2009-10 Budget Analysis Series: Health

DHCS—IHSS Fraud Investigation

Background. The In–Home Supportive Services (IHSS) program provides in–home care to persons who cannot safely remain in their homes without assistance. The program is administered mainly by DSS. However, the Medi–Cal Program, administered by DHCS, has responsibility for investigating fraud within the IHSS program. The DHCS currently has two fraud investigators assigned to the IHSS program, which has a caseload of 456,000 persons.

Budget Proposal. The DHCS has indicated that its two investigators are unable to meet the growing workload associated with suspected fraud, and that the department currently has a backlog of approximately 400 cases that warrant investigation. On this basis, DHCS has requested six positions and $362,000 ($181,000 General Fund) to augment fraud investigation for the IHSS program.

We believe that the additional fraud positions may be warranted. However, we note that current IHSS policies regarding the receipt of provider time cards hamper the effectiveness of the fraud investigators. We believe that better controls over the time cards are needed in order for the positions to be used effectively. We discuss these policies and reforms the Legislature could take to increase accountability in our 2009–10 Budget Analysis Series: Social Services document, in a report entitled “IHSS Time Card Reforms.”

LAO Recommendation. We recommend that the requested positions be approved by the Legislature only if the additional resources are provided alongside legislation to reform current IHSS time card practices. The combination of these actions would increase program oversight and accountability.

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