New York’s Consumer Directed Personal Assistance Program (CDPAP) has long been the subject of enforcement at the New York State Attorney General’s Office (AG). Many of those enforcement actions involve caregivers who billed Medicaid for CDPAP services never provided but sometimes also implicate agencies that are responsible for processing caregiver payments and protecting against fraud.
In 2010, charges were brought against a Port Washington mother and her two daughters for a scheme in which they billed more than $100,000 for personal care services that were ostensibly provided to ill family members by both daughters and the mother’s late husband during periods when the family was traveling to Paris, the Bahamas, Puerto Rico, Miami Beach and Atlantic City, when one of the daughters was attending college and graduate school and when the daughters were working in Manhattan and out of state.[1]
In 2011, the AG prosecuted an upstate mother of a 20-year-old disabled son who qualified for CDPAP services. The mother had hired her daughter for the ostensible purpose of providing her son with services, but mother and daughter then defrauded Medicaid of more than $59,000 based on 3,100 fraudulently billed hours over a two-year period. The mother forged the daughter’s signature on timesheets that were processed through a fiscal intermediary. The AG required the fiscal intermediary to make restitution to the Medicaid program because the agency was responsible for ensuring the services were being provided but failed to take action when advised by the daughter that she was moving to Oklahoma.
In 2013, the AG prosecuted an Albany caregiver who submitted false timesheets to a fiscal intermediary for payment by Medicaid under CDPAP. As a result, the caregiver received several thousand dollars over six weeks for services that were never rendered. The caregiver was charged together with the sister of a disabled brother who qualified for CDPAP benefits. Both the sister and the caregiver signed the timesheets falsely attesting that the caregiver provided overnight care to the disabled brother when such services were not provided.
In 2015, the AG prosecuted the former Executive Director of a nonprofit agency servicing developmentally disabled persons for defrauding Medicaid, both in her role with the agency and as a personal assistant with CDPAP. The defendant was alleged to have submitted false timesheets to a fiscal intermediary claiming that she provided one-on-one care to two Medicaid beneficiaries for dates and times during which she also claimed to have provided group services to the same beneficiaries through her agency. As a result, Medicaid paid the fiscal intermediary more than two thousand dollars for services not rendered. The defendant was also charged with misappropriating funds from a bank account she was managing on behalf of a disabled person.
In 2016, AG brought multiple prosecutions involving CDPAP.
In one, a Rochester man pleaded guilty to grand larceny for falsifying time sheets submitted to a home care agency for CDPAP services that were never rendered. The defendant hired his girlfriend as an aide for a Medicaid recipient and submitted time sheets purporting to show that the girlfriend had spent about 500 hours providing services when she could not have done so because she was working another job or because the consumer was enrolled in an adult day care program at the same time. The home care agency billed Medicaid for more than nine thousand dollars based on the false timesheets.
In the second case, the AG charged a mother and son from Poughkeepsie with falsifying time sheets submitted to a CDPAP fiscal intermediary for personal care services allegedly provided by the son to two relatives in Dutchess County when the son was not present in Dutchess County at the time. The fiscal intermediary, relying on the time sheets, billed Medicaid more than $50,000 for hours that the son did not work.
In a third case, the AG charged an upstate woman with grand larceny for submitting false timesheets to a CDPAP fiscal intermediary claiming that her daughter had provided personal care services to a Medicaid beneficiary while the beneficiary was out of the country. The fiscal intermediary, relying on the time sheets, billed Medicaid more than $50,000 for services not rendered.
In 2017, the AG prosecuted a Freeport woman for defrauding Medicaid of approximately $75,000 for CDPAP services to two relatives that were never rendered. The defendant used the personal identification numbers of two aides and entered log-in and log-out times during periods when they were not working or were out of the country. The defendant also falsified time sheets and submitted them to the fiscal intermediary, which relied on the time sheets in billing Medicaid for the CDPAP services. The defendant picked up the paychecks from the fiscal agent, forged the aides’ signatures and cashed the checks, paying the aides for the work they performed, but retaining for herself the excess.
The AG also has taken other kinds of enforcement actions against the CDPAP fiscal intermediaries which process caregiver timesheets and handle other administrative functions on behalf of patient-consumer. In 2022 and 2023, the AG took action against fiscal intermediaries based in Queens and Brooklyn for entering into an anti-competitive agreement that barred them from poaching each other’s existing patients and which effectively prevented patients and their caregivers from choosing a fiscal intermediary that paid higher hourly wage or supplied superior service. The offending fiscal agents were barred from entering into future anticompetitive agreements restricting patient options and were required to pay hefty penalties of $500,000 and $350,000 (and their principals were required to pay fines of $50,000 each) to New York State. The companies were also required to administer an antitrust compliance program which included training for their management and executives.
These examples make plain that, historically, the AG consistently has demonstrated a willingness to bring enforcement actions to protect CDPAP against those who would seek to defraud or otherwise undermine the program. New York home care agencies and fiscal intermediaries would do well to remember this in all their business dealings by ensuring regulatory compliance and avoiding the type of unwelcome attention from the AG received by those featured in the cases described above.
[1] https://ag.ny.gov/press-release/2010/attorney-general-cuomo-announces-mother-and-daughter-sentenced-jail-stealing-more
