Media Release

For Immediate Release Thursday, July 22, 2010

COUNTY ENDS RELATIONSHIP WITH MEDICAID VENDOR FOLLOWING INVESTIGATION

Center for Disability Rights Removed as Vendor; Investigation Uncovers Pervasive Failures in Client Care

The Monroe County Department of Human Services today terminated its business relationship with the Center for Disability Rights, Inc. (CDR) following an investigation of their participation in the Consumer Directed Personal Assistance Program (CDPAP) that found widespread lapses in client care.

CDR is primarily known as an advocacy group for people with disabilities. In 1998, CDR decided to become a municipal vendor and entered into an agreement with the County to act as one of several service providers for the County's Consumer Directed Personal Assistance Program (CDPAP). The CDPAP is a Medicaid program that provides services to the chronically ill or individuals with physical disabilities who have a medical need for help with activities of daily living or skilled nursing services. Services can include any of the responsibilities provided by a personal care aide (home attendant), home health aide, or nurse.

As a service vendor, CDR had an obligation and the responsibility to maintain the highest degree of patient care and fiscal management for clients who were otherwise unable to care for themselves. Results of an investigation conducted by the County have found CDR to be highly negligent in their ability to monitor care for the clients in their charge. A report from County Human Services Commissioner Kelly Reed is attached to this release and describes in detail many of the findings that forced the County to remove CDR as an approved vendor for the program. Some examples include:

• An extremely unsettling complaint involving a quadriplegic client living with Multiple Sclerosis. This client reported that she was often left unattended, with the knowledge of CDR. During a recent home visit conducted by a Physical Therapist from Home Care of Rochester, the client was found alone, as the CDR attendant had failed to arrive for coverage at all that day. When the client was found, the puffer apparatus that assists her in moving her wheelchair had fallen out of her mouth (meaning she was not able to operate her chair or call anyone for help), and her urine bag was overflowing. The client was hospitalized as a result of this incident. She is now in nursing home care - where it is expected she will be forced to remain.

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• A client living with disabilities requiring 24-hour service cannot write and has a Self Directing Other (SDO) who schedules her aide service for her. Client fears for her safety because the SDO schedules aides without the approval of the client. On one occasion, an aide came to the client's home intoxicated and fell asleep on the client's couch. The SDO threatened to put the client in a nursing home if the client complained.

A letter has been sent to clients who are active in the CDPAP notifying them of the County's decision to remove CDR as a vendor for this program. Monroe County currently contracts with five other service vendors for CDPAP and clients will see no interruption in service during this transition.

«These are just some examples of unannounced home visits to CDR clients conducted by DHS investigators. All visits demonstrated an obvious lack of professionalism, care, concern, and diligence on the part of CDR, and an inability to perform the necessary obligations to ensure client safety as a vendor for Monroe County," said Commissioner Kelly Reed. «Based on these investigations, attorneys from the Monroe County Law Department have deemed 4 accounts - at the very least - serious enough to terminate CDR from operating in a business capacity for Monroe County. 7)

The New York State Attorney General's Office is currently investigating CDR for fraud and abuse of the Medicaid program, and is prosecuting aides working under the auspices of CDR in Monroe and Ontario counties.

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Media Inquiries, contact:

Department of Human Services at 753-6298

Department of Human Services Monroe County, New York

Maggie Brooks County Executive

Kelly A. Reed Commissioner

To:

Maggie Brooks, County Executive

Date:

July 14, 2010

Subject:

CDR Contract for CDPAP Services

CC:

Dan DeLaus, Deputy County Executive Rick Marchese, Deputy County Attomey

Robert Franklin, Deputy Commissioner, MCDHS

Marc Natale, Director, Administrative Services, MCDHS File

County Executive Brooks,

As Commissioner of the Monroe County Department of Human Services, I feel obligated to inform you of recent findings and serious concerns regarding a Department of Human Services (DHS) vendor, the Center for Disability Rights, Inc. (CDR).

