14 indicted for health care program fraud in 'Operation Home Alone 3'

14 indicted for health care program fraud in 'Operation Home Alone 3'

ILLINOIS (KFVS) - A Mount Vernon woman plead guilty Friday, Oct. 3 to an indictment charge related to Operation Home Alone 3.

Stephen R. Wigginton, United States Attorney for the Southern District of Illinois, says 32-year-old Margaret R. Teriet plead guilty to a one-count indictment charging that she engaged in a scheme to commit health care fraud. Sentencing has been set for January 15, 2015, in United States District Court in Benton, Illinois. Teriet will face up to 10 years in prison, a fine of up to $250,000, and up to 3 years of supervised release.

During her plea hearing, Teriet admitted that she had submitted false and fraudulent bills in relation to her alleged performance of personal assistant services in the Home Services Program, a Medicaid Waiver Program designed to allow individuals to stay in their homes instead of entering a nursing home. Teriet admitted to falsely billing the program between April 30, 2012 and December 31, 2012, when she purportedly rendered personal assistant services to an individual when she, in fact, did not. As a result, Teriet improperly received payments for services not performed.

The investigation was conducted by the U.S. Department of Health and Human Services, Office of Inspector General and the Illinois State Police, Medicaid Fraud Control Bureau.

Rounds of indictments from Operation Home Alone 3 were announced on Thursday, June 5.

The indictments were part of a third wave of charges that target the abuse of a Medicaid program in Illinois that provides personal assistants to Medicaid recipients to help them with general household activities and personal care. The program is intended for recipients under 60 years of age and is designed to reduce Medicaid expenditures by avoiding more expensive institutional care, including nursing home care.

According to Wigginton, in May of 2012 and again in July of 2013, during the first two phases of Operation Home Alone, 29 defendants who claimed to have been providing personal assistant services were charged with fraud. The defendants were both Medicaid beneficiaries and the personal assistants.

In the third round announced on June 5, 14 additional defendants were indicted, bringing the total number of defendants to 43. The 14 named throughout southern Illinois  have been charged in 12 separate indictments by a Federal Grand Jury in Benton, Ill. with health care program fraud.

Wigginton says, the charges carry a maximum penalty of 10 years imprisonment, a $250,000 fine and up to three years of supervised release.

In all cases, the false claims were submitted to the program after the first round of prosecutions. Four of the defendants made false claims against the program after the second round of indictments.

Due to several complaints about the Home Services Program, law enforcement in southern Illinois originally began Operation Home Alone to investigate and hold accountable people committing fraud against the program.

Those charged in the indictments include four defendants where the personal assistant or customer were in jail or prison during the times the services were supposed to be performed, six defendants where the personal assistant or the customer was in the hospital, three cases where the defendant was working full time jobs while the services were supposed to be performed and one case where the customer was dead and the personal assistant continued billing for months after the death of the customer.

The people charged recently include:

  • Connie D. Evans, 50, of Belleville, Ill.
  • Quincy O. Gamble, 39, of Cahokia, Ill.
  • Jody R. Wooters, 46, of Centralia, Ill.
  • Felicia M. Gibson, 47, of East St. Louis, Ill.
  • Beatrice L. Randall, 59, of East St. Louis, Ill.
  • Charlietta M. Lee, 51, of Marion, Ill.
  • Tamekia L. Hall, 39, of East St. Louis, Ill.
  • Maurice L. Burks, 43, of East St. Louis, Ill.
  • Christopher W. Spivey, 30, Olney, Ill.
  • Angel D. Jones, 50, of Collinsville, Ill.
  • Lawrence M. Thigpen, 53, of Collinsville, Ill.
  • Lakeshia W. White, 23, of Centreville, Ill.
  • Margaret R. Teriet, 31, of Mount Vernon, Ill.
  • Maketa N. Davis, 33, of East St. Louis, Ill.

According to Wigginton, some of the cases in this round of indictments include the following:

  • Personal assistant boyfriend claimed to be providing services for his girlfriend, first while she, the customer, was in the hospital and then continued filing claims for 560 hours of services for six months after she had passed away.
  • Personal assistant claimed to be providing personal assistant services to her boyfriend while she was in jail and prison. Together, they claimed more than 1,000 hours of personal assistant services during the periods where she was incarcerated.
  • Personal assistant claimed that she performed more 450 hours of personal assistant services for the customer during times that she was employed at a full time job and more than 140 hours where she was not only working a job at another location, but the customer was also receiving kidney dialysis.
  • Medicaid recipient who agreed to split the proceeds with the personal assistant who performed little or no services.

Wigginton said they have seen dozens of instances in which the State of Illinois paid for ghost employees and fictitious services, which is why they called it "Home Alone."

Nationwide, Wigginton said one of the biggest fraud problems in the Medicaid program has been the personal assistant programs, particularly in cases that allow the Medicaid recipient to control the selection and payment of personal care attendants. In most cases, he said the personal care assistant is a relative or family friend, who is often a ghost employee. In a typical scenario, Wigginton said 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 35 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.

The Operation Home Alone 3 investigations were conducted by the U.S. Department of Health and Human Services, Office of Inspector General; the Federal Bureau of Investigation, and the Illinois State Police Medicaid Fraud Control Bureau Collinsville, Du Quoin and Sterling offices.

The cases are being prosecuted by Assistant U.S. Attorney Ranley R. Killian and William E. Coonan and Special Assistant U.S. Attorney Michael J. Hallock.

Copyright 2014 KFVS. All rights reserved.