The Cayman Islands National Insurance Company has reported a case of suspected fraud in its home healthcare program to police after a patient who was supposed to be receiving the care said that had not happened.
CINICO Chief Executive Officer Lonny Tibbetts told the Legislative Assembly’s Finance Committee on Tuesday that it appeared someone had forged a signature on an official document stating that care had been provided during a certain period.
“We believe we have received fraudulent documents,” Mr. Tibbetts said. “They forged the signatures of the former caregiver.”
No evidence was presented to CINICO to show that a change in the patient’s caregiver had occurred, Mr. Tibbetts said.
The Royal Cayman Islands Police Service said officers opened an investigation after receiving the complaint last week.
Legislative Assembly members on the Finance Committee questioned Mr. Tibbetts regarding how receipts from the home-care program were authenticated if they are received from the caregiver, rather than from the patient receiving the service.
“The only evidence we have of a caregiver is a signed copy of their caregiver application form,” Mr. Tibbetts said.
East End MLA Arden McLean asked whether those signatures were examined to see if, in all cases, they “match up.”
“For the most part, yes, sir,” Mr. Tibbetts said.
“What do you mean ‘for the most part?’” Mr. McLean asked.
Mr. Tibbetts said the majority of claims submitted via the home healthcare program are accurate and comply with all the procedures CINICO requires during the application process. He said CINICO would investigate anything it discovered that was not correct, although he acknowledged that the agency has some staff limitations.
“This country needs to understand that, as far as possible, CINICO verifies the money that is being spent, is being spent correctly, efficiently and effectively, and no one is defrauding this country,” Mr. McLean said. “I do not believe I am receiving those answers.”
Mr. Tibbetts said in most cases, applications for home care are received from individuals who need limited-time assistance following surgery or other medical procedure if they are unable to do certain things for themselves around the house.
If the CINICO-insured patient is able, he or she would complete the form, and a secondary form would be completed by the patient’s doctor to explain why home healthcare would benefit the patient. Also, information would have to be provided regarding the care provider, if the patient was hiring someone, and whether that person was qualified to perform the services.
CINICO covers between $1,200 and $3,000 per month, depending on the level of care required. The insurance agency does not pay for long-term home care as part of this program, Mr. Tibbetts said.
Mr. Tibbetts said to the extent possible, the home-care program examines the validity of caregivers’ qualifications.
“There are a number of times where individuals have presented as caregivers … and we did not accept them for a number of reasons,” Mr. Tibbetts said. “We do not accept any liability for the quality of care.”
Mr. McLean said he was “confused” by this answer and indicated that CINICO representatives seemed to be saying they examined caregivers’ qualifications, but “in the other breath” they could not guarantee the person’s qualifications.
“Does CINICO verify if providers have [certification] when they’re paying out $2,000 [a month]?” Mr. McLean asked.
“Yes, sir, we do,” Mr. Tibbetts said.