Monroe County has worked with CDR in earnest for nearly a year to rectify what we feel is an unacceptable level of performance on the part of any County-contracted vendor. In our opinion, CDR has acted, or failed to act, in a way that not only represents a disservice to taxpayers, but blatantly jeopardizes the health and overall wellbeing of some of our community's most vulnerable residents. Furthermore, it IS Monroe County's understanding that CDR has been under and continues to be under investigation by the New York State Attorney General's Office for cases of client neglect, resulting in ongoing prosecutions of client aides in both Monroe and Ontario counties. One of these instances involved aides who allegedly left patients with severe disabilities un-attended on several occasions while they were off-site playing BINGO. Other aides were revealed to be both usmg and selling illegal drugs from a patient's residence. Both of these were cases involving CDR.

It is important to recall that concerns with CDR were a driving force behind Monroe County's implementation of the Voice Recognition System (VRS) III the DHS COILSumer Directed Personal Attendant Program (COP AP). VRS was launched in July 2009 to ensure the safety of clients in the CDPAP Program as well as to reinforce Monroe County's commitment to eliminating waste, fraud, and abuse in all Social Service programs. We had hoped at the time that VRS would effectively put an end to our concerns with CDR. However, not only did CDR take serious issue with our Implementation of a program designed to protect the very clients they are contracted to serve, but DHS continued to hear of instances where CDR was allegedly making program decisions that compromised the safety and best interest of our clients.

These concerns ranged from direct complaints by clients who reported that CDR was not performing routine home visits to an extremely unsettling complaint involving a quadriplegic client living with Multiple Sclerosis. This client reported that she was often left unattended, with the knowledge of CDR, despite the fact that she IS largely unable to do anything for herself and her medical needs require 24

111 Westfall Road. Rochester, New York 14620

(585) 753-6000. Wl1'li'.monroecoun1)!.gov. mchhs@mom·oecounty.gov

hour care. During a recent home visit conducted by a Physical Therapist from Home Care of Rochester, the client was found alone, as the CDR attendant had failed to arrive for coverage at all that day. When the client was found, the puffer apparatus that assists her III moving her wheelchair had fallen out of her mouth (meaning she was not able to operate her chair or call anyone for help), and her urine bag was overflowing. It was later revealed that CDR was directly aware of this incident and knew it had not provided sufficient coverage for a 24-hour case, but failed to inform DHS of the dire need to reassess for a different plan of care.

The client was hospitalized as a result of this incident. She is now III nursing home care - where it is expected she will be forced to remain.

When this appalling case was brought to our attention, DRS initiated a series of unannounced home visits to 24-hour clients receiving services through the Center for Disability Rights. In each case, we found some degree of negligence on the pa.l1 of CDR. The following includes four specific findings of the twelve cases we investigated:

• A DHS investigator knocked on the door of Client #1 's horne, but there was no answer.

The investigator was told by a neighbor that the client had moved. Our Home Care Unit (HCU) located the client with the assistance of family members, finding that he had moved nine days prior and had notified CDR of his move. This represents a safety issue because HCV must assess the suitability of an apartment to ensure the well being of a client. It also appears, through Medicaid billing, that this client frequently goes without coverage. From 2/1 - 4/4/2009, for instance, this client had less than 24-hoUl" coverage for 24 out of 63 days, including days where he recieved only 8, 12, and 16 hours of coverage. CDR receives timesheets weekly. CDR's Service Coordinator is explicitly assigned to review coverage hours and notify DHS of any change in conditions for a client within 2 days. ThIS was never done, yet CDR is under contractual obligation to do so.

• Client #2 is a spasmodic paraplegic and is unable to care for himself without assistance.

A CDR Attendant was present when the investigator's visit was conducted. However, the attendant had not checked-in on the VRS system, as required. The client relayed to the investigator that he sometimes has trouble with his aides who call III at the last minute and say that they are not able to come for their shift. As a result, this client often goes without coverage for a period of time, usually throughout the night. In a shoddy attempt to mitigate this issue, CDR provided the client with a Lifeline call button to push in case there was an emergency when an aide was not present. The obvious concern with this plan is that the client does not have dexterity in his arms or hands to utilize the call button. The client stated that it was his opinion that, "it is done this way so that they (CDR) avoid any liability/responsibility", CDR has not notified DHS about coverage Issues with this client. A check of Medicaid billing shows that for 30 of tile past 69 days this client has received less than 24-hoUl" coverage, and at times he has had coverage for only 6 or 10 hours in a 24 hour period.

