Personal Assistants Indicted in Illinois for Defrauding Medicaid

The United States Attorney for the Southern District of Illinois announced the indictment of 14 people for submitting false claims for providing personal assistant service under the Home Services Program to Medicaid recipients in Southern Illinois. In most cases, the service billed could not have been provided. This is the third wave of indictments under Operation Home Alone. In the previous waves, 29 individuals, both Medicaid beneficiaries and personal assistants, have been indicted.

Illinois’ Home Services Program allows Medicaid beneficiaries under the age of 60 to select their own personal assistant to provide general household activities and personal care services. It is designed to reduce Medicaid expenditures and to keep beneficiaries out of expensive institutional care settings such as nursing homes which is a “laudable purpose” according to a press release issued by Stephen R. Wigginton, U.S. District Attorney for the Southern District of Illinois.

Fraudulent Activities

In these indictments, four personal assistants or Medicaid recipients were provided services during a time period that they were in jail, according to the date of service on the claims submitted. An additional six of the people indicted billed for services provided while the Medicaid recipient was in the hospital. In three instances, the personal assistant billed for numerous hours of services provided, but at the same time had another full-time job, and in one instance, a personal care assistant continued to submit claims for service after the date of the death for the Medicaid recipient. In many of the instances, the personal care assistant agreed to split the money with the Medicaid recipient.

“The Office of Inspector General of the Department of Health and Human Services is determined to get the attention of these program abusers,” said Gerald Roy, Special Agent in Charge from HHS’ Office of Inspector General (OIG) from the Kansas City office. “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,” continued Roy.

Claims for services were submitted by those indicted in this wave after the indictments in the previous two waves were announced. “One of the four specifically admitted having seen news reports of our crackdown on this type of fraud but went ahead and submitted false claims anyway,” said Wigginton. Operation Home Alone was initiated following the receipt of numerous complaints about the Home Services Program to law enforcement agencies in Southern Illinois. “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 do everything right,” added Wigginton.

Personal Assistant Coverage

These types of personal assistants programs are one of the biggest fraud problems in the Medicaid program. According to an OIG report Medicaid costs for personal care services totaled $12.7 billion nationally in 2011; representing a 35 percent increase since 2005. Personal assistants and home health care workers constitute one of the fastest growing job categories in the country according to the U.S. Department of Labor Occupational Handbook, 2010-2011 Edition. The OIG’s report highlighted numerous problems with these programs that make them vulnerable to fraud and abuse; problems such as lack of training standards, uneven oversight of services provided, and failure to implement prepayment controls.

The charges leveled against the 14 in this round of indictments carry a maximum penalty of 10 years imprisonment, a $25,000 fine and up to three years of supervised release. “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 our investigation and root out those defrauding the program,” said Wigginton.

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