The third wave of a home care-related Medicaid fraud scheme that originated in Illinois has resulted in 14 more indictments, bringing the total number of defendants involved to 43, according to the Federal Bureau of Investigation (FBI).
Last week’s indictments constitute the third round of charges stemming from Operation Home Alone, an initiative led by federal investigators that targets the abuse of Illinois’ Home Services Program, which provides personal assistants to Medicaid recipients to assist them with personal care and general household activities.
These 14 additional defendants reside throughout southern Illinois and have been charged in 12 separate indictments by a federal grand jury in Benton, Illinois, 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, the FBI stated.
Law enforcement agencies originally began the Operation Home Alone investigation after numerous complaints surfaced concerning the Home Services Program, which is intended for Medicaid recipients under 60 years of age that intends to keep beneficiaries in their homes and out of more costly institutional care settings, including nursing homes.
During the first two phases of Operation Home Alone, which occurred in May 2012 and July 2013, investigators charged 29 defendants, which included both Medicaid beneficiaries and personal assistants, with fraud.
In all of the 14 cases, the FBI states false claims were submitted to the program after the first round of prosecutions, with four of the defendants having made false claims against the program after the second round of indictments.
One of the four even specifically admitted to law enforcement officials that he/she went ahead and submitted false claims even after having seen news reports of a crackdown on the Home Alone fraud.
“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,” stated U.S. Attorney Stephen Wigginton. “Ignore us at your own peril.”
One case in the latest round of indictments include a personal assistant boyfriend claiming to be providing services for his girlfriend, first while she was in the hospital, and then continued filing claims for 560 hours of services for six months after she had passed away.
Another case involved a personal assistant claiming to be providing services to her boyfriend while she was in jail and prison. Together, the FBI notes they claimed over 1,000 hours of personal assistant services during the periods where she was incarcerated.
In another instance, a Medicaid recipient agreed to split the proceeds with the personal assistant who performed little or no services, according to the FBI statement.
Medicaid costs for personal care services totaled $12.7 billion in 2011, according to an Office of Inspector General (OIG) report released in December 2012.
While spending in this area is well above the billion-dollar range, the U.S. Department of Labor projects that the employment of personal assistants and home health care workers will grow by 46% by 2018.
“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,” stated Gerald Roy, special agent in charge with the OIG of the Department of Health and Human Services. “Working together with our law enforcement partners at the Illinois State Police-Medicaid Fraud Control Bureau and the FBI, we will continue to investigate these cases and submit them for prosecution until this widespread abuse stops.”
Written by Jason Oliva