Stephen R. Wigginton, United States attorney for the Southern District of Illinois, and Gerald Roy, special agent in charge, United States Department of Health and Human Services, Office of Inspector General, Office of Investigations for Region 7 (Kansas City office), have announced indictments arising out of Operation Home Alone 3.
The indictments constitute a third wave of charges that targets the abuse of a Medicaid program in Illinois that provides personal assistants to Medicaid recipients to assist them with general household activities and personal care. The program is intended for recipients under 60 years of age and is designed to reduce Medicaid expenditures by avoiding more expensive institutional care, including nursing home care.
In May of 2012 and again in July of 2013, during the first two phases of Operation Home Alone, 29 defendants, including both Medicaid beneficiaries and the personal assistants, who claimed to have been providing personal assistant services, were charged with fraud.
In this third round announced Thursday, 14 additional defendants have been indicted, bringing the total number of defendants to 43. The fourteen individuals named today reside throughout southern Illinois and have been charged in 12 separate indictments by a federal grand jury in Benton, Ill., with the offense of health care program fraud. The charges carry a maximum penalty of 10 years imprisonment, a $250,000 fine, and up to three years of supervised release.
In all cases, the false claims were submitted to the program after the first round of prosecutions. Four of the defendants made false claims against the program after the second round of indictments and widespread media coverage. One of the four specifically admitted having seen news reports of our crackdown on this type of fraud but went ahead and submitted the false claims anyway.
“Many of these 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,” said Wigginton. “Federal and state law enforcement in Illinois have spoken forcefully and with one voice against the abuse of a program vital to the health of Illinoisans, but those who are abusing this needed program just don’t seem to be listening. Ignore us at your peril.” Wigginton added.
“The Office of Inspector General of the Department of Health and Human Services is determined to get the attention of these program abusers” said Special Agent in Charge Gerald Roy. “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,” said Roy.
“These cases are critical to ensuring the integrity of the home-care program that provides vital services for many of our most vulnerable residents,” said Attorney General Lisa Madigan.
Due to numerous complaints concerning the Home Services Program, law enforcement agencies in southern Illinois originally initiated Operation Home Alone to investigate and hold accountable individuals perpetrating fraud against the Home Services Program. As was true of the charges brought in rounds one and two, these indictments allege that the charged individuals exploited the Home Services Program and received Medicaid funds to which they were not entitled. Those charged in this wave of indictments include four defendants where the personal assistant or customer were in jail or prison during the times the services were supposed to be performed, six defendants where the personal assistant or the customer was in the hospital, three cases where the defendant was working full time jobs while the services were supposed to be performed and one case where the customer was dead and the personal assistant continued billing for months after the death of the customer.
The persons charged in this wave, their ages, and their last known city of residence are:
Connie D. Evans, age 50, Belleville, Illinois
Quincy O. Gamble, age 39, Cahokia, Illinois
Jody R. Wooters, age 46, Centralia, Illinois
Felicia M. Gibson, age 47, East St. Louis, Illinois
Beatrice L. Randall, age 59, East St. Louis, Illinois
Charlietta M. Lee, age 51, Marion, Illinois
Tamekia L. Hall, age 39, East St. Louis, Illinois
Maurice L. Burks, age 43, East St. Louis, Illinois
Christopher W. Spivey, age 30, Olney, Illinois
Angel D. Jones, age 50, Collinsville, Illinois
Lawrence M. Thigpen, 53, Collinsville, Illinois
Lakeshia W. White, age 23, Centreville, Illinois
Margaret R. Teriet, age 31, Mount Vernon, Illinois
Maketa N. Davis, age 33, East St. Louis.
The purpose of the program is laudable – keep Medicaid recipients in their home 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. Cases in this round of indictments include the following:
• Personal assistant boyfriend claimed to be providing services for his girlfriend, first while she, the customer, was in the hospital and then continued filing claims for 560 hours of services for six months after she had passed away.
• Personal assistant claimed to be providing personal assistant services to her boyfriend while she was in jail and prison. Together, they claimed over one thousand hours of personal assistant services during the periods where she was incarcerated.
• Personal assistant claimed that she performed over 450 hours of personal assistant services for the customer during times that she was employed at a full time job and over 140 hours where she was not only working a job at another location, but the customer was also receiving kidney dialysis.
• Medicaid recipient who agreed to split the proceeds with the personal assistant who performed little or no services.
Wigginton said the agency has seen dozens of instances in which the State of Illinois paid for ghost employees and fictitious services, hence the reason why we are calling this initiative “Home Alone.”
Nationwide, one of the biggest fraud problems in the Medicaid program has been these 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.
In a typical fraud scenario,
the 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 in December, 2012, Medicaid costs for personal care services in 2011 totaled $12.7 billion, a thirty five percent increase since 2005. The U.S. Department of Labor projects that the employment of personal assistants and home health care workers will grow by 46 percent by 2018. U.S Department of Health and Human Services, Office of Inspector General: Personal Care Services, Trends, Vulnerabilities, and Recommendations for Improvement, OIG-12-12-01 (November 2012). Home personal care is one of the fastest growing job categories in the country. However, the OIG’s report points to numerous problems in Medicaid personal care 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 or fraudulent payments.
Operation Home Alone 3 investigations were conducted by the U.S. Department of Health and Human Services, Office of Inspector General; the Federal Bureau of Investigation, and the Illinois State Police Medicaid Fraud Control Bureau Collinsville, DuQuoin and Sterling Offices.
The cases are being prosecuted by Assistant United States Attorneys Ranley R. Killian and William E. Coonan and Special Assistant United States Attorney Michael J. Hallock.