NAPHSIS Conference June 20051 Funeral Director Fraud in New York City: Enforcement Using the Administrative Tribunal Flor Betancourt, Director NYC Vital.

NAPHSIS Conference June 2005 1

Funeral Director Fraud in New York City:Enforcement Using the Administrative Tribunal

Flor Betancourt, DirectorNYC Vital Records Registration

NAPHSIS Conference June 2005 2May 2005

What is the Administrative Tribunal?

Adjudicates New York City Health Code violations

Part of the Department’s overall enforcement strategy

Mostly for restaurants, day care, smoking law enforcement

35,000 cases annually

NAPHSIS Conference June 2005 3May 2005

Why issue Notices of Violations?

Hold funeral firms and their agents accountable for improper actions

Deter forging and altering death certificates

Encourage funeral directors to improve their practices

NAPHSIS Conference June 2005 4May 2005

NYC Death Registration

Two registration (“Burial Desk”) sites

Operates 24/7 in Manhattan

60,000 deaths annually

165 deaths registered daily

Permits required for disposition

Signatures of MD and FD required

NAPHSIS Conference June 2005 5May 2005

Quality Assurance

QA team reviews all death certificates

Questionable certificates investigated

Certificates are compared

same funeral home

same physician

Problem cases may be identified prior to registration

NAPHSIS Conference June 2005 6May 2005

Questionable Certificates

Different ink in legal and medical sections Signature of physician differs in both sectionsConfidential medical report appears alteredDates of signature, other dates not consistentTyped vs. handwritten sections of certificate

NAPHSIS Conference June 2005 7May 2005

Investigation

Contact hospital or physician

Obtain copy of death certificate

If alteration confirmed, obtain written statement

Contact funeral home

Obtain written statements from staff and agents

Determine Health Code violation

Issue Notice of Violation (NOV)

Submit NOV and evidence to Tribunal

NAPHSIS Conference June 2005 8May 2005

Notice of Violation

NAPHSIS Conference June 2005 9May 2005

NYC Health Code Violations

§ 3.19-Forgery of Signature [N=39]§ 3.21-Alterations to death certificate (including cause of death) [N=27]§ 205.03 (c) - Failure to report death certificate within 72 hours [N=1]§ 205.23 (a) – Removal of human remains without filing death certificate and obtaining permit [N=1]§ 205.25 (a) – Cremation of human remains without permit [N=1]

NAPHSIS Conference June 2005 10May 2005

Summary of Violations

Funeral Homes Issued Notices of Violations = 40

Total Cases = 521 violation = 36

2 violations = 15

3 violations = 1

Number of Violations = 69

NAPHSIS Conference June 2005 11May 2005

Outcome of Adjudications

N=52 Cases

81%

13%

6%

Sustained Dismissed Pending

42

73

NAPHSIS Conference June 2005 12May 2005

Range of Fines by Type of Violation

§ 3.19-Forgery of Signature$250 - $2000

§ 3.21- Alterations to death certificate (including cause of death)

$1000 - $2000§ 3.19 and § 3.21

$300 - $2000§ 205.03 (c) - Failure to report death within 72 hours and§ 205.23 (a) – Removal of human remains without filing a death certificate and obtaining a permit

$2000

NAPHSIS Conference June 2005 13May 2005

Factors Impacting Adjudication - 1

Judge’s level of knowledge

Funeral home admission or denial

Custodial responsibility of death certificates

Trade firm staff

Format and language of NOV

Laws, codes, regulations regarding confidentiality of death certificates

NAPHSIS Conference June 2005 14May 2005

Factors Impacting Adjudication - 2

Evidence, testimony and cross examination

Written statements from facility/MD/FD

Extent of investigation

Legal representation

Challenging the health department Did registration staff commit violation?

NAPHSIS Conference June 2005 15May 2005

Summary

Administrative Tribunal is an informal and relatively quick judicial proceedingNo attorney general or district attorney neededFuneral directors alter death certificates to minimize rejection riskEDRS should minimize, if not prevent, alterations and forgeries