EAST ST. LOUIS – A federal jury has convicted an area woman of a scheme to defraud Medicaid.
Irma Jones, 67, of Centreville, was convicted in less than an hour Wednesday after a three-day jury trial in the United States District Court in East St. Louis, Stephen R. Wigginton, U.S. attorney for the Southern District of Illinois, announced.
She was convicted on all three counts of an indictment charging that she engaged in a scheme to defraud the Medicaid program. The three counts included health care fraud, making false statements in connection with a healthcare benefit program, and lying to investigating agents when confronted with her scam.
Sentencing is set for Oct. 10. The charge carries a maximum penalty of 10 years in prison, a $250,000 fine, and up to three years of supervised release.
Evidence in court showed that Jones was a Medicaid beneficiary and that she submitted false claims for Medicaid home health care services claiming that her daughter, who Jones falsely represented was her niece, provided services that were never performed. When investigators from the Illinois State Police, investigating federal charges, questioned Jones about the false billing, Jones lied to investigators.
“Nationwide, the biggest fraud problem in the Medicaid program has been these personal assistant programs which represent the number one fraud complaint to state Medicaid fraud units,” Wigginton said. “Especially vulnerable to fraud are programs, such as the one implemented in Illinois that allows the Medicaid recipient to control the selection and payment of personal care attendants.
In most 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. By prosecuting these frauds, I hope to get more accountability into the programs and to preserve these funds for deserving people who really do benefit from the assistance.”
This is the latest of a series of prosecutions targeting Medicaid abuse. On June 5, the U.S. Attorney and Special Agent in Charge Gerald Roy of the U.S. Department of Health and Human Services, Office of Inspector General, announced Operation Home Alone 3, a third wave of charges arising out of the troubled Medicaid home health care program in Illinois. Thus far, 43 defendants have been charged in the Southern District of
Illinois in all three rounds of indictments. One defendant from Operation Home Alone 2 is awaiting trial (and is presumed innocent unless proven guilty beyond a reasonable doubt), but with this jury verdict all other defendants from rounds one and two have been found guilty. The defendants recently charged in Operation Home Alone 3 are all awaiting trial.
The investigation was conducted by the U.S. Department of Health and Human Services’ Office of Inspector General and the Illinois State Police’s Medicaid Fraud Control Bureau.
The case was tried by Special Assistant U.S. Attorney Michael Hallock and Assistant U.S. Attorney Michael Quinley.