our budget gap.”
In 2007, 41 counties performed a random quality assurance review of 23,823 cases as part of the state-mandated California Department of Social Services (CDSS) IHSS Quality Assurance effort. This review involved intense auditing of each case to insure that state assessments are uniform and that errors are minimized. These reviews also checked for fraud or any other inconsistencies.
“The governor has been unable to produce evidence to support his claim that 25% of IHSS costs are due to fraud,” added Evans. “In fact, this is just another proposal to gut the IHSS program using fraud as a fig leaf. Contrary to the governor’s unsupported assertions, this recent audit is an unbiased analysis of fraud in IHSS and provides the best projection for any potential budget savings through reforms geared to reduce fraud.
Of the 23,823 cases reviewed, the administration’s own audit found 1,043 cases (4.3 percent of all cases) where there was some type of red flag that warranted further investigation regarding fraud. Of this amount:
- 786 cases (3.3 percent of all cases) required some type of fraud prevention activity to investigate, like referral to a local district attorney;
- 523 cases (2.2 percent of all cases) were referred to the Department of Health Care Services anti-fraud investigators for further investigation; and
- 248 (1 percent of all cases) of the cases QA investigators found fraudulent overpayment.
IHSS is a program of in-home supportive care that was established in 1979. The purpose of in-home care is to assist the elderly and disabled to live independently in their own homes and communities in order to avoid the state’s earlier practice of institutionalizing the disabled in state hospitals and the elderly in nursing homes. |
