Cuomo Expands Home Health Industry Probe To Syracuse Region

SYRACUSE, NY (April 17, 2008) - Attorney General Andrew M. Cuomo today announced that his industry-wide Medicaid fraud probe of the home health care industry has expanded to the Syracuse region with the issuance of subpoenas to 15 central New York home health care providers. In addition, the investigation, known as “Operation Home Alone,” has resulted in the conviction of a Syracuse area licensed practical nurse who falsified billings for home nursing services she never provided.

“Operation Home Alone” is the Attorney General’s long-term and statewide investigation into fraud in the home health care industry, which is one of New York’s fastest growing industries. Thus far, “Operation Home Alone” has resulted in charges against more than 80 defendants, including patients, aides, nurses, instructors, and the administrators of licensed and certified home health agencies. Defendants convicted during the investigation have been ordered to repay nearly $14 million in restitution.

“Medicaid fraud in all its forms remains a statewide problem, and my office will continue using effective approaches to weed it out in all corners of New York,” said Attorney General Cuomo. “My office’s ‘Operation Home Alone’ investigation into the home health care industry has led to prosecutions both downstate and up. Taxpayers throughout the State cannot continue to shoulder the burden of unscrupulous companies and individuals that put patients at risk and rip off all New Yorkers.

Cuomo’s investigation has now expanded into the Syracuse area with both a recent conviction and today’s announcement of industry subpoenas. The Attorney General’s Medicaid Fraud Control Unit recently arrested and charged registered nurse Anna Reid, 58, with grand larceny in the third degree, and licensed practical nurses Suzan Sheldon, 41, Michele Schug, 33, and Monica Webster, 36, with grand larceny in the second degree, for falsely billing Medicaid for the care of a young adult patient in Onondaga County.

At various times over a four-year period, all four defendants cared for the same patient, a young adult with cerebral degeneration and pulmonary collapse who requires around-the-clock home care nursing services. Although the patient’s parents provided up to 12 hours of care daily, the nurses routinely split up among themselves the billing for those hours. They also billed Medicaid during times when the nurses were out of the country on vacation and when the patient was in the care of another nurse. The investigation found nearly $250,000 in payments for services that were not rendered: $66,322 wrongfully paid to defendant Sheldon; $80,161 wrongfully paid to defendant Webster; $77,260 wrongfully paid to defendant Schug; and $18,814 wrongfully paid to defendant Reid. On April 11, 2008, Sheldon, pleaded guilty to grand larceny in the third degree. She is scheduled to be sentenced on June 20, 2008. Charges against Reid, Schug, and Webster are pending.

Attorney General Cuomo said, “Sheldon blatantly failed to provide vital services to a severely disabled young person and at the same time robbed taxpayers of vital Medicaid dollars. We will continue to root out this sort of Medicaid fraud wherever we find it.”

In the wake of this conviction, this week the Attorney General issued 15 subpoenas to certified home health agencies in the Syracuse region. These subpoenas seek information about home health aides whose services were paid for by Medicaid, including personal information, verification of qualifications, and the names of the licensed home care service agencies that supplied the aides for which the certified agencies billed.

Because Medicaid reimbursement for home health services is very generous, the costs of the program are a serious taxpayer expense. Last year alone, Medicaid expended $17,071,458 in Onondaga County on home health care for Medicaid recipients. Every month, more than 150,000 New Yorkers receive some sort of Medicaid-funded home health services. In 2007, Medicaid spent approximately $3.8 billion on home health care statewide. Moreover, because these services are provided outside an institution and therefore cannot be supervised, the home health care program is particularly prone to fraud.

Attorney General Cuomo continued, “This is a burgeoning industry that is ineffectively regulated, that is expensive for taxpayers, and that can victimize our most vulnerable citizens.”

Onondaga County Executive Joanne M. Mahoney said, “State law enforcement is it at its best when it is working to protect our seniors and prevent fraud that waste’s our tax dollars. I commend Attorney General Cuomo’s work on the issue of Medicaid Fraud and I am pleased that our offices can work together for the benefit our community and our senior citizens.”

AARP New York State Director Lois Aronstein said, “Older New Yorkers overwhelmingly prefer to receive long-term care services for themselves or a family member through home care and community-based services rather than institutional care. Thanks to the leadership and efforts of Attorney General Andrew Cuomo, New Yorkers now have some assurance that they and their loved ones are receiving quality home health care and can continue to age at home as they choose.”

“Operation Home Alone” has so far exposed a statewide range of fraudulent practices and schemes in the home health care industry by home health and personal care aides, the schools that train them, and the agencies that recruit and employ them. The crimes and frauds include the sale and distribution of falsified certifications, aides working without proper training or certifications, no-show aides who split their payments with complicit patients, aides billing multiple agencies for a total of up to 36 hours in one day, and nurses and certified home health agencies billing Medicaid for services never provided.

Along with the rigorous enforcement of current laws through initiatives like “Operation Home Alone,” Attorney General Cuomo has also called for a statewide registry of certified home health aides to be developed and maintained by the state Department of Health. The registry would enhance the State’s ability to oversee the industry, provide potential employers with the ability to screen home health aides, and help to detect and deter fraud. A registry already exists for nurse aides that work in nursing homes. By creating a registry for home health aides, this bill would extend the same protections that exist in the nursing homes to care-dependent persons being cared for in their homes.

The cases of Suzan Sheldon, Anna Reid, Michele Schug, and Monica Webster are being handled by Ralph Tortora, Regional Director in charge of the Attorney General’s Medicaid Fraud Control Unit’s Syracuse office, with the assistance of Supervising Special Auditor Investigator Ronald Sienkiewicz and Senior Special Investigator Thaddeus S. Kaczor, under the direction of Heidi Wendel, Special Deputy Attorney General for Medicaid Fraud.

New Yorkers are urged to report cases of suspected fraud to the Attorney General’s toll-free Medicaid Fraud Hotline, at 1-866-NYS-FIGHT (697-2444).

Charges against Reid, Schug, and Webster are merely accusations and they are presumed innocent unless and until proven guilty.