Casey Urges Medicare Agency to Prevent Abuse of Older Adults and Workers at Caregiving Tech Company

Papa Inc., is a health tech company that pairs older adults with caregivers

Last summer, Casey pressed company to address alleged abuse and harassment of company’s customers and workers

Casey: “[The agency] must ensure that Medicare and Medicaid enrollees receive safe and high-quality home care”

Washington, D.C. - Today, U.S. Senator Bob Casey (D-PA), Chairman of the U.S. Senate Special Committee on Aging sent a letter to the Centers for Medicare and Medicaid Services (CMS), expressing concerns about reported abuse and care issues associated with Papa Inc., a company that pairs older adults with a caregiver to assist them with daily non-medical tasks such as shopping, transportation, and assistance with prescriptions. Last year, reporting uncovered instances of sexual harassment and alleged assault of the company’s customers and caregivers. Papa Inc., partners with health plans and receives payments from Medicaid and Medicare for the services it provides to plan enrollees, and in the letter, Chairman Casey inquired how CMS is ensuring the company is not delivering low quality or abusive care while taking federal funding.

Chairman Casey wrote, “As demand for home care services that enable older adults and people with disabilities to live at home continues to increase, service providers, insurers, and CMS must ensure that Medicare and Medicaid enrollees receive safe and high-quality home care. Similarly, care workers deserve to be treated with dignity… As Chairman of the Aging Committee, I have an interest in ensuring that older adults and people with disabilities are receiving high-quality care that is free from abuse, and that Medicare and Medicaid are receiving good value for taxpayer dollars.”

Last July, Chairman Casey sent a letter to Papa Inc., pressing the company to ensure that caregivers and care recipients are not being abused. In today’s letter, Casey requested that CMS provide information on its oversight of companies like Papa, Inc. that provide supplemental services to Medicare and Medicaid enrollees.

Read the full letter HERE or below:

The Honorable Chiquita Brooks-LaSure

Administrator

U.S. Centers for Medicare & Medicaid Services

7500 Security Boulevard

Baltimore, MD 21244

Dear Administrator Brooks-LaSure:

Recent reports about Papa Inc.—a private company that “provides companionship and assistance” to older adults—have detailed troubling allegations about the company’s workers providing inadequate care and abusing customers. Papa Inc. (Papa) offers its services primarily as a supplemental health plan benefit and has reportedly partnered with more than 65 health plans, including Medicare Advantage and Medicaid plans, to make its services available to beneficiaries. As demand for home care services that enable older adults and people with disabilities to live at home continues to increase, service providers, insurers, and the Centers for Medicare & Medicaid Services (CMS) must ensure that Medicare and Medicaid enrollees receive safe and high-quality home care. Similarly, care workers deserve to be treated with dignity. I therefore request that CMS provide information about how it oversees providers like Papa and guarantees the responsible use of federal funds for their services.

Papa pairs older adults and people with disabilities with contract workers (known as Papa Pals) who provide non?clinical assistance with daily tasks. Examples of Pal services include grocery shopping, pet help, light household chores, and transportation. Pals also provide health reminders (e.g., reminding the customer to have their eyes checked or to take their medication). These services are facilitated via the company’s website, mobile phone application, email exchanges, call-in service, and may be advertised to eligible insurance enrollees via plan benefit documents.^,  Additionally, Papa’s recently-announced Medicare Advantage Star Enhancement program “focuses on advancing actions that directly impact CMS Star Rating measures” such as coordinating in-home assessments. The company reportedly operates in all 50 states; is recruiting Pals in more than 40 states, including Pennsylvania; and generates tens of millions of dollars in revenue annually.

To become a Pal, the company requires that applicants be 21 years or older and able to pass background checks facilitated by a third-party company, although Pals are not required to have health care experience or training. I have raised concerns in the past about the adequacy of Papa’s vetting process. Recent reporting by Bloomberg revealed Papa logged over 1,200 confidential complaints during the past four years. These complaints included harassment of both clients and caregivers, allegations of sexual harassment and assault, as well as reports of theft and unsafe work environments.

The Senate Special Committee on Aging has jurisdiction over the problems older adults face, including matters of maintaining older adults’ health and their ability to obtain care or assistance. As Chairman, I have an interest in ensuring that older adults and people with disabilities are receiving high-quality care that is free from abuse, and that Medicare and Medicaid are receiving good value for taxpayer dollars. I therefore request your assistance in better understanding how CMS oversees the financing, provision, and utilization of supplemental benefits, including the services provided by Papa, by answering the following questions no later than April 26, 2024:

1. In response to Bloomberg reporting, CMS shared it has been reviewing and monitoring complaints and grievances involving Papa.

1. What steps has CMS taken to review and monitor complaints and grievances involving Papa? What determinations has CMS made regarding the safety of Papa’s services based on the review of the complaints and grievances?

2. Has CMS taken any steps to communicate with Medicare Advantage and Medicaid managed care organizations about contracting with Papa or taken any other action to address the complaints against Papa’s care workers?

3. How does CMS ensure that Medicare Advantage organizations and Medicaid managed care organizations do not contract with providers, vendors, or individuals that fail to protect enrollees from harm and/or consistently provide low-quality care? 

2. Many Medicare Advantage plans categorize Papa’s services as in-home support services. According to guidance from CMS, such services “must be provided by individuals licensed by the state to provide personal care services, or in a manner that is otherwise consistent with state requirements.”

1. Has CMS confirmed that Papa’s services are provided to Medicare Advantage enrollees by qualified individuals?

2. How does CMS audit or assess generally that in-home support services and other supplemental benefits are provided to Medicare Advantage enrollees by qualified individuals?

3. According to CMS, supplemental benefits in Medicare Advantage have grown considerably over the past five years, and per-person payments from CMS to Medicare Advantage Organizations for supplemental benefits have more than doubled. Meanwhile, the United States Government Accountability Office found that CMS has limited information on enrollees’ use of supplemental benefits.

1. What factors does CMS consider when determining whether to permit a non-traditional supplemental benefit offering proposed by a Medicare Advantage plan such as services from Papa?

2. How does CMS evaluate the extent to which Medicare Advantage supplemental benefits—including but not limited to the services provided by Papa—are safe, utilized by enrollees, and improve enrollee health outcomes, thereby ensuring such services are a worthwhile investment for taxpayers and the Medicare program?

Thank you for your commitment to ensuring that the Medicare and Medicaid programs are subject to appropriate oversight. It is imperative that CMS safeguards Medicare and Medicaid enrollees from harm and abuse while ensuring they receive high-quality care.

Robert P. Casey, Jr.

Chairman

Senate Special Committee on Aging