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ilbegone
12-28-2009, 06:02 PM
Crackdown set as fraud drains funds


WELFARE: County to use high-tech system to find cheaters, stop increasing losses

By Troy Anderson, Staff Writer

12/27/2009

At an age in which she could have received in-home care herself, Pacoima resident Susie Claborn, 73, seemed an unlikely welfare cheat.

But prosecutors say she used two identifications - belonging to her incarcerated son and her granddaughter - to fraudulently bill the In-Home Supportive Services program $116,000.

She pleaded guilty to grand theft, identity theft and forgery and was placed on five years of probation, ordered to perform 500 hours of community service and pay $116,000 in restitution.

Claborn was one of nearly two dozen people arrested last summer during a joint-agency arrest sweep targeting people accused of bilking taxpayers out of more than $2.3 million in phony public assistance benefits. Claborn's public defender, David Foley, did not return calls for comment.

Authorities say her case and the others caught up in the sweep represent the kind of welfare fraud in Los Angeles County that has seen an astounding increase recently, going up more than 39 percent in only the past two years.

To combat the rise, county officials this month approved a new high-tech "data-mining" system designed to alert authorities to signs of possible fraud and catch cheaters and fraud rings before they bilk the government out of hundreds of thousands or millions of dollars.

"This technology will be a vital tool in our effort to prevent public assistance fraud and enhance the district attorney's fraud investigators," Supervisor Michael D. Antonovich said.

"In a recent successful pilot program I initiated utilizing this technology, we achieved an 85percent success rate in detecting fraud rings."

The Board of Supervisors last week approved the contract to use data mining to detect child care, IHSS and other welfare fraud. The technology looks for hidden patterns and red flags in welfare applications, IHSS documents and Food Stamps reports to identify fraud and people receiving duplicate benefits.

It looks at suspicious characteristics and circumstances, such as unusually large distances between work and home addresses listed in county paperwork, inconsistencies in information and relationships among people who are participating in activities that have been flagged, Antonovich said.

The supervisors first voted to study the use of data mining technologies in 2007 following a Daily News series that examined and detailed the widespread fraud in federal, state and local government health and welfare programs by organized crime groups.

Experts estimate as much as $300 billion a year is lost to health and welfare fraud in the United States - about half of it to organized crime.

In 2007, the county's civil grand jury estimated child care fraud costs county taxpayers $500 million annually. Last year, the civil grand jury found "scam artists" were "embedded" in DPSS' IHSS program, which provides in-home care to the elderly and disabled.

"Welfare fraud is a huge problem in Los Angeles County," said Patrick Sequeira, the assistant head deputy in the District Attorney Office's Welfare Fraud Division.

"When I came to this unit (recently), I was astounded by the scope and breadth and just the huge amounts of fraud going on. I had no idea, even as a prosecutor for (more than 20 years), there was this much welfare fraud going on in the county."

In recent years, the number of reports of child care fraud the Department of Public Social Services has investigated has shot up almost 39 percent, increasing from 539 in all of 2007 to 747 as of Nov. 30 this year. In the past three years, DPSS has referred nearly 900 IHSS fraud cases to the state for investigation, according to DPSS data.

Sequeira said organized crime rings are involved in welfare fraud, often targeting multiple programs such as child care, IHSS, Food Stamps, Medicare and Medi-Cal.

"There are definitely organized crime rings involved in what I call public assistance fraud," Sequeira said. "The booming area is IHSS fraud. There is a tremendous amount of fraud we've found in the small area of investigation we've done in that area."

DPSS Director Phillip L. Browning said his department got permission last week from the state Department of Social Services to began investigating IHSS fraud.

"There have been organized fraud rings involved in both child care and IHSS fraud and this data mining tool is going to help us in these areas," Browning said.

In the past decade, the number of county residents receiving in-home care has doubled to 190,000 and officials say fraud in the $1.6 billion program has grown, too.

Growing concerns about fraud in the program arose after the settlement of two whistle-blower lawsuits involving DPSS workers.

Last year, the Board of Supervisors approved a $148,000 settlement for DPSS employee Sandra Siedenburg who said she suffered retaliation for reporting fraud. In 2006, the supervisors approved a $250,000 settlement with former DPSS welfare case reviewer Gamil Youssef who alleged he was retaliated against for blowing the whistle on fraud inside the department.

Prosecutors say many of those involved in in-home care scams are also involved in abuse of programs to help the needy with child care, Section8 housing and food stamps, as well as assistance through federal and state welfare and Supplemental Security Income programs.

By defrauding various programs, prosecutors say welfare cheats can make up to $100,000 a year tax-free.

"Generally speaking, some of your major welfare cheats find ways to commit fraud in more than one program," Sequeira said. "Sometimes, the fraud is fairly complicated. Many involve people claiming to be providing IHSS care for a patient who has died, or may have been in a convalescent home or a hospital for lengthy periods of time."

In the past, Sequeira said a lack of state IHSS fraud investigators, institutional barriers and bureaucratic inefficiencies have permitted welfare fraud to flourish.

But Browning is optimistic the new data mining tools and the ability of DPSS to now investigate IHSS fraud will help bring many more welfare cheats to justice.

In October, the county supervisors passed a motion to identify the necessary matching county funds to free up nearly $10 million in state funding to combat fraud in the IHSS program. The plan includes the use of data mining.

"We are going to be one of the first jurisdictions in the nation to actually have a system like this one," Browning said.

Manuel H. Moreno, the research director in the Chief Executive Officer's Service Integration Branch who is overseeing the data mining operation, said the tool will assign a number similar to a credit score to welfare recipients, alerting investigators to suspicious activities.

"We know certain individuals and providers have committed fraud in the past so we can use their past characteristics to develop a model to identify new participants and providers who fit that model," Moreno said. "We'll assign them a risk score."

"In addition, data mining technology has a really sophisticated tool called social network analysis. It allows us to see relationships between participants and providers so we can put the whole picture together based on these models to identify and detect suspicious activities."

Jeanfromfillmore
12-28-2009, 08:15 PM
Well at least they're admitting to the fraud. But how much they'll actually do something about is still another question. I sound cynical but I don't put much faith in their monitoring themselves, they're too used to doing what they've done in the past. Only when they risk losing their own job will they put much effort into correcting their own negligence.