In-Home Supportive Services Fraud

Fraud is when a caregiver or person being cared for try to get unauthorized payments or benefits from the program.

Reporting Requirements

A person cared for must report all known facts and level of need under the California Department of Social Services Manual of Policies and Procedures §30-760.14, including:

  • Any changes in household living situation
  • Temporary stays in a hospital or skilled nursing facility
  • Significant changes in functional ability

Fraud Issues and What Actions Could be thought of as Fraud

Recipient's Functional Ability

A person cared for or caregiver cannot lie about disabilities or claim more hours than needed for their in-home care.


Using a False Identity

Caregivers must use their own personal information, such as name, address, and Social Security Number. A provider must have Legal Employment Status. Using a false identity is a crime under Penal Code §529.5.


Timesheets

Caregivers cannot claim more hours than actually worked. This is a crime punishable under Penal Code §72 and §487(a).

  • Only the person being cared for or an authorized signer can sign a timesheet and only after all hours claimed have been worked. Do not sign your own timesheet. Do not submit your timesheet before all hours have been worked.
  • If the person being cared for dies, write "deceased," the date they died, and your name. Do not sign their signature and do not claim any hours after their death.

Recipient Out of Home

A caregiver cannot be paid if the person being cared for is out of home due to:

  1. Hospitalization
  2. Placement in a nursing home or skilled nursing facility
  3.  Incarcerated (in jail)
  4. Living out of the county

IHSS is designed to help the person being cared for to remain safely in their own home. You cannot claim hours worked while the person being cared for is temporarily residing out of the home.

If the person being cared for is hospitalized or out of their home, you cannot claim any hours. This includes time for providing translation services, housekeeping, laundry, or preparing and bringing the recipient food.

When a person being cared for returns home, a provider cannot make up hours by adding extra hours to their next timesheet.


Subcontracting

Caregivers cannot hire others to do their IHSS duties for them and claim those hours on their own timesheet.

Caregivers must be registered and authorized through IHSS. Hiring others is a punishable crime under Penal Code §72.


Check Splitting

A caregiver cannot submit timesheets and accept payment for work that was not done or split the pay with the person being cared for or others. The caregiver and person being cared for can be taken to court for theft and submitting a false timesheet under Penal Code §487(a) or Penal Code §72.


More About Fraud


Prosecution

If You Are Reported for IHSS Fraud

An investigation may be conducted. If you are found to be withholding income information to another program, a referral will be sent to the appropriate agency.

For suspected IHSS fraud reporting in the COUNTY OF SANTA CLARA, CA

Please immediately contact the COUNTY OF SANTA CLARA, IHSS main line at (408) 792-1600, or email the COUNTY OF SANTA CLARA, IHSS at [email protected].

You can also submit complaints of suspected fraud to:

The California Department of Health Care Services Fraud Hotline at (800) 822-6222.
You can also e-mail your compliant to [email protected] or use Stop Medi-Cal Fraud.

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