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Post date: October 25 2007

Ag Cuomo's 'operation Home Alone' Arrests 19 In Medicaid Scam

NEW YORK, NY (October 25, 2007) Attorney General Andrew M. Cuomo today announced arrests in connection with "Operation Home Alone," the sweeping investigation of fraud in the home health industry. The arrests include 16 home health aides, two registered nurses and a home care patient alleged to have defrauded Medicaid through improper billing and no-show jobs.

Home health aides' responsibilities include administering medication and providing catheter care, colostomy care and wound care to the elderly and infirm. They are required to successfully complete a training program licensed by the State Department of Health or the Education Department. All such aides must receive a minimum of 75 hours of training, including sixteen hours of supervised practical training conducted by a registered nurse.

For a fee of approximately $300 - $400, the charged aides were able to obtain certificates that indicated they had received that training, when in fact they had not. The aides then went on to obtain jobs as home health aides. In a separate indictment, of the school that issued the certificates, Attorney General Cuomo alleges these aides were responsible for over $1 million in Medicaid billings.

"The fraud we are uncovering is not just an economic crime, it is a human tragedy," Attorney General Cuomo said. "These aides, who possess little or no training, are supposed to take care of elderly and infirm people who are virtually captive in their homes. Sometimes, the aides don't show up at all, and in many cases, their supervising nurses are in on the scam. The risk to patients and the waste of taxpayer dollars are immense."

In addition to the massive certificate-buying corruption uncovered by investigators, the latest arrests have also exposed a new form of Medicaid fraud involving the sale of so-called "50/50" arrangements between Medicaid recipients and their aides. One of the aides arrested is alleged to have set up other home health aides with complicit patients in exchange for a $2,500 "finder's fee." Pursuant to this scheme, aides then billed for services that were never provided and then split the proceeds with complicit patients. In some cases, the patients' supervising nurses allegedly looked the other way as such schemes were carried out.

The investigation also uncovered a home health aide who allegedly lent her certificate to another person who used it to become a home care provider. Though apparently untrained, this "certificate borrower" masqueraded as an aide and worked in the home of at least one elderly patient.

The charges against the defendants are merely accusations, and the defendants are presumed innocent until and unless proven guilty.

To help combat fraud relating to home health aides, Attorney General Cuomo has announced a legislative proposal calling for a statewide registry of certified home health aides to be developed and maintained by the New York State Department of Health.
The proposal calls for the following:

  • Name, address, gender and date of birth of certified home health aides.
  • Name and date of state-approved training and competency evaluation program successfully completed.
  • A copy of the training certificate issued to the individual.
  • The aide's employment history in home care and health care.

According to Cuomo, a state-wide registry of certified home health aides would be a first step toward enhancing the State's ability to oversee the industry 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 those receiving home care.
The Legislature will also be holding hearings on the matter in December.

Attorney General Cuomo has also issued subpoenas to nearly 60 of the state's Certified Home Health Agencies that bill Medicaid for care provided by aides and nurses. The aim is to identify cases of fraud, and separate the legitimate operators from the frauds in the multi-tiered home care industry.

Provisions establishing and regulating home health care in New York were set forth in Chapter 895 of the state laws of 1977. The aim was to create a "nursing home without walls," reducing the costs associated with institutionalization and providing patients a greater level of comfort. Every month, more than 80,000 New Yorkers receive some sort of Medicaid-funded home health services. In 2006, Medicaid spent nearly $1.3 billion on home health care. Because there is currently no centralized registry for home health aides, an accurate estimate of their numbers cannot be given.

Attorney General Cuomo urged New Yorkers to report cases of suspected fraud to the AG's Complaint Hotline, at 800-771-7755.

The investigation of fraud in the home health care industry, dubbed "Operation: Home Alone," is ongoing, and has so far resulted in charges against more than 50 defendants. The case is being prosecuted by Richard Harrow, Director of the New York City Regional Office of the Medicaid Fraud Control Unit, assisted by Special Assistant Attorneys General Kiran Heer and Mark Cannon, under the supervision of Special Deputy Attorney General Heidi Wendel.