DiNapoli's audit questions billions of dollars in NY's home health care program

ALBANY — Comptroller Thomas DiNapoli said he found a "disturbing lack of oversight" in the state’s payment of $14.5 billion in home care services, including taxpayer-funded wages the state paid to relatives to care for a family member.

DiNapoli’s auditors found the state Health Department had a feature in its computer software that could have detected concerns of any waste and fraud, "but this feature was not turned on."

Auditors said they also found:

• Although Medicaid payments require services for at least eight minutes, $116 million in billing during the 15 months audited were for services that provided less than eight minutes of care. One bill was for $207 for one second of service, auditors said.
• The state paid for $333,372 of "overlapping" time service in which more than one caregiver was being paid to serve the same recipient. In one case, one paid caregiver reported working from 6 a.m. to 9 p.m. while another charged the state for serving the same patient from 7:30 a.m. to 11:30 p.m. on the same day.
• $9.7 million was paid for home services that should have been suspended since the patient was hospitalized.
• Live-in caregivers, often relatives, were exempt from some requirements to prove they provided services. But the health department hasn’t done its own audit to make sure live-in caregivers actually live at the same address as the recipient. These live-in caregivers received $1.8 billion in Medicaid payments over the 15 months reviewed and "it is uncertain" the caregivers qualified for the pay because they may not have lived at the patient's address.

The state Consumer Directed Personal Assistance Program provides help for the chronically ill or physically disabled for services that can include help with housekeeping, meals, bathing and use of toilets.

The rate is about $20 an hour, depending on the services provided to hundreds of thousands of New Yorkers. Under the state’s system, caregivers are supposed to show they made a visit by reporting through a cell phone app, a landline phone or through a device placed in the home.

The audit found 44% of these services weren’t verified.

"Medicaid’s home care services are vital and allow many New Yorkers to remain in their homes and communities," DiNapoli said. "This audit found a disturbing lack of oversight and failure to comply with the required service verifications."

In its response to the comptroller’s office, the health department said it "will issue reminders" to caregivers that they must verify they live at the same address as the person for whom they provide care. Comptroller’s auditors, however, said unless the health department directly verifies the addresses, "there is no assurance that the status of live-in caregivers ... will be accurate."

The state Health Department said improvements will be in place in "early 2025," according to a statement from spokeswoman Cadence Acquaviva.

The department stated the findings by DiNapoli’s auditors in some cases reflect a mismatch of data and "does not necessarily indicate that the corresponding underlying claim was inappropriate and that a recovery should be made."

"I have never seen an audit on this scale," said Bill Hammond, senior fellow on health policy at the Empire Center for Public Policy, an independent think tank. "One of the challenges of personal care is that it goes on in peoples’ private residences, so it is out of sight. There is no manager to show that someone has shown up and done the work."

When a family member is chosen to provide the care for state wages, a patient is less likely to complain that they didn’t get their care, Hammond said Friday.

"It seems like the health department wasn’t ready to enforce the claims system," Hammond said. "They didn’t turn on that option ... as a result, there is massive noncompliance because the providers, the caregivers, everyone knows they are not using it."

The program was created nationwide to deal with a shortage of health care workers to provide home care. The service is growing in New York and in other states. TikTok includes postings that refer to the programs in several states, such as, "Making $25 an hour to watch my grandma and all we do is take naps together."

Earlier this year, Gov. Kathy Hochul announced measures to provide more accountability to the program, including direct meetings with caregivers and recipients.

By Michael Gormley

michael.gormley@newsday.com@GormleyAlbany

Michael Gormley has worked for Newsday since 2013, covering state government, politics and issues. He has covered Albany since 2001.