Fraud Disabled

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35447741 - close-up of man using wheelchair reading book

The Home Services Program under the Illinois Department of Human Services provides in-home personal care services to individuals who are severely disabled. The program, which aims to keep people as independent as possible, offers numerous service options including personal assistants (PA), maintenance home health directed by a physician or other healthcare professional, home-delivered meals and respite services, just to name a few. Today’s fraudster from Decatur, Illinois chose the PA option for her situation, then proceeded to commit Medicaid fraud by filing bogus claims for services she never received.

Individuals with severe disabilities under the age of 60 are allowed to receive services provided by the Home Services Program. Qualified beneficiaries are also allowed to hire their own PAs to assist them in their home. (That’s a pretty nice benefit to be able to choose someone you trust, not just some Joe Schmo off the street who might steal your silverware.)

The person in the fraud spotlight is a 44-year-old woman who designated her son as her PA. She regularly filled out time cards claiming that her son provided home care services, even though he did not. He couldn’t because he was incarcerated. (You can see how that would be a problem.)

Over a cumulative period of two years and nine months, she filled in the fraudulent time cards and submitted them to the Medicaid-funded program for payment. She forged her son’s signature on the time sheets and when she received payment, she endorsed the checks in her son’s name. (That sounds way too easy.) Thankfully, the Home Services Program was on to her ruse and followed her time sheet trail.

The Decatur, Illinois woman pleaded guilty to Medicaid fraud by submitting false Home Services Program time sheets. In exchange for her guilty plea, the woman received 18 months in federal prison. She was also ordered to pay restitution of $50,244.

While the Office of Inspector General for the U.S. Department of Health and Human Services disabled this woman’ fraud scheme, it’s unfortunate that she will be serving time behind bars as a disabled individual. (Unless that was a scam as well.) Perhaps she’ll be incarcerated in the same prison as her son. (It looks like the apple doesn’t fall to far from the tree.)

Today’s “Fraud of the Day” is based on an article entitled, Decatur woman sentenced to 18 months in federal prison for Medicaid fraud,” published by Herald & Review on November 21, 2017.

URBANA — A 44-year-old Decatur woman has been sentenced to 18 months in federal prison for defrauding a Medicaid waiver program.

Charissie Davis pleaded guilty on May 5 to submitting false Home Services Program time sheets to receive payment from the program, according to a statement from the U.S. Attorney’s Office, Central District of Illinois. She was sentenced Monday, ordered to pay restitution of $50,244 and told to report to federal prison on Jan. 23, 2018.

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.