215 Cal. App. 4th 56
Cal. Ct. App.2013Background
- IHSS program enables the aged, blind or disabled poor to remain in their homes with supportive services.
- Nancy Bedoe was found eligible and chose her son Michael Bedoe as her IHSS provider in 2007.
- In 2010 the County sought repayment of $29,560 for payments to Michael from 2007–2009 on the ground he did not perform services.
- Michael admitted he received IHSS payments March 2007–August 2009 but did not personally provide services; his sister Julie provided them instead.
- Julie provided services and Nancy/Julie mailed timesheets to Michael, who completed and signed them, depositing funds into Nancy’s account and keeping small amounts.
- IHSS rules prohibit subcontracting of services; the hearing officer sustained an overpayment based on Michael’s unsupported timesheets and payments.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Did an overpayment occur where Michael was paid for hours not worked? | Bedoe: overpayment since Michael did not provide services yet claimed payment. | Bedoe: subcontracting to Julie could avoid overpayment since services were performed by another. | Overpayment occurred; subcontracting not allowed. |
| Does the Program Guide authorize subcontracting or merely illustrate fraud scenarios? | Bedoe: subcontracting would be permitted under Guide language. | Bedoe: Guide only provides examples for possible prosecution, not a defense. | Guide does not authorize subcontracting; it describes potential fraud scenarios. |
| Is the finding of overpayment supported by substantial evidence? | Bedoe: evidence shows payments were for non-provided services. | Bedoe: lack of direct personal service by Michael could be explained by subcontracting. | Substantial evidence supports overpayment. |
Key Cases Cited
- Donley v. Davi, 180 Cal.App.4th 447 (Cal. Ct. App. 2009) (substantial evidence standard of review for agency decisions)
- Miller v. Woods, 148 Cal.App.3d 862 (Cal. Ct. App. 1984) (administrative regulations—relationship to statutes)
