Two public employees charged in health care fraud case; one on unpaid leave, another gets to work

News-DemocratJuly 13, 2013 

The St. Clair County Probation Department employee who is one of the 15 people accused of committing fraud in the Home Services program was placed on unpaid administrative leave while another public employee will remain on her job despite being charged.

Probation Department employee Darron A. Suggs, 39, of East St. Louis, will have a hearing within a week since he is part of a union, said Michael Buettner, who is director of court services and probation for the 20th Judicial Circuit, which includes St. Clair County.

Suggs, who also serves as a Washington Park Village Board trustee, could not be reached for comment.

Rosalyn Ross, 46, of Swansea, is another metro-east public employee charged in the Medicaid fraud investigation but she remains on the job.

Ross is an administrative assistant with the East Side Health District.

Elizabeth Patton-Whiteside, director of the East Side Health District, said Ross is still working full time.

"She has not been to trial or been convicted. She is presumed innocent until proven guilty," Patton-Whiteside said. Ross could not be reached for comment.

On Thursday, federal prosecutors announced indictments in connection with the alleged abuse of a Medicaid program in Illinois that pays personal assistants to help Medicaid recipients with general household activities and personal care. The program is intended to reduce Medicaid costs by keeping people out of more expensive nursing home care.

Everyone who is convicted has to pay restitution, U.S. Attorney Stephen Wigginton said.

Jason Weinstock, an inspector with the U.S. Department of Health and Human Services, Office of Inspector General, agreed with Wigginton that meaningful supervision and mandatory training for personal assistants and their customers is needed.

"The program is operated on an honor system -- outside of the view of health professionals or the Department of Human Services," Weinstock said.

"It is for people who need help with a loved one and who cannot afford to not work and take care of their loved one," he said.

Fraud investigators found that benefits and payment for services went to friends of people in jail, in the hospital, who weren't home and to those who fraudulently obtained checks and simply split the proceeds with the supposed caregivers, prosecutors said. One Southern Illinois caregiver claimed to be caring for a person who had moved to Texas.

Wigginton and officials with the U.S. Department of Health and Human Services want the Illinois General Assembly to tighten the reins on the way the program is handled.

Gerald Roy, special agent in charge with the U.S. Department of Health and Human Services, Office of Inspector General in Kansas City, was at the U.S. Attorney's office in Fairview Heights when the health care fraud indictments were announced.

"I think that the Illinois General Assembly has an obligation to see that this program is run in an efficient manner. And, it needs to ensure proper legislation is passed and enacted to ensure proper oversight and solvency of the state Medicaid program," Roy said.

"There's very little supervision over the program and this needs to change," Wigginton said.

"But improvements are being made to help straighten out this program," Wigginton said.

Wigginton said that the state pays $2 million annually to the Service Employees International Union, which represents the personal assistants, for training, but the training is not mandatory and very few attend the training.

Wigginton said Illinois taxpayers paid $590 million in 2011 for the program and from 2008-2012, taxpayers paid $500 million per year.

Nationwide, Medicaid costs for personal care services in 2011 totaled $12.7 billion, a 35 percent increase since 2005, according to federal officials.

Roy said, "I think it is very important that people understand the personal service program has three essential components -- beneficiaries with disability, beneficiaries with brain injuries and beneficiaries with HIV/AIDS. This represents the most vulnerable of a vulnerable population that Medicaid protects. When money is diverted for personal gain, those vulnerable citizens do not get the care they deserve and need.

"The fact that a beneficiary died should be as appalling to the public as it is to me. Someone died because of greed and because the program didn't have the proper oversight to stop this from happening," Roy said.

Roy was referring to the death of 62-year-old Dorothy Cooper.

Lisa C. Luckett, 49, of Cahokia, faces additional charges from St. Clair County that she neglected an elderly person's care, leading to the death of Cooper, a family friend. Charges state Cooper was starved and her hygiene and medical care were ignored to the point that she developed sepsis. Luckett used a relative's identity to obtain benefits although she, too, was disabled, and neglected Cooper until Cooper died in Luckett's home.

Wigginton said the dollar amount stolen may be between $5,000 and $100,000, but "when it occurs over and over again -- it becomes death by a thousand cuts."

The personal assistant gets paid $11.65 an hour and if the person they provide care goes into the hospital or a nursing home, they do not get paid. So, there is no incentive for them to take the individuals to the hospital or recommend a nursing facility for them, Wigginton said.

The Medicaid program has been around for more than 30 years, officials said.

Prosecutors said fraud indictments in the case were first announced in May and now 29 people have been charged. Eleven Medicaid beneficiaries and 18 personal assistants have been charged.

The indictment against Suggs alleges he did not provide services to his mother and another person but still received payment for services not performed. The fraud occurred between June 2006 to April 16, according to the indictment.

The indictment against Ross alleges she did not provide services to her mother, Irma Jones, 67, of Centreville. The fraud occurred between March 1 and March 15 and Jones also is charged in the case, according to the indictment.

Contact reporter Carolyn P. Smith at 618-239-2503.

Belleville News-Democrat is pleased to provide this opportunity to share information, experiences and observations about what's in the news. Some of the comments may be reprinted elsewhere in the site or in the newspaper. We encourage lively, open debate on the issues of the day, and ask that you refrain from profanity, hate speech, personal comments and remarks that are off point. Thank you for taking the time to offer your thoughts.

Commenting FAQs | Terms of Service