As Home Health Care Industry Booms, Little Oversight to Counter Fraud

It is one of New York’s fastest growing industries, driven by government policy and nourished by tax dollars. But as the home health care industry has expanded, the state appears to have been a step behind, with a confusing hodgepodge of regulations and agencies to police it, experts and state officials say.

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There are uneven levels of oversight, as the hundreds of contractors who directly employ home health aides receive less scrutiny than the agencies that bill Medicaid for their services.

And there are two different bureaucracies that accredit programs to train home aides, but no central registry of the tens of thousands of people who have been granted training certificates.

As a result, state officials do not even know precisely how many home health aides work in New York, though such figures are readily available for dozens of other state-regulated fields, from interior design to acupuncture.

“To make someone else’s home fabulous, you need a license and your name goes in a state registry,” said Jeffrey Lerner, a spokesman for the state attorney general, Andrew M. Cuomo. “But to care for someone in their home who is old and infirm, there is no central registry.”

Mr. Cuomo is in the middle of a two-year investigation into fraud in the home health industry, including scores of cases involving schools that improperly issued training certificates and agencies that billed Medicaid for work that was never done. One aide claimed to be working 24 hours a day while she was in North Carolina belting out “Be My Love” to the judges of “American Idol.”

It remained unclear whether any patients were unknowingly endangered or harmed after being cared for by improperly certified workers. State investigators said that in many cases, the patients were complicit in the fraud.

But while the investigation has focused on attempts to bilk the Medicaid system, it has also shed light on outdated oversight policies that experts and state officials said have allowed the industry to escape adequate scrutiny. “It’s a burgeoning industry that is ineffectively regulated, that is expensive for taxpayers, and can victimize consumers,” Mr. Cuomo said in an interview on Friday.

Experts said that until recently, state officials had not paid close attention to home health care fraud. New York only recently became the second state, after Texas, to create a Medicaid inspector-general’s office, and Gov. Eliot Spitzer, who initiated a number of the current fraud investigations when he was attorney general, has made reining in Medicaid fraud a key priority.

Many in and outside the industry say the incidence of fraud in the home health care system is no greater than that of the medical system at large, and that the complaints are limited to a small portion of agencies and caregivers.

“We’re being portrayed negatively when we do a very good job at this every day,” said Valerie Collins, the administrator of Village Care Plus, which trains home health care aides and employs about 500 certified aides.

Home health aides and other personal care workers are a lifeline for many older or disabled people, their link from isolation to the outside world. In the growing number of cases in which family members are too busy or too far-flung to care for their relatives, the aides can become a de facto family, offering companionship to their clients in life and comfort to their relatives after their deaths.

“You’re my tie to the outside world,” David Pincus said during a recent visit by his evening aide, Yvonne Julius, who also assists 11 other clients. Mr. Pincus, 92, lives in a Village Care assisted living community in Midtown Manhattan.

His aide, Mr. Pincus said, “does nothing in particular and everything in general.”

At the heart of the industry — which accounted for $1.3 billion of the $35.7 billion spent on Medicaid in New York last year — are more than 140 home care agencies, which are overseen by both the federal and state governments and are responsible for supervising patients’ care and billing Medicaid.

On the front lines are home health care aides, almost all of them working long hours for low wages. Based on surveys, the federal government estimates that there are at least 131,000 aides working in New York, but the state does not keep precise figures. Among those workers is an unknown but growing number of uncertified aides who work outside the Medicaid system.

In between are more than 1,000 state-licensed contracting agencies that directly employ the workers, train them, and provide their services under contracts to the home care agencies.

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