12 face federal charges in southern Illinois for fraudulently billing Medicaid home care program | St. Louis Public Radio

12 face federal charges in southern Illinois for fraudulently billing Medicaid home care program

Jun 18, 2015

Twelve people are facing federal charges in southern Illinois for allegedly defrauding a Medicaid program that provides home care for people with disabilities.

State and federal officials announced the charges Thursday in the U.S. Attorney’s office for the Southern District of Illinois as part of a coordinated national crackdown on health care fraud that brought charges against more than 240 people in 17 different federal districts.

It’s the fourth time in four years that the U.S. District of Southern Illinois has investigated home health care fraud, raising the total number of people charged for the crime in the district to 55 since 2012.

“There are really three victims in this,” said Stephen Wiggington, U.S. Attorney for the Southern District of Illinois. “There’s the direct victim, that customer who needs the care who isn’t getting the care the personal assistant is billing for. Then there’s the indirect victim who is the remaining pool of customers who need care but can’t get the care they deserve because there isn’t enough money. Then the other direct victims are the American taxpayers who are paying for this program.”

Of the 12 people charged, most are home care workers who left their clients untended or submitted claims for clients when their clients were away from home. An East St. Louis man also was charged for colluding with his care worker.

Wiggington said he wasn’t sure how many fraudulent bills the 12 racked up, but those charged across all 17 districts defrauded the government of about $712 million.

Credit dleafy | sxc.hu

Wiggington also said it was difficult to estimate how many bills submitted statewide for home care are fraudulent.

“I know that we as taxpayers each and every one of us in Illinois pay over $500 million (for the home care program). Now what percentage of that is fraud? I’d say a pretty substantial part. But I couldn’t say whether it was 50 percent or 40 percent,” Wiggington said.

The U.S. District of southern Illinois has charged 55 people for home health care fraud since 2012. Punishment ranges from probation to four years in prison. Those who are convicted also can be barred from working health care jobs in the future, according to Bradley Hart, Inspector General for the Illinois Department of Healthcare and Family Services.

“You are basically terminated or going to be terminated from the health care system nationwide. It’s a life-changing decision that somebody is going to steal from the system. You basically cut yourself off from 20 percent of the U.S. economy,” Hart said.

Multiple officials at the news conference called for a national redesign of the Medicaid home care program in order to make it more difficult to file false claims.

“I think all of us really wholeheartedly believe in the aspect of keeping our Medicaid and Medicare beneficiaries out of institutionalized settings,” said Gerald Roy, Special Agent in Charge with the U.S. Department of Health and Human Services. “Being able to stay at home makes a tremendous improvement on people’s lives. And in order to maintain that we have to make sure our program is free from fraud and abuse.”

Follow Camille Phillips on Twitter: @cmpcamille.