Funeral Director Fraud in New York City:

1. Funeral Director Fraud in New York City: Enforcement Using the Administrative Tribunal Flor Betancourt, Director NYC Vital Records Registration NAPHSIS Conference June 2005

2. 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

3. 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

4. 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

5. 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

6. Questionable Certificates • Different ink in legal and medical sections • Signature of physician differs in both sections • Confidential medical report appears altered • Dates of signature, other dates not consistent • Typed vs. handwritten sections of certificate NAPHSIS Conference June 2005

7. 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

8. Notice of Violation NAPHSIS Conference June 2005

9. 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

10. Summary of Violations • Funeral Homes Issued Notices of Violations = 40 • Total Cases = 52 • 1 violation = 36 • 2 violations = 15 • 3 violations = 1 • Number of Violations = 69 NAPHSIS Conference June 2005

11. Outcome of Adjudications NAPHSIS Conference June 2005

12. 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

13. 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

14. 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

15. Summary • Administrative Tribunal is an informal and relatively quick judicial proceeding • No attorney general or district attorney needed • Funeral directors alter death certificates to minimize rejection risk • EDRS should minimize, if not prevent, alterations and forgeries NAPHSIS Conference June 2005