U.S. Department
of Justice
Federal Jury Finds Missouri Woman Guilty Of Health Care Fraud
Stephen R. Wigginton, United States Attorney for the Southern District of Illinois, announced today that on March 19, 2014, Tisa V. Vaughn, 49, of Florissant, Missouri, was found guilty in United States District Court in East St. Louis, Illinois, on an indictment charging that she engaged in a scheme to commit health care fraud. Sentencing is set for July 11, 2014. The charge carries a maximum penalty of 10 years in prison, a $250,000 fine, and up to 3 years of supervised release.
Vaughn was the personal assistant for her sister, a Medicaid recipient, who resides in East St. Louis. Evidence at trial showed that Vaughn billed for hours of care when she was either not caring for her sister or when her sister was actually in the hospital. Furthermore, testimony indicated that the sisters split the payments that Vaughn billed and received from the Home Services Program for the State of Illinois.
“Nationwide, the biggest fraud problem 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. By prosecuting these frauds, I hope to get more accountability into the programs and to preserve these funds for deserving people who really do benefit from the assistance.” said United States Attorney Wigginton.
The investigation was conducted by the U.S. Department of Health and Human Services’ Office of Inspector General and the Illinois State Police’s Medicaid Fraud Control Bureau. The case was tried by Special Assistant U.S. Attorney Stuart J. Zander and Assistant U.S. Attorney Liam Coonan. The lead prosecutor for the case is Assistant U.S. Attorney Michael J. Quinley.
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 800.447.8477.