Illinois Open To Serious Medicaid Fraud

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(KTVI)-- Federal authorities charged 15 Metro East  Medicaid patients and paid care givers with fraud Thursday. The U.S. Attorney for Southern Illinois blamed a poorly designed Illinois Home Services program for failing to monitor cases and check to be sure the clients truly needed home care assistance.

The indictments included 39-year old Darron Suggs an elected trustee of Washington Park and a St. Clair County Probation and Parole employee.  In some instances the care giver was accused of collecting a pay check from the state while serving time in jail.

In another case the assistant failed to properly care for the patient and neglected to take her to a hospital when she became ill.   62-year old Dorothy Cooper died from malnutrition and sepsis (blood poisoning).  Her care giver, Lisa Luckett of Cahokia now faces both federal and state charges.

"The program has systemic fraud throughout the state of Illinois," charged  U.S. Attorney Stephen Wigginton.  He and other federal agents involved in the investigation labeled Illinois as having one of the most vulnerable Medicaid Home services programs in the country.

In 2011 the U.S. spent $12.7 billion dollars on personal care services that were supposed to help disabled people age 60 and younger remain in their homes and avoid nursing home and hospital stays.

Wigginton said investigators found both ghost workers and patients allowing others to steal tax dollars.  One key problem has been the Illinois rule allowing the patient (Medicaid recipient) to control the selection and payment of a personal care attendant.   Only the patient's spouse is prohibited from serving as the attendant.

U.S. Department of Health and Human Services Special Agent Gerald Roy said, "The numbers are sobering and they cannot be ignored.  We have an obligation and the taxpayers expect us to insure these programs are efficient and free from fraud waste and abuse."

There is no requirement that personal care assistants take any training.  Yet the Service Employees International Union has a two million dollar annual contract with the state of Illinois to provide voluntary training sessions for its personal care attendant members.

Wigginton criticized Governor Rod Blagojevich for issuing an executive order in March of 2003 paving the way for the SEIU to become the bargaining agent for the personal care assistants despite a court case and Illinois Labor Relations Board ruling that these assistants were not state workers.   He said the SEIU was one of Governor Blagojevich's major campaign donors.
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