DOH and PPL identify fraud in previous home care program

By Friday, all of the more than 280,000 Medicaid recipients and care providers who were part  of the popular Consumer Directed Personal Assistance Program will need to transfer over to Public Partnerships LLC, the sole fiscal intermediary approved by the state. Gov. Kathy Hochul believes the move will cut down on the “waste, fraud and abuse” contributing to the state’s bloated healthcare budget, though PPL had to contend with its own allegations of fraud after one of its contractors’ employees was caught stealing. As evidence that the switch to PPL will cut down on fraud, the company has already identified dozens of fraud cases that were initially obscured by the sheer number of financial intermediaries previously allowed. 

The state Department of Health and PPL identified more than 30 instances where personal assistants billed patients who were dead or hospitalized and five where assistants logged time worked even though they were out of the country. They also discovered one case where a personal assistant logged time showing them in two places at once and another case where a personal assistant logged time for two consumers on different health insurance plans at once. PPL said its billing system will prevent situations like this from occurring in the future.

“We knew that there were inconsistencies we needed to address to make the system fair. But in that lies the idea that there was likely some fraud, waste and abuse that was occurring with the program that we needed to start to identify and work with DOH on,” PPL Vice President of Government Relations Patricia Byrnes told City & State.

 As of July 14, DOH reported that approximately 206,000 consumers are registered with PPL, and approximately 80,000 consumers have transitioned to personal care services, a similar program where an aide is selected by a home care agency rather than a consumer. According to DOH, PPL has also registered 222,000 personal assistants, 10% of whom serve multiple clients, and 99.7% of registered personal assistants have been paid to date.

DOH is still combing through records to identify fraud trends within the system, and it could not provide an exact scale of fraud in a program serving more than a quarter of a million people, but the agency believes that fraud will be much harder to commit with just one system administering claims.

“In partnership with PPL, the Department is using enhanced data and monitoring tools to protect program integrity, support consumers, and take timely action when issues arise,” DOH spokesperson Danielle DeSouza said in a statement. “At the same time, this transition has reduced administrative costs – saving taxpayers over $1 billion per year – and ensured that resources are going where they’re needed most.”

Still, advocates against the planned switch are still angered by what they feel was a lack of outreach to members of the disability community and those who use the program. The rapidly approaching deadline to switch is only heightening tensions since some CDPAP users fear they’ll lose their care providers and be kicked out of the program. Personal assistants also have until Aug. 15 to make the switch. 

Blaise Bryant, spokesperson for the New York Association on Independent Living, said that at this point, the damage is done for people who have opted to leave the program after realizing they won’t be able to keep their personal assistants, some of whom have reportedly left the program due to payment issues. 

“The only way to reverse this,” Bryant said, “is if it were just totally tossed out in the courts, or if there's legislation that's passed, or if things just get so bad to the point where the governor and DOH say, ‘Okay, well, we really messed up here. We need to just return it back to its roots.’”