By CSLEA-CACI Member Roxana Rivas

As published in California Welfare Fraud Investigators Intercom

 

In June 2016, Department of Health Care Services (DHCS) Investigator Roxana Rivas presented an In Home Supportive Services (IHSS) fraud case to the Los Angeles County District Attorney’s Office involving an IHSS provider who submitted and obtained payments for IHSS services not rendered. The provider and recipient, who are son and mother, knowingly and willfully concealed the fact that the IHSS recipient was residing in a skilled nursing facility in order to collect IHSS payments that she and her provider were not entitled to receive.

The IHSS recipient was residing in a skilled nursing facility from October 2011 until June 2016. The scheme involved the recipient signing herself out of the facility for the day and meeting with her son at his apartment where the scheduled yearly assessment would take place. The social worker would conduct the interview and both subjects would sign all pertinent documents for the IHSS Program. The social worker assigned to the IHSS case was unaware that the recipient, in fact, lived in a nursing home and not at the reported address.

When Investigator Rivas interviewed the recipient, the subject claimed that her son came to the facility to bring her food and bathe her. When asked why she did not report her true residence to the social worker, the subject claimed she did not have time to contact the social worker.

When interviewed, the provider claimed that it was okay to sign the timesheets while his mother was in the nursing facility because “everyone does it.” The provider was advised that while his mother was in a skilled nursing facility he was not entitled to IHSS payments. He said that he knew it was not right, but that his mother told him it was okay.

Subsequently, the Los Angeles District Attorney’s Office filed a criminal complaint against the IHSS provider and recipient for violation to Penal Code Section 487(a)-Grand Theft.

On March 7, 2017, both defendants pled guilty to grand theft and were court ordered to pay restitution in the amount of $54,604.76 and three years of formal probation.

A referral to the DHCS Office of Legal Services is forthcoming with a recommendation to Mandatorily Suspend the IHSS provider. Pursuant to Welfare and Institutions Code Section 14123 (A), DHCS has the authority to suspend IHSS providers from participation in the IHSS program for up to 10 years upon a felony or any misdemeanor involving fraud, abuse of the Medi-Cal program or any patient, or otherwise substantially related to the qualifications, functions, or duties of a provider of service.

IHSS Provider Nicholas Suriano

IHSS Recipient Gloria Suriano