New York Times Continues Series on New York’s Homes for Adults with Mental Illnesses
In the final article of a three-part series on New York state's privately-run homes for adults with mental illnesses, the New York Times examines some of the tactics often used by homes' operators and affiliated health care providers to "exploit" mentally ill residents. The for-profit facilities, created to provide "decent alternative[s] to the dead-end misery" of state psychiatric hospitals, have become "magnets for schemes" that take advantage of the mentally ill, according to the Times. Generally operated by business people with no mental health training, the homes receive $28 per person per day, which the state takes from residents' monthly Social Security disability checks, to "feed, shelter and supervise" residents. The facilities, which do not provide health care themselves, contract with outside providers for health services. With such low reimbursement coming from the state, several operators decided that they could make a substantial profit by charging contracted providers rent or fees in return for a "bountiful supply of patients." Some operators also have set up side businesses, such as van services that residents are required to use to go to clinics or doctors' offices. Workers at several of the homes said that residents who refused to see doctors or other providers that had financial agreements with the operators were often threatened. A former worker at the Queens-based Leben Home for Adults said, "We would usually tell them, 'If you don't see the doctor, you don't get your allowance,'" adding, "I had to do that ... [it] was the policy." Inappropriate billing practices were found at almost all of the 26 adult homes the Times investigated. In addition, the Times found that many residents "often go without proper psychiatric or medical care, [but] they are paraded before allergists, vocational therapists, dermatologists, podiatrists," and other providers and often receive unnecessary procedures. Operators then charge Medicare or Medicaid for the services.
The "coercive tactics" employed by operators and providers at the adult homes are largely "symptomatic of a system that is loosely regulated and licensed," the Times reports. A 1999 audit by the state comptroller found that the state Department of Health did not verify references or financial information for operator applications and did not investigate if applicants had criminal records. When questioned about its efforts to protect adult home residents from fraudulent operators and providers, the health department only pointed to its recent "crackdown" on part-time medical clinics throughout the state, some of which are located in adult homes. The department has denied license renewal for 50 part-time clinics in the state, and delayed the approval of 23 more, according to Deputy Health Commissioner Robert Hinckley. "The disapprovals of part-time clinic applications for adult homes were based on quality of care concerns and the potential for Medicare fraud," he added (Levy, New York Times, 4/30).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.