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Alleged Fraud in Illinois Consumer-Directed Program Brings Calls for Legislative Action

September 5, 2013

In Illinois, 25 people have been indicted for committing fraud in the Home Services Program, the state’s Medicaid consumer-directed care program which serves individuals with severe disabilities up to age 60 and employs approximately 28,000 personal care assistants.

Following two waves of indictments that took place on May 24 and July 11, a total of 18 personal care assistants and 11 consumers were indicted by Stephen Wigginton, United States Attorney for the Southern District of Illinois, for receiving Medicaid funds to which they were not entitled.

The charges carry a maximum penalty of 10 years of imprisonment, a $250,000 fine, and up to 3 years of supervised release, according to a press release issued by Wigginton’s office.

After receiving “numerous complaints” about the Home Services Program, an investigation was initiated to root out fraud, the release explains, and uncovered these abuses in the Home Services Program:

  • Services were being billed, but not performed, because the personal care aide was in jail or out of town.
  • The client was residing in a hospital, a nursing home, or out of town at the time the services were supposedly rendered in the home.
  • Some personal care aides and clients were receiving the Medicaid payments for services not rendered and split the paychecks.

Wigginton’s release cited several problems in the Illinois Home Services Program:

  • There are no mandatory training requirements for its personal assistants.
  • While the state sets wages and pays the personal assistants directly, it does not require them to receive any instruction or education concerning their obligations as caregivers or as paid providers of Medicaid services.
  • The state has no formal mechanism to supervise the work of the personal assistants it pays and ensure that the services it pays for are actually being rendered.

The state of Illinois has made some investment in training personal care workers. According to the Service Employees International Union (SEIU), the state has provided $2 million under a collective bargaining agreement to “conduct a voluntary training program” for the state’s 28,000 personal care aides. However, in his press release, the district attorney noted that the training program “is attended by almost no one in the Southern District of Illinois and has been of no practical benefit in deterring fraud or insuring that services are performed properly.”

“While the findings from this investigation are unfortunate, we think this creates an opportunity for the union, consumer advocates, and policymakers to identify ways to strengthen training for both personal assistants and consumers in the Home Services Program in a way that respects the principles of consumer direction and enhances workers’ skills,” said PHI Midwest Program and Policy Manager Tameshia Bridges.

After the indictments for fraud committed in the Home Services Program were announced, state legislators from both sides of the aisle called for legislative fixes and hearings to address the problems in the program, according to an August 22 article in the Illinois Observer.

— by Deane Beebe

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