• Client #3 IS a disabled 90 year-old gentleman whose attendants had not used the VRS system at all prior to the home visit conducted by our investigator. The client reports he was having Issues with an aide who was showing up late on a regular basis thereby presenting periods of time where he had no coverage. The client notified CDR of this concern, but CDR failed to report this to DHS or to directly address it for the client.

111 Westfall Road. Rochester, New York 14620

(585) 753-6000 • fax: (585) 753-6296 • 11'11'11'. 111 onro eco u nty. go 11 • mchhs@mollroecounty.gov

• Client #4 lives with disabilities requiring 24-hour service. She cannot write and has a Self Directing Other (SDO) who schedules her aide service for her. She fears for her safety because the SDO schedules aides without the approval of the client, For example, one aide came to her home intoxicated and fell asleep on her couch. The SDO threatens to put the client in a nursing home if she complains, This client had told CDR on two separate occasions about her concerns, the most recent being a week before the unscheduled visit by our investigators, but CDR failed to do anything to ensure the safety of the client. CDR also failed to notify DHS about the concern.

These are just some examples of unannounced home visits to CDR clients conducted by DHS investigators. All visits demonstrated an obvious lack of professionalism, care, concern, and diligence on the part of CDR, and an inability to perform the necessary obligations to ensure client safety as a vendor for Monroe County. Based on these investigations, attorneys from the Monroe County Law Department have deemed 4 accounts - at the very least - serious enough to terminate CDR from operating in a business capacity for Monroe County.

DHS has also met with multiple State agencies who indicated their continued interest 1Il pursuing CDR for fraud and abuse of the Medicaid program. Due to ongoing investigations of this vendor for both patient neglect and financial mismanagement, the Monroe County Law Department has ultimately advised that Monroe County not enter into a new contract with CDR. Continuing a business relationship with CDR under these circumstances would ultimately place many DHS clients in immediate and grave danger.

I cannot conclude any discussion regarding the County's business relationship with CDR without also making mention of the two dual and distinctly different roles that CDR holds within our community. CDR is primarily an advocacy organization for local residents livmg with disabilities, which ultimately chose to enter into business as a for-profit home care provider several years ago. With this 1Il mind, we must hold CDR to the same standard as we do any other County-contracted vendor, regardless of its advocacy roots. This IS especially hue when the safety ofDHS clients IS placed at risk.

Therefore, in closing, it 1S my recommendation that Monroe County end its relationship with the Center for Disability Rights as a vendor for the CDPAP Program immediately.

Sincerely,

Kelly A. Reed Commissioner

111 Westfall Road. Rochester, New York 14620

(585) 753-6000 • fax: (585) 753-6296 • 11'11'11'. 111 onro eco u nty. go 11 • mchhs@mollroecounty.gov

News From

THE MONROE COUNTY DEPARTMENT OF COMM:UNICATIONS

FOR IMMEDIATE RELEASE:

Tuesday, July 27, 2010

FREQUENTLY ASKED QUESTIONS REGARDING MONROE COUNTY'S DECISION TO END RELATIONSHIP WITH CDR Addresses Common Misconceptions Perpetuated by CDR

QUESTION: Why did Monroe County termi.nate its business relationship with the Center for Disability Rights, Inc. (CDR)?

ANSWER: Following a series of direct complaints from clients in the Consumer Directed Personal Assistance Program (CDPAP), the Monroe County Department of Human Services (DHS) launched an investigation. DHS visited 12 clients receiving CDPAP services through CDR - In 100% of these cases (12 of 12) investigators found an obvious lack of professionalism, care, concern, and diligence on the part of CDR, and an inability to ensure client safety as a vendor for Monroe County. The decision was made to remove CDR as a vendor in order to protect clients that were being put at risk.

QUESTION: Will clients currently receiving services through CDPAP be removed from the program?

ANSWER: NO. Monroe County recently sent a letter to CDPAP clients notifying them of the County's decision to remove CDR as a vendor. Because Monroe County still contracts with FIVE other service vendors for CDPAP, clients have the opportunity to maintain CDPAP services while seeing no interruption in coverage during the transition. While the County requested that clients make this decision within 10 days, more time will be given if needed.

