U.S. Attorney Stephen R. Wigginton and U.S. Department of Health and Human Services Special Agent in Charge Gerald Roy have announced indictments arising out of Operation Home Alone 3.
The indictments constitute a third wave of charges targeting the abuse of a Medicaid program in Illinois that provides personal assistants to Medicaid recipients to assist them with household activities and personal care. The program is intended for recipients younger than 60 and is designed to reduce Medicaid expenditures by avoiding more expensive institutional care, including nursing home care.
In May 2012 and again in July 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 14 individuals named Thursday reside throughout southern Illinois and have been charged in 12 separate indictments by a federal grand jury in Benton 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 admitted seeing news reports of the crackdown but 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,” Wigginton said. “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.”
Because of 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 the suspects 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 people charged in this wave, their ages, and their last known city of residence are:
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
Cases in this round of indictments include:
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 1,000 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.
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 35 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. 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.