In-Home Supportive Services Fraud
Fraud is an intentional attempt by providers or recipients to receive unauthorized payments or benefits from the program.
Reporting Requirements
Recipients must report all known facts impacting eligibility 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
Common Fraud Issues and What Actions Could be Considered Fraud
Recipient's Functional Ability
Recipients and providers may not make false statements about the recipient's disabilities or claim that more hours than necessary are needed for their proper in-home care.
Using a False Identity
Providers 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
Providers cannot claim more hours than actually worked. This is a crime punishable under Penal Code §72 and §487(a).
- Only the recipient 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 your recipient 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 provider cannot be paid to take care of a recipient who is out of home due to:
- Hospitalization
- Placement in a nursing home or skilled nursing facility
- Incarcerated (in jail)
- Living out of the county
IHSS is designed to help recipients remain safely in their own home. You cannot claim hours worked while the recipient is temporarily residing out of the home.
If the recipient 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 recipient returns home, a provider cannot make up hours by adding extra hours to their next timesheet.
Subcontracting
Providers cannot hire someone to perform their IHSS duties for them and claim those hours on their own timesheet.
All persons providing care must be registered providers who have been approved and authorized through IHSS. Subcontracting is a punishable crime under Penal Code §72.
Check Splitting
A provider cannot submit timesheets and accept payment for work that was never performed and split the pay with the recipient or another person. The provider and recipient can be criminally prosecuted 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.