QUESTION: Can CDPAP clients keep their personal aides as a result of the transition?

ANSWER: YES. It is likely that clients will be able to maintain their personal aide once they have selected one of five other CDPAP vendors. Each former CDR aide will be eligible to be hired by any of these five vendors, provided they pass a criminal background check, physical exam, drug test, and Tuberculosis screening test.

QUESTION: Are the five other contracted agencies ready to accept new clients?

ANSWER:

YES, all five agencies are prepared to offer expedited services to hire aides to make the transition as seamless and efficient as possible for clients.

QUESTION: Should CDPAP clients follow the advice of CDR by refusing to select a new CDPAP vendor, fail to recertify, or complete relevant paperwork?

ANSWER: NO. Monroe County is working closely with CDPAP clients to ensure a

seamless transition of care during the vendor selection process. Failing to select a new vendor or comply with the guidelines of that process could compromise care for those clients.

QUESTION: Have CDPAP aides employed by CDR. been convicted of fraud or abuse in the CDPAP program?

ANSWER: YES. There are several cases that came to the attention of the New York State Attorney General's Office (AG) , including what is commonly known as the "Bingo" case. CDR aides involved in this case were proven to have left a client's apartment to play Bingo for hours at a time, all while billing Medicaid for hours they were not caring for the client. Convicted CDR aides include:

• Loretta Lowry - charged w] petite larceny on 12/10/2009. On 2/4/09 - sentenced to 3 years probation, 30 hours of community service and ordered to pay restitution of $756.40.

• Patrina Mason - charged with Grand Larceny 4th, falsifying business record 1st on 6/19/09. on 8/13/09 sentenced t03 months in jail, 5 years probation, ordered to pay restitution of $947.40.

• Patricia McCauley - charged with Grand Larceny 4th, Falsifying Business records 1st on 6/19/09. On 8/13/09 sentenced to 24 weekends in jail, 5 years probation, and ordered to pay restitution of $345.00.

• Denise Wright - charged with Petite Larceny, Falsifying business records l st on 12/16/08. On 2/10/09 sentenced to 26 weekends in jail, 1 yr conditional discharge and ordered to pay restitution of $747.00.

There are several other CDR aides currently under investigation by multiple State Agencies in relation to activities perpetrated while working for CDR.

QUESTION: Did CDR have prior knowledge of MonroeCou.nty's concerns regarding its performance as a vendor for the CDPAP program?

ANSWER: YES. Monroe County worked with CDR in earnest for nearly a year to rectify what was an unacceptable level of performance on the part of any Countycontracted vendor. CDR acted, or failed to act, in a way that not only represents a disservice to taxpayers, but blatantly jeopardized the health and overall wellbeing of CDPAP clients.

QUESTION: How much was CDR's .agreement with Monroe Cou.nty to provide services as a CDPAP vendor worth?

ANSWER: Approximately $15.4 million for calendar year 2009. However, compared with other regional CDPAP providers, CDR paid its aides the lowest average salary. Yet CDR was able to afford exorbitant salaries for its executives, including:

• CEO Bruce Darling - $184,000 annual salary (in 2008, has likely grown since)

(SOURCE: IRS Forrn 990 Filings for income tax year 2008)

QUESTION: Will Monroe Cou.nty's decision to remove CDR asa vendor for the CDPAP program ultimately cost taxp.ayers more?

ANSWER: Most likely not. While hourly compensation wages for aides working under the five other CDPAP vendors contracting with Monroe County could change, Monroe County anticipates that the overall cost of providing service for CDPAP clients will remain flat.

QUESTION: Will any amount of grandstanding or protesting by CDR Executives sway Monroe Cou.nty'sdecision to end its business relationship with CDR?

ANSWER: NO. Monroe County's decision is final. The Monroe County Department of Human Services is working to facilitate the smooth transition of uninterrupted services to clients of the Consumer Directed Personal Assistance Program. If it truly cares about persons with disabilities, CDR should assist clients during the transition period rather than be disruptive. Multiple reports have indicated that CDR is instructing clients not to cooperate with the transition, which could impact their ability to continue recervrng services.