Starvation case shows abuse in state system

Some issues reported by CareStar in home care programs statewide July-September 2011:

Amount of criminal restitution orders and settlements for Medicaid fraud secured by the Ohio Attorney General’s Office last year:

DAYTON — In the year leading up to 14-year-old Makayla Norman starving to death in her home, the home care agency responsible for feeding her received nearly $1 million in Medicaid funds caring for Makayla and 112 other disabled clients.

Makayla was caught in an extensive bureaucracy where officials say fraud is a massive and growing problem, and where regulators are swamped with thousands of allegations every year. Government officials say they’re reviewing their systems to determine how she got lost.

Makayla, stricken with severe cerebral palsy and unable to speak, walk or feed herself, was cared for at home under a program intended to keep her safe with her family rather than in a more expensive nursing home, saving taxpayers money.

State officials, citing state and federal privacy laws, declined to say how much taxpayers paid for Makayla’s care through Medicaid.

At her death March 1, Makayla weighed 28 pounds, her unwashed body covered with open bed sores, some packed with her own feces.

The Montgomery County Coroner ruled her death a homicide by reason of medical and nutritional neglect. Her only source of nutrition was the five to six cans of Ensure — an over-the-counter dietary supplement — she was to get daily through a feeding tube.

Her mother, Angela Norman, and three nurses — Molly Parsons, Kathryn Williams and Mary Kilby — charged with Makayla’s care, are facing criminal charges. Parsons and Williams worked for Exclusive Home Health Care of Huber Heights. Parsons provided the daily care, and Williams — a registered nurse — supervised that care and reported back to Exclusive monthly the state of Makayla’s health. Williams was to see Makayla every month.

Kilby worked for CareStar of Ohio as case manager for Makayla to ensure her eligibility for the program, to develop her care plan and to check that the care plan was followed. Kilby was to see Makayla every six months.

Both Exclusive and CareStar worked as proxies for Ohio Department of Job and Family Services under separate contracts. ODJFS had no face-to-face contact with Makayla or any of the other disabled children for which it is responsible.

Despite the oversight of two health care providers and a state agency, Makayla lived the last year of her life in horrific conditions.

“We don’t get cases like this. She was the worst malnourished child I think we’ve ever seen,” said Ken Betz, director of the Miami Valley Regional Crime Laboratory and Coroner’s Office.

Home care

Parsons, 41, of Dayton, a licensed practical nurse for Exclusive, had cared for Makayla for 11 years, Dayton homicide Detective Rebecca Rose testified at Parsons’ bond hearing. The grand jury indicted Parsons with involuntary manslaughter. She remains in the Montgomery County Jail on $250,000 bond.

Parsons filled out daily nursing reports, showing she worked up to 48 hours a week, caring for the child. Rose testified that witnesses, however, reported seeing Parsons at the family home only three to four times a month.

Those daily reports were given to Williams, 42, of Englewood, a registered nurse hired by Exclusive to supervise Parsons’ work and monthly check on the care given Makayla. Williams’ reports on Makayla’s care — based on Parsons’ reports — were forwarded by Exclusive to ODJFS. None of the reports indicated weight loss, bed sores or any abnormal physical problems for Makayla. The grand jury indicted Williams on charges of failing to report neglect or abuse.

Makayla’s mother, Angela Norman, 42, of Dayton, like Parsons, was indicted on charges of involuntary manslaughter and remains jailed on $250,000 bond.

Exclusive was the subject of 20 investigations by the Ohio Department of Job and Family Services, in 2010 and 2011, according to a Dayton Daily News analysis of state data. Only three were substantiated. By comparison, the data had 10 other home care agencies in this region with more than a dozen substantiated complaints in the past two years.

A spokeswoman for Exclusive owner Sheila Grubbs said Grubbs cannot comment during the ongoing investigation. Dayton police detectives have praised the cooperation of Grubbs and Exclusive in the police probe of Makayla’s death.

Oversight

The Ohio Department of Job and Family Services, meanwhile, is reviewing the strength of its safety net, and how it failed to protect Makayla.

ODJFS pays CareStar of Ohio roughly $30 million annually to act as its proxy to oversee various Medicaid programs, including the one that covered Makayla.

ODJFS relied soley on reports prepared by CareStar and Exclusive that Makayla was getting the care for which taxpayers were paying.

Mary K. Kilby, 62, of Miamisburg, Malayla’s CareStar care manager, was responsible for ensuring Makayla received the proper care by reviewing Exclusive’s reports and visiting the child every six months. Dayton police detectives said Kilby had visited the home five days before Makayla’s death. A Montgomery County grand jury indicted Kilby on a charge of failing to report abuse or neglect.

ODJFS monitors CareStar through annual, quarterly and monthly reports prepared by CareStar. The most recently quarterly report said the company had a 99 percent compliance rate with its visitation requirements over the past year.

CareStar President Tom Gruber said he can’t comment on Makayla’s case. “We are cooperating with the investigation, both the police and the state, and unfortunately we’re not at liberty to share any details,” he said.

In general, he said the company does “a very good job. ... There are prescriptions within the contract and guidelines we need to adhere to and, generally speaking, we not only adhere to but exceed the standards they put upon us.”

CareStar has 400 employees and a contract worth $30 million a year to oversee about 10,000 home care providers.

“It’s a large pool of providers and by and large they do an excellent job,” Gruber said.

Kerstin Sjoberg-Witt, legal director for the Ohio Legal Rights Service — a federal agency that acts as an advocate for people with disabilities — said the agency’s concerns with CareStar have stemmed mostly from the company refusing services for people to keep costs down. She said the agency is monitoring the Norman case.

CareStar and ODJFS handle thousands of investigations of providers every year, according to documents obtained by the Daily News via a public records request. This does not include home care provided through the Ohio Department of Aging or the Ohio Department of Developmental Disabilities.

In this region, ODJFS found more than 500 substantiated allegations in 2010 and 2011. This included 20 substantiated claims of neglect and abuse.

CareStar’s quarterly report says there were 35 substantiated fraud allegations in southwest Ohio through September this year.

Statewide, there have been 3,804 investigations of 441 home health agencies in 2011. So far, 1,714 of the allegations have been substantiated and 1,671 have been unsubstantiated. Substantiated claims are referred to law enforcement — some become AG’s Office investigations — or licensing agencies.

Parallel probe

As the criminal prosecution proceeds, the state attorney general has begun a parallel investigation into Medicaid fraud is under way.

The number of Medicaid fraud complaints investigated by the state AG’s office increased 10 percent to 549 this year. The largest subject of opened investigations was home care providers.

Ohio Attorney General Mike DeWine said this growth is fed largely by increasing reliance on in-home care, which saves taxpayers money and keeps people in the comfort of their own homes, but also opens the door to fraud.

“There’s less supervision, there’s less accountability. It’s easier to steal money,” he said. “The person who’s getting the care sometimes is not in the position to complain.”

To address this, DeWine said he’s beefing up his Medicaid fraud staff. From July 2010 through June 2011, the Ohio Attorney General’s fraud unit obtained 114 Medicaid fraud convictions and seven for patient abuse or neglect. The total value of restitution orders and civil settlements was $101.8 million.

Allegations of fraud include falsified documents, kickbacks to consumers from providers and billing for services not provided. Through September 2011, there were 158 substantiated fraud allegations. CareStar’s quarterly report says more than $500,000 is suspected of going to ineligible providers in July through September alone.

“If you are relying on other people for your care, that does make you more vulnerable to abuse or exploitation by your caregivers,” Sjoberg-Witt said.