Bilking Medicaid And Callous Treatment Of Medicaid Patient Lands Cahokia Woman In Federal Prison
Stephen R. Wigginton, United States Attorney for the Southern District of Illinois, and Gerald Roy, Special Agent in Charge, United States Department of Health and Human Services, Office of Inspector General, (Region 7 - Kansas City), announced today on February 14, 2014, that Lisa C. Luckett, 50, and Henry J. Billups III, 49, both from Cahokia, IL, were sentenced in the United States District Court in East St. Louis on a two-count indictment charging that they engaged in a scheme to commit health care fraud.
Luckett was sentenced to serve forty eight (48) months in prison, to serve three (3) years of supervised release, pay restitution of $78,336.96 to the Illinois Department of Human Services (IDHS), and pay a special assessment of $200.00.
Billups was sentenced to serve six (6) months in prison, to serve three (3) years of supervised release, pay restitution of $20,965.38 to IDHS, and pay a special assessment of $100.00.
According to court records and proceedings, Luckett and Billups both admitted that they had submitted or caused to be submitted, false fraudulent bills in regard to providing personal assistant services in the Home Services Program, a Medicaid Waiver Program. The program is designed to provide a disabled individual with assistance in performing daily living activities in the home in order to allow the person to stay at home instead of entering into a nursing home.
“Payments by the State of Illinois, funded by federal dollars, are supposed to keep Medicaid recipients out of a nursing home. In this case, the consequences for the Medicaid recipient were catastrophic. A family friend, who herself was on disability, became the personal assistant for the Medicaid recipient. This friend even invited the Medicaid recipient into her own home. However, the friend (Luckett) misappropriated her daughter's name and used a neighbor's name for purposes of obtaining and receiving personal assistant payments from the State of Illinois to care for this Medicaid recipient because she did not want to lose her own benefits. Luckett ignored serious and ongoing medical issues suffered by the recipient which should have led to hospitalization. Instead, Luckett kept the recipient in the home and continued to receive personal assistant payments from the State. The recipient died in Luckett’s home as a result of malnutrition and sepsis due to neglect of medical, nutritional, and hygienic care.” noted United States Attorney Wigginton. “The death of this blameless person is shocking on every level. It should serve as the spear point in the fight to reform this program.”
On July 26, 2013, the Saint Clair County States Attorney’s Office obtained an indictment against Luckett for two felony counts of Criminal Neglect of an Elderly Person Resulting in Death.
Nationwide, one of the biggest fraud problems in the Medicaid program has been these personal assistant programs which represent the number one fraud complaint to state Medicaid fraud units. Especially vulnerable to fraud are programs, such as the one implemented in Illinois, that allows the Medicaid recipient to control the selection and payment of personal care attendants. In most cases, the personal care assistant is a relative or family friend, who often is a ghost employee. In a typical fraud scenario, the scam payments made by the State of Illinois are split between the Medicaid recipient and the ghost employee.
According to an Office of Inspector General report released in December, 2012, Medicaid costs for personal care services in 2011 totaled $12.7 billion, a thirty five percent increase since 2005. The U.S. Department of Labor projects that the employment of personal assistants and home health care workers will grow by 46 percent by 2018. U.S Department of Health and Human Services, Office of Inspector General: Personal Care Services, Trends, Vulnerabilities, and Recommendations for Improvement, OIG-12-12-01 (November 2012). Home personal care is one of the fastest growing job categories in the country. However, the OIG’s report points to numerous problems in Medicaid personal care services that leave it vulnerable to improper payments, abuse, and fraud, including lack of training standards, uneven oversight of services provided, and failure to implement prepayment controls to prevent improper or fraudulent payments.
"I have had the pleasure of meeting many deserving Illinois residents who have profoundly benefited from this program. Unconscionably, the woman who was supposedly being cared for by these two defendants was not among them. They put their own greed ahead of her welfare and the result was an absolute tragedy." said U.S. Attorney Wigginton.
“Today’s sentence should put all personal care attendants in the State of Illinois on notice that my office will aggressively investigate anyone who callously neglects our Medicaid beneficiaries and then seeks to profit from that neglect by submitting fraudulent claims to the Medicaid program. These cases remain my priority and through the strong working relationship forged among my office, the U.S. Attorney’s Office and the Illinois State Police’s Medicaid Fraud Control Bureau, we are holding fraud perpetrators accountable,” said Gerald T. Roy, Special Agent in Charge, U.S. Department of Health and Human Services, Kansas City Division. The investigation was conducted by the U.S. Department of Health and Human Services, Office of Inspector General; the Illinois State Police’s Medicaid Fraud Control Bureau; and the St. Clair County Sheriff’s Department. The case is being prosecuted by Assistant United States Attorneys Ranley R. Killian and William E. Coonan.
If you suspect or know of an individual or company that is not complying with healthcare laws or public aid programs, you may report this activity to the local office of the U.S. Department of Health and Human Services, Office of Inspector General or call 1-800-447-8477.