Fraud and Abuse Are Routine In Care of Disabled in New York

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?

Related Care2 Coverage

4 Adults With Disabilities Chained Up In Social Security Scam

Left In a Van, Asphyxiated: Two Disabled NYC Men Died Tragically (VIDEO)

Closure of NJ Institution for Disabled Stokes Mixed Feelings


Photo by Just Jefa


Duane B.
.5 years ago

Thank you for sharing.

Robert Sloan
Robert Sloan5 years ago

Aside from fraud and abuse in group homes and poor care in group homes, there are serious risks involved in any group home situation.

The person loses everything going into the group home. Their time is structured to other people's convenience. They're subjected to rigid schedules designed for the efficient running of the institution regardless of how that affects their function. I know what personal adaptations I make to my disabilities. If I had to live in a nursing home I would lose half to two thirds of my function and constantly be looking over my shoulder for theft, confrontations over unpopular opinions or just "uppity" attitude and spend the end of my life being treated like a delinquent child because I'm not at my best living at a "Standard" pace of life.

I don't function in mornings but nursing homes wake residents early in the morning and serve breakfast before my stomach can accept food - I don't actually eat till I've been awake three or four hours. I don't sleep nights. If I'm forced to get up early in the mornings, I don't sleep because I don't feel decent till the middle of the night. There go any productive hours of the day. The hypocrisy of being told this is good for me, or eating diets structured around the foods others can eat but with my allergies and sensitivites left out could easily leave me undernourished as well as overtired, portions are controlled to try to keep people from getting fat but I need a lot of concentrated, easily digestible calo

Carole R.
Carole R6 years ago

Thanks for the post.

Debra M.
Debra G6 years ago

Berny P., mistakes made are no excuse for allowing people to be left in the care of an at risk facility. Many people are opening these money making homes, and very few of them are being supervised by the state. Any state. We will all find ourselves old, or broken, or in need of care. Eventually, we will all be in the position of needed hospice of some kind. May we all have compassionate family members willing to be the watchful eyes of our care, and may we all get the compassionate care we need. In the meantime, more oversight, not less, is required.

Andrew Carvin
Andrew Carvin6 years ago

Most businesses who service those who are disabled in some manner do so in a "farm like" fashion. They give patients the bare minimum treatment they can get away with, and most of the time do even less until they get caught. Every month they receive money for their "service," make huge profits doing so, and have the gall to whine about not having the money when they get cited for abuse.

They need to be federally regulated like they used to be.

You cannot rely on private business to take care of society.

Private business is not for the people by the people. Private business is for the money by the company. Private business will take your money, and give you nothing in return whenever they can get away with it. See private health care for examples.

Huge government is great because as long as it is run properly it protects the people it represents from private business that will murder them for their money if they can get away with it.

Colleen L.
Colleen L6 years ago

Makes me ill to read about these creeps. It concerns me that all states don't further investigations pf of these child care places. I understand that they always fault it on the budgets, but to me if my child was in one of these places, I'd be asking daily questions when I brought my child home. That also goes for elder care places too. Here in California there's a lot of places that abuse them too. I hope the ones who are doing the harm rot in prison. Thanks Kristina

Lin Moy
Lin M6 years ago

"If the people in charge did their job there would be less trouble but they have so many to check on it is difficult doing the job each person.

Debbie W.
Past Member 6 years ago

Don't feel so special, New York. Same running rampant everywhere. Sign of the times I'm afraid. How sad are we?

Berny P.
Berny p6 years ago


june t.
june t6 years ago

This just makes me so sad and angry at the same time. It's like this everywhere, every country, even in those cultures that are supposed to have a tradition of valuing their elders. What happened to that? The sick, the disabled and the ill - the most vulnerable in society are living hellish lives and what little bit they have is being cut even more. When I read about things like this, I can't help thinking how pathetic and nasty humans are - the good ones are few and far between.