June 5, 2014

Fourteen more indicted on Medicaid fraud charges

Fourteen more people have been indicted as part of an ongoing federal investigation into Medicaid fraud.

The suspects were indicted as part of Operation Home Alone III, which targets people who are being paid for services to the home-bound disabled under age 60 that they did not perform. They face a maximum of 10 years in prison if convicted.

U.S. Attorney Stephen Wigginton said in one case the person was aware that others before him had been arrested for Medicaid fraud and that still didn't deter him.

"Many of the individuals just don't get it. They either don't care or don't believe me when I say we will continue to investigate and root out those defrauding the program," Wigginton said. "Federal and state law enforcement in Illinois have spoken forcefully and with one voice against the abuse of a program vital the health of Illinoisans, but those abusing this needed program don't seem to be listening. Ignore us at your peril," Wigginton said.

In one case, a Cahokia man was collecting money to care for a person who had been dead for six months, according to Wigginton, who announced the indictments Thursday.

The suspects were from nine cities across Southern Illinois, including East St. Louis, Olney, Marion and Cahokia.

Gerald Roy, from The Office of the Inspector General for the U.S. Department of Health and Human Services, said his office assisted in the investigation.

"With the adverse impact on this state's budget and the larger issue of patient abuse, personal care service fraud will continue to be the focus of my office. Working together with our law enforcement partners at the Illinois State Police Medicaid Fraud Control Bureau and the FBI, we will continue to investigate these cases and submit them for prosecution until this widespread abuse stops," Roy said.

In the first two phases of the investigation, which occurred in May 2012 and again in July 2013, 29 people, including Medicaid beneficiaries and the personal assistants were charged with Medicaid fraud. Wigginton said his office has a 100 percent conviction rate with one person dying before his trial began.

The new indictments that were announced Thursday afternoon at Wigginton's office in Fairview Heights were against:

* Connie D. Evans, 50, Belleville

* Quincy O. Gamble, 39, Cahokia

* Jody R. Wooters, 46, Centralia

* Felicia M. Gibson, 47, East St. Louis

* Beatrice L. Randall, 59, East St. Louis

* Charlietta M. Lee, 51, Marion

*Tamekia L. Hall, 39, East St. Louis

* Maurice L. Burks, 43, East. St. Louis

* Christopher W. Spivey, 30, Olney

* Angel D. Jones, 50, Collinsville

* Lawrence M. Thigpen, 53, Collinsville

* Lakeshia W. White, 23, Centreville

* Margaret R. Teriet, 31, Mount Vernon

* Maketa N. Davis, 33, East St. Louis

Wigginton told reporters that the charged individuals "exploited the Home Services Program and received Medicaid funds to which they were not entitled."

Of those charged, four of the individuals are defendants where the personal assistant of the customer was in jail or prison during the times the services were supposed to be performed.

Six of those charged were cases where the personal assistant or the customer was in the hospital. people charged were working full-time jobs when they were being paid through Medicaid for hours they were suppose to be working in someone's home.

And, one customer was dead, but that did not stop her personal assistant from billing Medicaid for six months after the customer died, Wigginton said.

Wigginton and Roy said the personal assistant program is laudable. It's designed to keep Medicaid recipients in their homes and out of more costly institutional settings. "These prosecutions show that there are individuals who, by their actions, take money from the thousands of deserving customers and harm the reputation of those personal assistants who are doing everything right," the U.S. Attorney said.

Wigginton said there have been dozens of cases in which the state of Illinois paid for ghost employees and fictitious services, which is the reason why his office calls this initiative "Home Alone."

Wigginton said the fraud that is being committed in the personal assistant program is not exclusive to Illinois. "Nationwide, one of the biggest problems in the Medicaid program has been the personal assistant programs, particularly in cases that allow the Medicaid recipient to control the selection and payment of personal care attendants. In most of these cases, the personal care assistant is a relative or family friend, who often is a ghost employee," Wigginton said.

He said scam payments made by the State of Illinois are split between the Medicaid recipient and the ghost employee.

According to an Office of Inspector General report released December 2012, Medicaid cost for personal care services in 2011 totaled $12.7 billion, a 35 percent increase since 2005, Roy said.

Wigginton said the U.S. Department of Labor projects that the employment of personal assistants and home health care workers will grow by 26 percent by 2018.

The OIG report cites numerous problems in Medicaid's personal services that leave it vulnerable to improper payments, abuse and fraud, including lack of training standards, uneven oversight of services provided, and failure to implement prepayment controls to prevent improper fraudulent payments.

Operation Home Alone 3 investigations were conducted by the U.S. Department of Health and Human Services, Office of Inspector General, the FBI, Illinois State Police Medicaid Fraud Control Bureau Collinsville, DuQuoin and Sterling offices. Assistant U.S. Attorneys, Ranley R. Killian and William E. Coonan and Special Assistant U.S. Attorney Michael Hallock are prosecuting the cases.

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