IHSS - In-Home Supportive Services certified provider Fraud Prevention and Reporting Questions and Answers 1 — Questions and Answers
Question 1: An IHSS provider, Mark, is asked by his recipient to sign a timesheet for the entire pay period on the first day, with the promise that the recipient will 'let him know' if any days are missed. What is the most appropriate and compliant action for Mark to take?
- Sign the timesheet as requested to maintain a good relationship with the recipient.
- Refuse to sign the timesheet until all the hours for the pay period have been actually worked. (Correct answer)
- Sign the timesheet but keep a separate, personal log of hours worked to submit later if there's a discrepancy.
- Ask the recipient to initial each day on the timesheet in advance to confirm the planned hours.
Correct answer: Refuse to sign the timesheet until all the hours for the pay period have been actually worked.
Signing a timesheet is a legal declaration that the hours claimed have been worked. It is a fraudulent act to sign for work that has not yet been performed. Providers must only ask the recipient to sign a completed and accurate timesheet after the work for the pay period is finished.
Question 2: A provider suspects that a recipient is exaggerating their needs to the county social worker to receive more authorized hours than necessary. Which of the following is the provider's responsibility regarding potential fraud?
- Confront the recipient directly and demand they correct the information with the social worker.
- Continue working the authorized hours, as it is the social worker's job, not the provider's, to assess needs.
- Adjust the timesheet to reflect the hours they believe are actually needed, regardless of what is authorized.
- Report their concerns about potential fraud to the appropriate IHSS fraud hotline or county office. (Correct answer)
Correct answer: Report their concerns about potential fraud to the appropriate IHSS fraud hotline or county office.
Providers have a responsibility to report suspected fraud to protect the integrity of the IHSS program. It is not the provider's role to investigate, confront the recipient, or unilaterally change the authorized hours. The correct channel is to report the suspicion to the designated authorities, such as the IHSS Fraud Hotline.
Question 3: What is the primary purpose of the IHSS Quality Assurance (QA) program activities, such as unannounced home visits and desk reviews?
- To find reasons to reduce a recipient's total number of authorized service hours.
- To exclusively monitor the provider's job performance and adherence to the work schedule.
- To enhance program integrity, verify services are being delivered as authorized, and prevent fraud. (Correct answer)
- To provide additional training and certification opportunities for providers during the visit.
Correct answer: To enhance program integrity, verify services are being delivered as authorized, and prevent fraud.
The IHSS Quality Assurance (QA) program was established to improve program integrity, detect and prevent fraud and abuse, and ensure the quality of service needs assessments. Activities like home visits and reviews are designed to verify that authorized services are being appropriately delivered to meet the recipient's needs.
Question 4: A provider is hired to care for a recipient. The recipient's son, who is not an authorized provider, performs the care duties for a week while the main provider is on vacation. The son asks the main provider to submit a timesheet for that week and then pay him in cash. This practice is known as:
- Check Splitting
- Subcontracting (Correct answer)
- Timesheet Forging
- Authorized Delegation
Correct answer: Subcontracting
Subcontracting occurs when a registered provider claims hours and receives payment for work that was actually performed by another, unauthorized individual. This is a form of fraud, as only enrolled and approved providers can be paid for rendering IHSS services.
Question 5: Which of the following actions constitutes timesheet fraud?
- Claiming hours for domestic services while the recipient is temporarily in a skilled nursing facility. (Correct answer)
- Reporting the exact number of hours worked each day, even if it varies.
- Submitting a timesheet on the last day of the pay period after all work is completed.
- Discussing a discrepancy in remembered hours with the recipient before submitting the timesheet.
Correct answer: Claiming hours for domestic services while the recipient is temporarily in a skilled nursing facility.
Providers are not authorized to claim hours for services when the recipient is out of their home in a hospital, skilled nursing facility, or other institution. Claiming time for work under these circumstances is a form of fraud because services are meant to help the recipient remain safely in their *own home*.
Question 6: If an IHSS provider is convicted of fraud against a government health care program, what is the consequence for their eligibility to be an IHSS provider?
- They must complete a fraud prevention course to be recertified.
- They are permanently banned from ever being an IHSS provider.
- They are ineligible to be an IHSS provider for 10 years following the conviction. (Correct answer)
- Their eligibility is suspended for 1 year and they are subject to random audits.
Correct answer: They are ineligible to be an IHSS provider for 10 years following the conviction.
California law explicitly states that anyone convicted of fraud against a government health care or supportive services program, which includes IHSS, is ineligible to provide or receive payment for providing IHSS services for a period of 10 years.
IHSS - In-Home Supportive Services certified provider Fraud Prevention and Reporting Questions and Answers 1
An IHSS provider, Mark, is asked by his recipient to sign a timesheet for the entire pay period on the first day, with the promise that the recipient will 'let him know' if any days are missed.
What is the most appropriate and compliant action for Mark to take?