopping with a companion. The beneficiary was not supposed to be left unsupervised at any time.”
Better internal controls possibly could catch reprobates like these because they sometimes do stupid things, such as billing for “impossibly or improbably large volumes of services,” for hours of service to multiple patients on the same day or for service on the same day to beneficiaries who lived too far apart for that to be possible.
The inspector general’s office recommended that the department set “minimum Federal qualifications and screening standards for PCS workers, including background checks,” require states to register all PCS attendants and require claims for payments to include dates of service and the names of the attendants providing service.
A CMS statement said the agency “takes the oversight of state personal care service programs seriously and we have taken a number of steps to improve personal care service programs in recent years.” It also plans to “offer additional guidance to states” to help protect beneficiaries and taxpayers.
But if CMS takes its oversight so seriously, why hasn’t it been more forceful in protecting beneficiaries by implementing previous recommendations?
“These are real beneficiaries, and they’re real people,” David Ceron, an OIG special agent, said by telephone, “whose lives and health care have suffered because of a lack of controls.”