Audit: Personal care services need more oversightby Tim Nelson, Minnesota Public Radio
Minnesota's Legislative Auditor issued a stinging assessment of one of Minnesota's fastest growing health care programs today. Personal Care Assistance provides aid to nearly 17,000 disabled and incapacitated Minnesotans at a cost of about $400 million a year. That cost has more than doubled in the last five years, and the auditor said the program may be out of control.
St. Paul, Minn. — Meet Jeff Bangsberg. He's from New Hope. In 1974, he dove into shallow water and broke his neck.
"Basically, I am an individual who is a c5-6 quadraplegic, who is in a wheelchair, who requires assistance with dressing, and transferring into and out of my wheelchair and into and out of bed," said Bangsberg. "Also, I require assistance with other activities of daily living. I'm unable to walk, and I have very limited use of my arms and my hands."
Decades ago, Bangsberg might have been institutionalized. But longstanding state policies have encouraged people like him to live their lives as normally as they can, with some state help. It's thought to be less expensive, and it encourages people with disabilities to live a fuller life.
It's worked for Bangsberg. One of the original clients of the state's Personal Care Assistance program, he's now married and doesn't need Medicaid anymore. He pays for his own care.
But he listened with concern today as the Office of the Legislative Auditor offered a damning assessment of the program he once depended on, and still supports.
The 100-page report said the cost of personal care is growing by at least 18 percent a year, more than doubling since 2003. The audit also found cases of what may be outright fraud in the billing and reimbursement process run by the state's Department of Human Services.
Joel Alter helped write the report, and talked about the findings at a Legislative hearing today.
"We reviewed one month of PCA claims from the middle of 2008. We found many instances in which providers were paid for more than 24 hours per day for an individual caregiver," said Alter. "There was one case where 254 hours of service by one PCA, in one day, was part of a paid claim."
Alter also said the state had virtually no checks on who got services, what services they were getting and whether clients were getting what the public paid for.
"Sometimes, we have observed that DHS has told provider agencies -- in training for example, that certain things are prohibited. Like, helping a child with homework is not an allowable activity," said Alter. "But we couldn't find things like that in the written policies or in the state rules or the laws. So we think there's some room to try and pin down exactly what services are allowable or not."
Lawmakers reacted with alarm at the report, noting that the PCA program now accounts for nearly $500 million in spending, almost 7 percent of the $6 billion Department of Human Services budget.
A number of lawmakers, including Sen. Linda Berglin, DFL-Minneapolis, said they'd been getting complaints about the program for years.
"we've also heard about people coaching each other, you know, borrow my walker, things like that, to make sure they would get more services or that they would qualify for services," said Berglin.
For its part, the Department of Human Services defended its record, saying nearly two-thirds of its Medicaid fraud investigations are already looking at personal care matters.
Deputy Commissioner Brian Osberg said his department had already taken steps to correct some of the faults found by the audit, like billing for more than 24 hours a day.
"Yes, we've made mistakes. Perhaps we haven't been as on top of this as we should have, in terms of managing this program," said Osberg. "But we are very dedicated that going forward, we will implement whatever legislation and policies are necessary to make this an effective program."
Lawmakers, though, told Osberg that may not be enough.
"Has anybody been fired?" asked Rep. Mary Liz Holberg, R-Lakeville. "Has anybody been disciplined? Has any action been taken to send the message that the culture in our agency has a problem, we're not going to tolerate it and things are going to change?"
The exchange also touched off deep concern among a dozen or so disabled people who attended the hearing, like Jeff Bangsberg. Some got services from the state, and a few ran personal care agencies themselves.
Neither Bangsburg or any of the others were suspected of fraud. Bt they worried that the audit, along with the state budget shortfall, would make even the most appropriate care a target at the Capitol.
John Tschida is a vice president at Courage Center, which also provides service for the disabled.
"We will be increasing the vulnerabliity of people with disabilites if we take this report too far," said Tschida. "We definitely need to regulate services. We need to manage these services well. What we can't do is eliminate these services for people who need them."
Legislators may begin discussing changes to the program next week.
- All Things Considered, 01/23/2009, 5:20 p.m.