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

3. May 2005NAPHSIS Conference June 20052 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

4. May 2005NAPHSIS Conference June 20053 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

5. May 2005NAPHSIS Conference June 20054 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

6. May 2005NAPHSIS Conference June 20055 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

7. May 2005NAPHSIS Conference June 20056 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

8. May 2005NAPHSIS Conference June 20057 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

9. May 2005NAPHSIS Conference June 20058 Notice of Violation

10. May 2005NAPHSIS Conference June 20059 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]

11. May 2005NAPHSIS Conference June 200510 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

12. May 2005NAPHSIS Conference June 200511 Outcome of Adjudications

13. May 2005NAPHSIS Conference June 200512 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

14. May 2005NAPHSIS Conference June 200513 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

15. May 2005NAPHSIS Conference June 200514 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?

16. May 2005NAPHSIS Conference June 200515 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