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Dozen from area charged in nationwide crackdown on Medicaid fraud

From Illinois Business Journal news services

FAIRVIEW HEIGHTS – Indictments representing the fourth wave of charges targeting the alleged abuse of a Medicaid program in Illinois were announced today by federal authorities as part of what is being called the largest health-care fraud takedown in the nation’s history.

The charges accuse several area people of billing for, but failing to fulfill roles as 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.

The local cases are part of a nationwide sweep announced this morning by U.S. Attorney General Loretta Lynch, and Department of Health and Human Services Secretary Sylvia Mathews Burwell, together with FBI Director James Comey and HHS Inspector General Daniel R. Levinson.

The Southern District of Illinois was one of 17 U.S. attorney’s offices participating in the nationwide takedown. Several hundred federal agents took part in the arrests that began on Tuesday, June 16.

The nationwide takedown centered on both medical services that were never performed but billed to the government, as well as medical services that were performed but were medically unnecessary. In the indictments returned in the Southern District of Illinois, the defendants are being charged with submitting bills for claimed personal assistant services that were purportedly medically necessary, but were not performed. Eleven of the 12 defendants were purported personal assistants and the other was a supposed recipient of the services.

The sweep is being referred to as Operation Home Alone IV. Charges were announced locally by Stephen R. Wigginton, U.S. attorney for the Southern District of Illinois, and Gerald Roy, special agent in charge, U.S. Department of Health and Human Services Office of Inspector General, Office of Investigations for Region 7 (Kansas City office)

Cases included the following:

• A recipient was found in her home in an incoherent state and partially covered in dried excrement. She was discovered by a friend checking on her welfare after she had been unable to reach the recipient by phone for many days. The daughter of the customer was her personal assistant (“PA”) and submitted claims for services.

• A recipient, who purportedly was unable to drive a car to work, indeed did drive to work as an East St. Louis School teacher. He also failed to disclose to the Social Security Administration that he was substantially gainfully employed as a teacher.

• A PA submitted false claims for services purportedly rendered in Illinois while the PA was actually in Costa Rica.

• A PA submitted claims while the recipient was in jail.

• A PA submitted claims for services at the same time she was working as a PA for a social services agency in East St. Louis.

• Several PAs submitted claims while their customers were in the hospitals and nursing homes.

The following individuals were charged and arrested locally as part of Home Alone IV:

Kevin Landis Boyd, 58, East St. Louis

Shirley A. Hair, 49, East St. Louis

Kiara S. Hopkins, 24, Belleville

Lisa Jorden, 50, Cottage Hills

Shelia Vickery, 40, Alton

Alfreda E. Perkins, 53, East St. Louis

Ann Marie Sheppard, 54, O’Fallon

LaTasha Stevenson, 37, Belleville

Jessica A. Teets, 27, Mulberry Grove

Terry L. Waeltermen, 30, Pocahontas

Two other defendants have been charged, but not yet arrested.

Previous Operations Home Alone I through III had resulted in the indictment of 43 individual defendants locally. Of those, 42 were convicted (one died before sentencing) and given federal sentences ranging up to three years in federal prison.

Past cases involved personal assistants who were in jail at the time they were purportedly providing care to their customer, a customer who was in jail at the time he was ostensibly receiving the medically necessary services, PAs who lived out of state who were claiming to provide services in Illinois and PAs who billed for services while their customers were in a hospital and nursing home. In one case, a customer died of neglect at the same time as her PA was billing for providing for her care.

“After three previous rounds of indictments, I am truly mystified how these defendants thought they could get away with defrauding Medicaid through bogus claims of personal assistant services,” said United States Attorney Wigginton. “I know that we can’t prosecute our way out of this problem; but the fact remains that I will continue to prosecute until there is no such widespread abuse of this program. People who cheat this system rob from a very worthy program and steal directly from our fellow citizens.”

“The home-care program provides vital services for many of our state’s most vulnerable residents,” Attorney General Lisa Madigan said. “These prosecutions are critical to ensure that the integrity of the program is maintained.”

“I find billing for personal assistant services while the customer was in a nursing home or hospital to be especially galling.” said Special Agent in Charge Gerald Roy. “The whole purpose of the program is to save federal and state tax money by providing assistance to recipients so that they don’t need to go to a hospital or nursing home.”

“Working with federal officials, other agencies and the public, we will continue to fight fraud, waste and abuse in the Medicaid system.” said Felicia Norwood, director of the Illinois Department of Healthcare and Family Services. Norwood added that HFS has been coordinating closely with the Illinois Department of Human Services to provide oversight over programs.

This investigation was conducted by the U.S. Department of Health and Human Services, Office of Inspector General, the Illinois State Police – Medicaid Fraud Control Bureau and the Federal Bureau of Investigation. The individual cases are being prosecuted by Assistant United States Attorneys Adam Hanna, William E. Coonan, Ranley R. Killian and Michael Hallock.

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