Maybe They Won’t Notice

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41913416 - medicaid torn newspaper headline on cash

Medical advancements in recent decades have contributed to Americans living longer. The U.S. Census Bureau states that the number of people age 65 and older in the United States is just about 15 percent, increasing by 1.6 million people since 2014. (This correlates with an increased need for long-term care.) Today’s fraudsters from Carbondale, Illinois and Murphysboro, Illinois used home healthcare services to commit Medicaid fraud. The home healthcare recipient and one of her personal assistants erroneously thought that perhaps the claims processors would not notice they were scamming the government healthcare programs.

The Illinois Department of Human Services’ (DHS) Home Services Program (HSP) exists to provide personal care services for people who have severe disabilities. This allows them to stay in their homes and be independent as long as possible. Some of the services include helping out with household tasks, personal care and sometimes certain health procedures. Today, we take a look at an HSP recipient who took advantage of the Medicaid program by submitting fraudulent time sheets to the DHS, then deposited the reimbursement checks into her bank account. (It’s a good guess that she was splitting the proceeds from the fraud scheme with one of her personal care assistants.)

Here’s how the scheme transpired. The Carbondale woman submitted fraudulent time sheets to DHS claiming she had received care in her home from multiple personal assistants. Her co-conspirator, one of the woman’s purported personal assistants from Murphysboro, also falsely claimed that she had provided personal assistance to the HSP beneficiary. (It turns out that they were both lying. And, much to their chagrin, someone noticed.)

The Illinois State Police (ISP) Medicaid Fraud Control Bureau (MFCB) opened an investigation after receiving an alert related to potential fraud against the Illinois DHS HSP. An in-depth examination of the healthcare beneficiary’s bank records found that reimbursements for most of the fraudulently claimed home health services were deposited into her personal bank account. (Fancy that. She must have been able to take better care of herself than she originally indicated.)

The 59-year-old HSP beneficiary from Carbondale ended up pleading guilty to vendor fraud, which is a felony. She was sentenced to four years of probation and ordered to pay restitution of $71,852 for her Medicaid fraud scheme. The 69-year-old personal assistant of Murphysboro pleaded guilty to theft, also a felony. She received a two-year probation sentence, along with 30 hours of community service and must pay $2,115.57 in restitution.

Many fraudsters think that their nefarious deeds will somehow slip through the cracks and they will get away with their crime. (Not so in this case.) Congratulations to the ISP MFCB for taking notice and putting a stop to the abuse of a program that is intended to assist Medicaid recipients who are truly in need.

Today’s “Fraud of the Day” is based on an article entitled, 2 convicted and sentenced in Illinois Medicaid fraud investigation,” posted on KFVS12.com on March 12, 2018.

ILLINOIS (KFVS) – Illinois State Police (ISP) and the Illinois Office of the Attorney General announced the conviction and sentencing of two Illinois residents in a Medicaid defrauding scheme.

Jeanie Akamanti,59 of Carbondale, pleaded guilty to one count of Vendor fraud, a Class 1 felony. She was sentenced to 48 months of probation and ordered to pay $71,852.00 restitution.

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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.