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Illinois Cracks Down On Medicaid Fraud

Jess Jiang
St. Louis Public Radio

The Department of Justice is charging 14 people with Medicaid fraud in Illinois.

The U.S. attorney for the Southern District of Illinois, Stephen Wigginton, said over the past few years, dozens of people have fleeced a Medicaid program that pays personal assistants to help disabled or sick Medicaid recipients live at home. The intention is to save the state money by keeping people in their homes and out of costly institutions such as hospitals or nursing homes.

But, according to Wigginton, some Medicaid recipients were in the hospital but their PAs were still getting paid for home health services. Wigginton explained that, in another case, the PA continued to bill the government for six months after the beneficiary had died. Some assistants were even in jail when they were claiming to be giving home care. And in other cases, the Medicaid beneficiary was involved in the fraud -- splitting the Medicaid funds for care that was never given. The people charged in this wave of indictments were from East St. Louis, Belleville, and other cities in southern Illinois. The crimes were allegedly committed on and off from about 2008 to 2014.

Wigginton said he expected more fraud charges relating to the Home Services Program in the future. He explained that the program is vulnerable to abuse, with a number of known weaknesses. For instance, the program in Illinois allows the sick or disabled person to pick anyone to be their personal assistant. "Boyfriend can be for girlfriend. Or girlfriend can be boyfriend. Brothers. Sisters. You name it," said Wigginton.

The U.S. attorney explained another problem: The person deciding whether someone is eligible for a personal assistant doesn't have to be a medical professional. "They don't have to be a nurse. They don't have to be a doctor," he said. "They could be someone who has no experience understanding the level of disability."

Wigginton said the U.S. attorney's office can only make recommendations and suggestions to fix these weaknesses. He explained that it'll be up to the governor and the Illinois Department of Health Services to make changes to the program.

Fraud in this program is not isolated to Illinois. Florida, Massachusetts and New York have brought similar charges over the last few years.