Pinay who ‘abused’ health care program flees to RP

By Alex P. Vidal

“Time will inevitably uncover dishonesty and lies; history has no place for them.”— Norodom Sihanouk

A 74-YEAR-OLD Filipino-American woman who has been reportedly under the radar of the federal government for “misusing, abusing, and exploiting the loophole” in a New York state health program for several years, has “fled” to Mindanao in the Philippines in a bid to avoid prosecution.

“Na buking talaga eh (she was caught flat-footed),” disclosed Hermie, a 72-year-old Fil-An retiree now based in Matag-ob, a component city in Leyte, Philippines.

Hermie said Dolores availed the New York State Department of Health’s Consumer Directed Personal Assistance Program (CDPAP) before the pandemic.

CDPAP is a medicaid program that provides services to chronically ill or physically disabled individuals who have a medical need for help with activities of daily living (ADLs) or skilled nursing services.

Services can include any of the services provided by a personal care aide (home attendant), home health aide, or nurse.

Recipients have flexibility and freedom in choosing their caregivers.

The consumer or the person acting on the consumers behalf (such as the parent of a disabled or chronically ill child) assumes full responsibility for hiring, training, supervising, and – if need be – terminating the employment of persons providing the services, according to New York State Department of Health.

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Hermie said without Dolores’ knowledge, she was being monitored on suspicion that all the information she had provided to qualify for the program was tainted with falsehood, deceit, misrepresentation, bad faith.

Dolores hired a younger male “caregiver” under the program who turned out to be her live-in partner. The caregiver is paid to “take care” of Dolores, who took a share of the caregiver’s salary.

“They have been abusing the system and defrauding the government,” pointed out Hermie, who has been cooperating with investigators.

New Yorkers with zero healthcare experience are allowed to care for their elderly or disabled relatives and friends — potentially earning more than $43,000 a year — under a $6 billion Medicaid program that’s been rife for fraud, abuse and overuse for years, insiders say.

The Consumer Directed Personal Assistance Program, known as CDPAP, exploded several years back when state lawmakers loosened rules to make more people eligible for the government cash, reported the New York Post.

Critics argue that CDPAP, which has received huge funding injections from the state government, has been allowed to expand rapidly with little oversight — despite rampant signs of dysfunction and being a waste of taxpayer money.

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“The program is growing many times faster than the size of the elderly population and shows no sign of slowing down,” Bill Hammond, a senior fellow for health policy at the Empire Center, an Albany-based government watchdog group, told The Post.

“It’s long past time for state officials to bring the program under control — while taking care to protect services for those who need them most.”

There are currently 250,000 New Yorkers enrolled in CDPAP across the state, the latest Medicaid enrollment report data show — up considerably from 140,000 in 2015

A CDPAP-funded home care worker in New York City can rake in as much as $21.09 an hour caring for their relatives or friends — or $43,867.20 a year based on a 40-hour work week. On Long Island, the CDPAP caregiver rate is $20.22 per hour, while in the rest of the state it’s $17.55 per hour.

The decades-old program was relatively small until legislative changes expanded eligibility by allowing family members or friends of Medicaid recipients to become CDPAP aides.

State lawmakers passed the bill, spearheaded by then-Assemblyman Joe Morelle — now a Democratic congressman for New York’s upstate 25th congressional district — in 2015 before it was implemented the following year by then-Gov. Andrew Cuomo.

Morelle said at the time that the changes, which now allowed parents of adult disabled children to be hired as their carers, would save those families from fearing for their financial security.

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But experts warn that the vague rules for eligibility are prime for exploitation — and that the program’s flaws run deep.

“Consumer-directed personal assistance is an important and life-changing benefit when used appropriately, but it’s also highly vulnerable to overuse and fraud — and in New York’s program, all the warning lights are flashing bright red,” Hammond said.

Under CDPAP, people can choose their own, unlicensed caregivers to help assist them at home in a bid to avoid more costly nursing homes or assisted-living facilities.

But while there’s been an increase in people signing up for the program, there hasn’t been much of a change in the nursing-home resident population.

Meanwhile, the criteria to qualify for CDPAP are somewhat hazy, added the Post.

For instance, those seeking Medicaid coverage who live in a nursing home are required to have their past five years of financial records reviewed.

The list includes “bathing or showering, dressing, getting in and out of bed or a chair, walking, using the toilet, and eating,” according to the US Centers for Medicare & Medicaid Services.

In comparison, those applying for home-based care don’t have any look-back period, which means they can potentially transfer cash, or sell off assets, to relatives so they can then qualify for Medicaid.

Currently, an applicant has to undergo an assessment of eligibility, which includes, in part, having an ongoing medical condition, a need for medical assistance and a need for long-term care.

(The author, who is now based in New York City, used to be the editor of two daily newspapers in Iloilo.—Ed)