Foley questions state handling of publicly funded program aiding people with disabilities
By Cindy Gonzalez | Nebraska Examiner
LINCOLN — Nebraska State Auditor Mike Foley has called out a state agency for allowing “outrageous” dysfunction in a publicly funded program that provides personal assistance to people with disabilities.
In an 11-page letter Monday to Steve Corsi, chief executive of the Nebraska Department of Health and Human Services, Foley’s team alleged “ongoing financial abuse” in the personal assistance services (PAS) program that helps Medicaid-eligible Nebraskans with mobility, hygiene and housekeeping.
“Numerous PAS caregivers continue to milk the program with false, inflated and duplicate billings,” Foley said, adding that the alarm to DHHS was his office’s third since February 2024.
He said DHHS “oversight failures may, in fact, be feeding the problem — effectively setting the stage for some truly mind boggling improprieties, financial and otherwise.”
Information uncovered by the audit team was forwarded to law enforcement for review of possible legal violations.
Energizer bunny?
In one case, the auditors said, a caregiver had been authorized to deliver 66 hours of personal assistance services a week despite holding down a full-time job as a school bus driver. Auditors identified 28 days during which the caregiver billed DHHS for performing client services at the exact times she was documented to have been driving students.
(DHHS) oversight failures may, in fact, be feeding the problem — effectively setting the stage for some truly mind boggling improprieties, financial and otherwise.
– Nebraska State Auditor Mike Foley
In another example, Foley described a personal caregiver who billed DHHS for 70 days of client services while working full-time for a family counseling business. He said that created an “impossible scenario” of the caregiver working more than 24 hours in each of 45 days during a three-month period reviewed.
“Some of these caregivers claim to be performing work schedules that would make the Energizer Bunny look like a slacker,” said Foley.
That caregiver had tapped into other public programs as well, including the larger personal care services (PCS) budget and foster care. Particularly troubling to the auditor was that the caregiver in that case provided help to two adult clients who lived in her home. And one, a relative, was on the sex offender registry for having been convicted of felony sex trafficking of children in 2014. Living in the home as well, said Foley, was a 14-year-old girl in the state foster care system.
He said the caregiver appeared to have been purposefully deceitful in failing to disclose to foster care agencies that the past offender lived in the house. In seeking personal care aid, the provider reportedly claimed the relative lived in a backyard “cabin,” for which cleaning was authorized.
“When the audit team reported this bizarre and unsafe domestic arrangement, DHHS removed the foster child from the home,” Foley said.
The findings surfaced during the ongoing statewide annual audit and were reported to Corsi early due to “urgent need for corrective action,” the letter said.
For fiscal year 2025, PAS expenses totaled $10.5 million, of which the federal government covers 60% of costs and the state pays 40%. The PCS program has the same federal-state split for a much larger budget. Foley said the Monday letter aimed mostly at the PAS program.
Revelations outlined in the Monday letter were based on a review of four care providers and one 10-client agency that deals with high dollar amounts. Of the fraction reviewed, the auditing team found about $19,300 in questionable spending.
‘Increasingly egregious’
Another of the examples cited by Foley was a caregiver authorized by DHHS to be paid for 118 hours of service per week, split across three separate clients. Two were her parents, who did not live with her.
“This would require the provider to perform services for more than 16 hours every day of the week,” the team noted in the report, calling that authorization unreasonable.
Foley said he is convinced that a more thorough combing would lead to “a whole lot more” problems. His concern was heightened by an ongoing pattern, he said. Monday’s letter is the latest in a series of communications to DHHS over the past decade alleging potential fraud and other issues that, according to Foley, “appear to have grown increasingly egregious.”
DHHS leadership saw the findings before the public release, and included a response in the letter.
In it, agency managers said they agree with the auditor team’s recommendations to implement procedures that ensure proper payments. They also said DHHS already has taken “significant” steps to implement controls that should mitigate most of the conditions observed by auditors.
In February, for example, the Medicaid and Long-Term Care team started requiring GPS/IVR visit verification and recipient signatures to support a claim payment.
Among other actions, the Child and Family Services will work with the Nebraska State Patrol to develop an automated process that compares addresses of foster parents with the Sex Offender Registry on a quarterly basis. The system is to help ensure no offender resides at the same address as a ward of the state.
DHHS contacts were listed as Jeremy Brussen of Medicaid and Long-Term Care and Kathleen Stolz of Child Family Services.
No pushback
Contacted Monday, a DHHS spokesman referred to the agency’s response in the auditor’s report, reiterating that the department agreed with recommendations and was actively implementing procedures and controls to ensure proper payment for services.
Foley said that with “all the attention” the personal assistance program has gotten, he would have expected more progress. However, he said, he is optimistic in the ability of Corsi’s DHHS, adding that his predecessor “used to fight us on everything.”
“We’re not getting any pushback,” Foley said of the agency.