Fifteen Face Federal Charges in Central Illinois for Allegedly Defrauding Medicaid Home Services Program
SPRINGFIELD, IL—Jim Lewis, U.S. Attorney for the Central District of Illinois, today announced that 15 individuals have been charged by federal criminal complaint or information for allegedly submitting false timesheets for work not performed as personal assistants through the Home Services Program, a state Medicaid waiver program. The individuals charged are all alleged to have submitted or assisted another in submitting fraudulent time sheets for hours that the personal assistant was working another job or was otherwise out of the area or during a time that the disabled customer was hospitalized or otherwise not using their services.
Medicaid waiver programs enable states to use both federal and state Medicaid funds to pay for services related to medical care that would not ordinarily be covered under Medicaid. Through the Home Services Program, the state of Illinois provides funding for services to individuals with significant disabilities so that they may remain in their homes and live as independently as possible. One of the services available to those with significant disabilities is the personal assistant program.
The 13 defendants charged by complaint will be issued summonses and are each scheduled to make initial appearances before U.S. Magistrate Judge Tom Schanzle-Haskins on June 16, 2014. The two defendants charged by information are each scheduled to appear before Judge Schanzle-Haskins on June 12, 2014.
All the charges are the result of investigations conducted by members of the Central Illinois Health Care Fraud Task Force. These agencies include the Illinois State Police Medicaid Fraud Control Bureau; U.S. Department of Health and Human Services Office of Inspector General; the FBI; IRS Criminal Investigation; and the Illinois Attorney General’s Office. The cases are being prosecuted by Assistant U.S. Attorney Patrick D. Hansen.
“We appreciate the importance of making sure that people make honest use of public money,” said U.S. Attorney Lewis. “And we certainly appreciate the work of law enforcement officials to hold people accountable.”
The Home Services Program provides for a qualified individual with disabilities, the customer, to hire one or more personal assistants to perform or assist the individual to perform household tasks, shopping, personal care, incidental health care tasks, and monitoring to ensure the health and safety of the customer. The personal assistant is hired by and reports directly to the customer or their family member but is paid by the state of Illinois through this Medicaid waiver program.
The Illinois Department of Human Services administers the Home Services Program; operational responsibility for the Home Services Program, with minor exceptions, rests with the Division of Rehabilitation Services, which is a part of the Illinois Department of Human Services. Funds for the program are administered by the Illinois Department of Health and Family Services. Approximately one-half of the program funding is provided by the U.S. Department of Health and Human Services.
To receive payment as a personal assistant, the customer and the personal assistant complete and submit time sheets twice monthly. These time sheets contain the dates and number of hours worked by the personal assistant. Both the customer and personal assistant are required to certify the accuracy of the time sheets. The time sheets are then submitted to the Department of Human Services, and, if approved, the claims are paid through the Office of the Comptroller.
When hired, the personal assistant is required to sign a DHS Division of Rehabilitation Services Individual Provider Payment Policies form acknowledging their awareness of Home Services policies including the following:
- Individual providers can only be paid for the hours they worked for the customer per the HSP Service Plan. Billing for hours not worked constitutes Medicaid fraud.
- Individual providers can only be paid for hours and tasks performed in the customer’s home unless the task must be completed outside the home such as laundry due to no facilities in the home, banking, and grocery shopping.
- Individual providers are not allowed to subcontract. Subcontracting means letting someone else work in your place, putting the time on your time sheet and then paying them yourself. Each individual provider will only be paid for services which he or she provided directly to the customer.
- Individual providers cannot charge HSP for the same hours worked when working another job. This includes working for other HSP customers or as a childcare provider paid through the Department of Human Services. This constitutes fraud and will be prosecuted as such.
On May 30, 2014, criminal complaints or informations were filed in the Central District of Illinois against the following:
- Michelle Calhoun, 36, of Cantrall Creek Rd, Cantrall, Illinois; Patricia Davis, 58, and Alicia Davis, 29, both of the 300 block of S. 7th St., Petersburg, Illinois, charged by complaint with mail fraud in May 2013 for allegedly submitting false time sheets for services that none of them performed;
- Jason C. Greene, 36, of Bloomington, Illinois, but currently in the custody of the Illinois Department of Corrections, charged by complaint with health care fraud, from December 2008 to May 2012 for allegedly submitting false time sheets for at least 300 hours of work performed during times when he was incarcerated;
- Thelma Gude, 55, of the 600 block of E. Kansas, Peoria, Illinois, charged by complaint with health care fraud from April 2013 to July 2013 for allegedly submitting false time sheets for hours claimed to have been worked while her client was hospitalized;
- Amber Gibson, 26, of Marengo, Illinois, charged by complaint with mail fraud in September 2011 or allegedly submitting false time sheets for hours worked when she was working at another job;
- Palestine Zambrella, 75, of Machesney Park, Illinois, charged by complaint with mail fraud in November 2012 for allegedly submitting false time sheets for hours worked that she was working at another job;
- Amber F. Pates, 19, of the 5200 block of N. Knoxville, Peoria, Illinois, charged by complaint with mail fraud in March 2013 for allegedly submitting false time sheets for work performed when her customer was incarcerated;
- Cheryl R. Hood, 33, of the 700 block of E. Milton Ave., Lewistown, Illinois, charged by complaint with health care fraud in September to October 2013 for allegedly submitting false time sheets for hours claimed to have been worked while her client was in the hospital;
- Gayle L. Schultz, 55, of the 1100 block of Hawkinson, Galesburg, Illinois, charged by complaint with mail fraud in April 2013 for allegedly submitting false time sheets for hours worked when she was working at another job;
- Karen Garske, 50, of the 2200 block of W. Wiswall St., Peoria, charged by complaint with health care fraud in February to July 2013 for allegedly submitting false time sheets for hours claimed to have been worked while her customer was in the hospital;
- Patricia Dismuke, 43, of Rockford, Illinois, charged by complaint with mail fraud in December 2011 for allegedly submitting false time sheets for hours worked when she was working at another job;
- Marlene A. Liss, 37, of Chicago, charged by information with health care fraud from June 2010 to August 2013 for allegedly submitting false time sheets for personal assistance work performed for a relative while she was employed full-time with the Illinois Office of the Secretary of State; and
- Mildred M. Day, 50, of Chicago, charged by information with making a false statement to a government agency in March 2012 by misrepresenting that a personal assistant was providing services at a time when that person was not providing any services.
If convicted, for the offense of mail fraud, the statutory penalty is up to 20 years in prison, and fines up to $250,000; for health care fraud, the statutory penalty is up to 10 years in prison and fines up to $250,000; and, for making a false statement, the penalty is up to five years in prison.
Members of the public are reminded that complaints and informations are merely accusations; each defendant is presumed innocent unless proven guilty.