New York City has agreed to pay $70 million over accusations of Medicaid fraud for a program intended to provide services for individuals with disabilities in their homes. For a decade, the city approved personal in-home care costing $75,000 to $150,000 a year for a number of individuals, but without “physically obtain[ing] the required assessments from doctors, nurses or social workers.” In other cases, the city also did not have periodic “independent medical reviews” conducted; these are required any time there is a dispute about the care involved. But while the settlement is being hailed for preventing abuses of the system, any sense of victory is already waning.
After Fraud Settlement, NYC Is “Paranoid” About Violating Medicaid Rules
Disability advocates say that their elderly clients are already being told by the city that it now intends to reduce or simply end 24-hour services such as bathing and toileting, services that had made it possible for many people to still live in their own residences rather than in nursing homes. That is, the $70 million settlement has caused the city to become ”so paranoid about violating Medicaid rules that it was threatening to withdraw services from patients,” as organizations including the Legal Aid Society and Selfhelp Community Services wrote in a letter to the United States attorney for Manhattan, Preet Bharara, and to the federal Medicaid administrator, Dr. Donald M. Berwick.
Robert Doar, the city’s commissioner of human resources, who oversees Medicaid in the city, said Friday that the city would not cut off services to people who needed them, but he acknowledged that as a result of the settlement, the city was being more vigilant about the rules.
Valerie Bogart, a lawyer at Selfhelp who signed the letter, said city officials had told her that 100 people received notices in the past week that their services would be discontinued.
City officials disputed that number, saying that notices were routine, and that if people believed they needed more hours, they could appeal the decision.
In other words, the people who genuinely need the services provided under Medicaid — which the federal government pays for about half of, and the state and city the rest — are being penalized because other people abused the system and because, it could also be argued, officials were not providing sufficient oversight.
1,200 Developmentally Disabled Adults Died of “Unknown” Causes in New York State Care
As for why people might prefer to live in their residences with the the support of in-home aides, one need only to read a separate New York Times article about the disturbingly high number of deaths of developmentally disabled adults in New York‘s state and privately run group homes and other institutional residences. In the past decade, one in six individuals with disabilities including autism, Down Syndrome and cerebral palsy living in such facilities has died of “unknown” causes:
The records suggested problems in care may be contributing to those unexplained deaths. The average age of those who died of unknown causes was 40, while the average age of residents dying of natural causes was 54.
The Times reviewed the case files of all the deaths not resulting from natural causes that the commission investigated over the past decade and found there had been concerns about the quality of care in nearly half of the 222 cases.
The records also showed that problems leading to deaths rarely resulted in systemwide steps, like alerts to all operators of homes, to prevent mistakes from recurring. Responses were typically limited to the group home where a resident died.
The NYT’s review of the records found that, in more than a few cases, choking was the cause of death, even though many of those who died were at risk for such and were not supposed to have access to food unless supervised.
Just as terribly, a group home for nine developmentally disabled adults in the Adirondack town of Wells burnt to the ground two and a half years ago. Four of the residents died; three wandered back into the burning house when staff members were preoccupied after one resident fell. The fire revealed that the staff were not adequately trained in safety procedures during such a disaster; indeed, “evacuation plans were based on unrealistic expectations that developmentally disabled residents would be able to flee in an emergency.” Sprinklers were only installed in some parts of the house and the fire department had never been told by the state about the presence of the group home and the developmental disabilities of its residents.
The Medicaid fraud settlement and the revelation of the “unknown causes” of the deaths of so many individuals with developmental disabilities under the state’s care do not only occur in New York. It’s more likely that such fraud is never detected, let alone reported, let alone prosecuted. Abuses against individuals with developmental disabilities, many of whom are not able to communicate what has happened to them, are vastly underreported. But will people hesitate even more to speak up about fraud and abuses, if doing so leads to reductions or even the elimination of services for those with disabilities?
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