Home care program’s costs under scrutiny

By David McGrath Schwartz (contact)

Saturday, Oct. 17, 2009 | 2 a.m.

Carson City — The state’s personal care service program is designed to save taxpayers money in the long run, while caring for some of Nevada’s poorest and most vulnerable residents.

At state expense, disabled Nevadans who are unable to bathe, clean, prepare food or shop for themselves receive care in their homes instead of at costly nursing facilities.

Yet over the past decade, the cost of the program has exploded — from $3 million a year in 2000 to $65 million in 2008. And the per-patient cost has increased by 23 percent, according to state data.

State administrators think at least some of that increase is because of fraud and the state providing more services to the disabled than are needed.

Officials are looking at new policies aimed at cracking down on fraud and better measuring how much in-home service each client needs. Instead of relying on an in-home interview by a social worker, the state is proposing examinations done by licensed medical workers, followed by home visits, according to Chuck Duarte, state administrator of Medicaid.

“This has been a concern for some time now,” he said. “We want to have a process to assure people are getting what they need.”

He said internal audits of the program have produced evidence of waste and excessive patient care. Though he declined to share the results of those audits, a memo he sent to the director of the Health and Human Services Department this summer outlines some of the problems:

• Caregivers forging recipients’ signatures to get paid for services they didn’t provide;

• Caregivers not performing services for clients, but submitting claims and splitting the payments with recipients;

• Home health care agencies altering documents before audits;

• Home health care agencies closing down after they get caught falsifying records, only to be reopened by the same people under a different business name.

As of this summer, $343,000 was owed the state for fraudulent billing, money the state was unlikely to recover because the businesses had shut down.

Though patient advocates said it’s good the state is cracking down on fraud and waste, some worry that the new policies could delay care.

Patti King, regional director with Addus HealthCare, one of Las Vegas’ largest home care providers, said she worries that using licensed physical and occupational therapists, under the supervision of doctors, could cost more on the front end. Plus, she said, “We have a shortage of therapists in this state. It might take a longer time (for patients to be evaluated). Those truly in need may end up suffering, thus being institutionalized and costing the state significantly more dollars.”

Barry Gold, director of government relations for AARP Nevada, shares the concern. “We understand a need to weed out waste, fraud or abuse. We’re concerned this will create an obstacle for the disabled and seniors who desperately need” these services.

Duarte said this is only an initial proposal. The first workshop on the proposal will be Thursday, when care providers and advocates can raise concerns. He said the state is likely to begin its new evaluation process with new patients before deciding whether to expand it to existing clients.

He wouldn’t estimate any possible savings other than to say the goal right now is to break even.

Gold, though, said that having patients go to a clinic or doctor’s office could be burdensome for some. He said two assessments might be “duplicative and possibly wasteful.”

But state officials say a significant amount of waste exists in the system.

The attorney general’s office has a unit dedicated to Medicaid fraud.

At least seven people and one company associated with the personal care services program have been prosecuted for Medicaid fraud since 2008.

“Based on our experience here, there is an issue of fraud,” said King, with the home-care provider Addus. “Is it significant? I can’t say that. But it does exist.”

Duarte said this is not about looking to cut those who need help off the state program. Nor would he characterize it as a budget cut.

“We need to make sure, particularly in tough economic times, programs are running efficiently,” he said.