Should some Medicaid recipients be subject to background checks?

Posted at: 02/01/2013 10:22 AM
Updated at: 02/01/2013 6:14 PM
By: Berkeley Brean

Every time you buy something and pay sales tax and in every paycheck you get, you contribute to the state's Medicaid system. So anytime someone steals that money, News10NBC wanted you to know about it. We also want to empower you and tell officials about ideas on how it might be prevented.

On Friday morning, a woman admitted she conspired to steal more than $60,000 from Medicaid. She was the Medicaid recipient but she was in a special program that made her the supervisor. That means she did the hiring, the scheduling and managed the money. But if the state and the counties could do background checks on these kinds of Medicaid recipients, they would have found that she was a convicted felon with time in prison.

Penny Thompson came to court Friday to admit she stole some of your money. An 18 month undercover investigation by New York State Attorney General's Office showed Thompson and four of her aids falsified time sheets and split $64,000 in Medicaid reimbursements.
Aaron Sperano, Thompson's attorney, said, “From her position, she needed these people around her not to commit welfare fraud, not to take money from CDR, or anyone else but to help her survive.”

Thompson was in Medicaid's consumer directed program, also called CD-PAP. Thompson was the supervisor of her own care. She hired her aids, set their schedules and submitted their time sheets. Thompson was accepted into the program even though she's considered a predicate felon and served time in prison on a drug conviction.

But the state and the county had no way of knowing this because they're not allowed to do background checks on people like Thompson.

Catherine Wagner, Attorney General's Office, said, “I mean the philosophy behind the program is that Medicaid recipient should be able to direct their own care in their home, but it also allows for the opportunity to be a fraudster, commit fraud.”

News10NBC asked the assistant attorney general if background checks would help.
Wagner said, “I would hope it would be a way to prevent this from happening.”

Chris Hilderbrant, Center for Disability Rights, said, “That's out right discrimination.”

Chris Hilderbrant is the chief operating officer of the Center for Disability Rights. The organization through which that the state funnels Medicaid money to CD-PAP recipients like Thompson.

News10NBC's Berkeley Brean said, “You don't think it lends itself to fraud because you could get people who know each other and could be in on it?

Hilderbrant said, “Not more than any other system. I think if we only focus on people who have criminal backgrounds then it's a real false sense of security too, while we're discriminating against someone who may be totally on the right path now. “

The New York State Attorney General's Office just announced that it recovered $335 million in Medicaid fraud money last year.
CD-PAP is a small part of that but we're still talking more than a million and a half since 2010.  
Thompson is going to prison for one to three years. When she gets out, get this, she will still be Medicaid eligible.

Medicaid is administered through the New York State Department of Health, but it's the counties that decide whether someone gets accepted into CD-PAP. In Monroe County, they do background checks on the aides that are hired, but they're only allowed to check the applicant's financial records to see if he or she is Medicaid eligible. The county is not allowed to check anything else in their background including criminal history.