IHSS Time Card Reforms

Some Efforts Have Been Made to Prevent Fraud and Abuse

In the IHSS program, as we previously discussed in the “Background” section of this report, the recipient is considered to be the employer of the person providing them services. As the employer, the recipient has the responsibility of signing and verifying the time cards of their provider. Below, we discuss current time card policies and two reform options to increase IHSS program oversight and integrity.

IHSS Quality Assurance Initiative. Chapter 229, Statutes of 2004 (SB 1104, Committee on Budget and Fiscal Review), created an IHSS quality assurance (QA) initiative. The QA initiative was designed to, among other things, enhance program integrity and increase the detection of program fraud and abuse. Pursuant to QA requirements, each county established a QA unit to review and investigate cases of potential fraud and abuse. The QA workers visit the homes of recipients, conduct case reviews, and make recipient phone calls to verify that IHSS hours are being authorized and used appropriately.

Current Time Card Practices Limit Program Oversight

Despite the recent QA efforts, we find that the process for documenting the number of service hours provided each month lacks the detail required to ensure adequate program oversight.

Documenting Service Hours. In order to receive payment, recipients and providers sign and return time cards to their counties for processing. These time cards require the recipient and the provider to jointly sign for the total number of service hours that were provided each day of the pay period, but do not ask either party to indicate the actual times that were worked. For example, while a provider may indicate that he or she worked for five hours on a particular date, the provider is not required to document that he or she worked from 1:00 p.m. to 6:00 p.m.

Our discussions with county officials revealed that this situation makes it difficult for county QA employees and fraud investigators to determine whether those hours were actually provided. In certain cases, fraud investigators may be aware, through case–monitoring efforts, that hours have not been provided. However, this fraud can be very difficult to prove because the provider can claim that he or she provided the services at times when the investigator was not monitoring their activities.

Submitting Time Cards for Payment. Each time card covers a two–week period. Notably, there is no time limit for providers to submit their time cards to the county for processing after the two–week period of service has been completed. The DSS indicates that providers frequently save up their time cards and submit them all for processing at the end of the calendar year. This means that counties are not able to monitor the use of IHSS hours on a regular basis. Many QA programs regularly scrutinize the records of providers who are paid for delivering over 300 hours of service each month (the equivalent of ten–hour days, seven days per week). Although providers are allowed to work such a heavy schedule, it would be difficult for a provider to actually work this many hours on an ongoing basis. The QA monitors regularly follow up with providers and recipients in such situations to verify whether the services were actually delivered. The lack of any deadline for providers to submit their time cards for payment undercuts these QA efforts. Providers who do not submit their time cards until the end of the year will not appear on a “300–hour report” and would therefore be able in many cases to avoid an investigation.

Time Card Reforms Could Improve Program Integrity

To increase oversight and accountability in the IHSS program, we recommend the enactment of legislation to reform current time card practices. Specifically, we recommend requiring providers to (1) document on their time card the actual hours that they provide services and (2) turn in their time cards within one month of providing care. This would assist IHSS fraud investigators, increase program oversight, and hold providers accountable for the services they provide.